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Social return on investment of emergency obstetric care training in Kenya
  1. Aduragbemi Banke-Thomas1,2,
  2. Barbara Madaj1,
  3. Nynke van den Broek1
  1. 1 Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2 Department of Health Policy, London School of Economics and Political Science, London, UK
  1. Correspondence to Dr Aduragbemi Banke-Thomas; a.banke-thomas{at}


Introduction Emergency obstetric care (EmOC) training is considered a key strategy for reducing maternal and perinatal morbidity and mortality. Although generally considered effective, there is minimal evidence on the broader social impact and/or value-for-money (VfM). This study assessed the social impact and VfM of EmOC training in Kenya using social return on investment (SROI) methodology.

Methods Mixed-methods approach was used, including interviews (n=21), focus group discussions (n=18) incorporating a value game, secondary data analysis and literature review, to obtain all relevant data for the SROI analysis. Findings were incorporated into the impact map and used to estimate the SROI ratio. Sensitivity analyses were done to test assumptions.

Results Trained healthcare providers, women and their babies who received care from those providers were identified as primary beneficiaries. EmOC training led to improved knowledge and skills and improved attitudes towards patients. However, increased workload was reported as a negative outcome by some healthcare providers. Women who received care expected and experienced positive outcomes including reduced maternal and newborn morbidity and mortality. After accounting for external influences, the total social impact for 93 5-day EmOC training workshops over a 1-year period was valued at I$9.5 million, with women benefitting the most from the intervention (73%). Total direct implementation cost was I$745 000 for 2965 healthcare providers trained. The cost per trained healthcare provider per day was I$50.23 and SROI ratio was 12.74:1. Based on multiple one-way sensitivity analyses, EmOC training guaranteed VfM in all scenarios except when trainers were paid consultancy fees and the least amount of training outcomes occurred.

Conclusion EmOC training workshops are a worthwhile investment. The implementation approach influences how much VfM is achieved. The use of volunteer facilitators, particularly those based locally, to deliver EmOC training is a critical driver in increasing social impact and achieving VfM for investments made.

  • emergency obstetric care
  • training
  • social return on investment
  • social impact
  • value for money

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  • Handling editor Seye Abimbola

  • Contributors AB-T, BM and NvdB were involved in the initial conceptualisation of the review. AB-T and BM conducted the data collection. AB-T led the analysis, which was overseen by BM and NvdB. All authors were involved in writing the manuscript and approved the final version.

  • Funding Department for International Development (DFID/UKAid) for the ‘Making it Happen’ programme (Grant number 202945-101).

  • Disclaimer DFID/UKAid had no role in the design of the study, in collection, analysis and interpretation of data or in writing the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was received from the Research and Ethics Committee of the Liverpool School of Tropical Medicine (LSTM) (14.054) and the Kenyatta National Hospital Ethics and Research Committee (P718/12/2014).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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