title: Cost-effectiveness of caesarean sections in a post-conflict environment: a case study of Bunia, Democratic Republic of the Congo.
abstract: This paper demonstrates the feasibility of health services research in an unstable environment during the transition from crisis to development and its importance for future planning. Effectiveness and the cost of caesarean sections (CSs) were investigated in Bunia, a town affected by conflict and insecurity, in the Democratic Republic of the Congo (DRC) in 2008. The CS rate was 9.7 per cent of expected deliveries. All CSs in the study sample were emergency procedures. A humanitarian non-governmental organisation (NGO) hospital, offering free services, performed 75 per cent of all CSs. The estimated provider cost for CS in 2008 at this hospital was USD 103,514 (that is, USD 144 per CS). With a cost of between USD 3.8 and 9.2 per year of health adjusted life expectancy (HALE) gained, CSs at the NGO hospital were very cost-effective. The estimates give an indication of funding requirements to maintain adequate access to CS after the departure of the humanitarian organisation.
authors.affiliation: Department of Clinical Tropical Medicine, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom. deboutted@gmail.com
authors.forename: Danielle
authors.initials: D
authors.lastname: Deboutte
authors.forename: Tim
authors.initials: T
authors.lastname: O'Dempsey
authors.forename: Gillian
authors.initials: G
authors.lastname: Mann
authors.forename: Brian
authors.initials: B
authors.lastname: Faragher
mesh_terms: D000328:Adult; D000533:Altruism; D002585:Cesarean Section / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D015023:Democratic Republic of the Congo; D004636:Emergency Service, Hospital / Q000191:economics*; D005240:Feasibility Studies; D005260:Female; D006302:Health Services Research; D016304:Hospitals, Private / Q000191:economics; D006801:Humans; D011247:Pregnancy; D012066:Relief Work / Q000191:economics*; D014857:Warfare
keywords: caesarean section; cost-effectiveness; emergency obstetric care; health adjusted life expectancy; humanitarian