Objective: To compare the training and deployment costs and surgical productivity of surgically trained assistant medical officers (técnicos 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. Técnicos 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 técnicos 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 técnicos de cirurgia and $144.1 for surgeons and obstetrician/gynaecologists. Doubling the salaries of técnicos 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 técnicos de cirurgia.
Conclusion: 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.