Improving maternal and newborn care: cost-effectiveness of an innovation to rebrand traditional birth attendants in Sierra Leone

Objectives This paper evaluates the cost-effectiveness of rebranding former traditional birth attendants (TBAs) to conduct health promotion activities and refer women to health facilities. Methods The project used 200 former TBAs, 100 of whom were also enrolled in a small income generating business. The evaluation had a three-arm, quasiexperimental design with baseline and endline household surveys. The three arms were: (a) Health promotion (HP) only; (b) Health promotion plus business (HP+); and (c) the comparison group. The Lives Saved Tool is used to estimate the number of lives saved. Results The HP+ intervention had a statistically significant impact on health facility delivery and four or more antenatal care (ANC) visits during pregnancy. The cost-effectiveness ratio was estimated at US$4130 per life year saved in the HP only arm, and US$1539 in the HP+ arm. Therefore, only the HP+ intervention is considered to be cost-effective. Conclusions It is critical to prioritize cost-effective interventions such as, in the case of rural Sierra Leone, community-based strategies involving rebranding TBAs as health promoters and enrolling them in health-related income generating activities.