Abstract:
Objective:
This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected
health care centres in Ghana.
Methods:
A descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in
selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The
CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS
(pre-intervention and intervention) were collected for the period between 2009–2013 from the provider perspective. The
ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent
costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and
cost with annualizing capital costs to represent economic cost.
Results:
Twenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012
and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in
the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in
the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of
CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation,
48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the
largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was
US$17,128–lower than the financial cost by 26.5%.
Conclusions:
The study provides useful information in the implementation of CDSS at health facilities to enhance health
workers’ adherence to practice guidelines and taking accurate decisions to improve maternal health care.
