Cost-Effectiveness analysis of competency based training (CBT) and conventional tranining (CT) for midwives in southeast Sulawesi, Indonesia

Abstract

The objective of this study was to compare and analyze the cost-effectiveness of competency based training (CBT) and conventional training (CT) for competent midwives. This study was conducted during 16th of February to 9th March 2005 in Buton anf Muna district, Southeast Sulawesi province, Indonesia. Operational cost of CBT and CT were obtained from provider's perspective and information on effectiveness was collected and analysed. Furthrmor, retrospective and decriptive analyses have been used to assess the effectiveness of training programs. Training Need Assessment (TNA) had been conducted prior to training with the aid of checklist based on competency standard. In order to determine effectiveness of the training programs, performance of the trainees had been evaluated using a checklist where criteria had been set by the competency test. It was found that the unit cost for competency based training was Rp.3,422,435 and it was Rp. 1,129,232 for conventional training. The higher cost of CBT was due to difference in duration of the training program, ratio of trainers and trainees, and the implementation of sandwich system. However, the number of trainees for CBT was 216 while the CT program had 172. In terms of the target of the program, using the baseline from TNA, the target was 65% (140)(for CBT) and it was 75% (for CT) to be bompetent (129). The outcome of the training for CBT was 130 while only 23 for CT. Therefore it can be said that the effectiveness of CBT is higher than the CT program (92.8% compared with 17.8%). The Cost effectiveness of CBT is more compared with CT (Rp.796,601,340 for CBT, Rp.1,091,168,539 for CT). However, this study has been carried out as a specific case (Southeast Sulawesi province), and pilot study was conducte in this decentralization era to Buton region. Its implementation was adjusted for the local need and condition. Therefore, in the implementation of CBT in other regions in general is to be cautious. In addition, it can be recommended not to shorter the duration of the CBT and do not increase more participants to maintain the high competency rate of midwives.