Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique

Objective To compare the training and deployment costs and surgical productivity of surgically trained assistant medical officers (tecnicos de cirurgia) and specialist physicians (surgeons and obstetrician/gynaecologists) in Mozambique in order to inform health human resource planning in a developing country with low availability of obstetric care and severe physician shortages. Tecnicos de cirurgia have been previously shown to have quality of care outcomes comparable to physicians. Design Economic evaluation of costs and productivity of surgically trained assistant medical officers and specialist physicians. Setting Hospitals and health science training institutions in Mozambique. Population Surgically trained assistants, medical officers, surgeons and obstetrician/gynaecologists in Mozambique. Methods The costs of training and deploying the two cadres of health workers were derived from a review of budgets, annual expenditure reports, enrolment registers, and accounting statements from training institutions and interviews with directors and administrators. Productivity estimates were based on a hospital survey of physicians and tecnicos de cirurgia. Main outcome measures Cost per major obstetric surgical procedure over 30 years in 2006 US dollars. Results The 30-year cost per major obstetric surgery was $38.9 for tecnicos de cirurgia and $144.1 for surgeons and obstetrician/gynaecologists. Doubling the salaries of tecnicos de cirurgia resulted in a smaller but still substantial difference in cost per surgery between the groups ($60.3 versus $144.1 per procedure). One-way sensitivity analysis to test the impact of varying other inputs did not substantially change the magnitude of the cost advantage of tecnicos de cirurgia. Conclusions Training more mid-level health workers in surgery can be part of the response to the health worker shortage, which today threatens the achievement of the health Millennium Development Goals in developing countries.