A cost analysis of postpartum home visit programming in Kenya: Estimates to aid policymakers

Ednah Akinyi Ojee^1*Joseph Odiyo²Judith Adhiambo Onyango^1,3Eliza Mabele^1,3Vincent Omondi⁴Emily Begnel^5,6Bhavna Chohan^7,8John Kinuthia^3,5,9Soren Gantt¹⁰Dara A Lehman^11,5Jalemba Aluvaala^1,12Fredrick Were^1,13Vincent Were¹⁴Dalton Wamalwa^1,5Jennifer Ann Slyker¹⁵

• ¹Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
• ²Adaptive Management and Research Consultancy, Nairobi, Kenya
• ³Department of Research and Programs, Kenyatta National Referral Hospital, Nairobi, Kenya
• ⁴Immunization and Digital Health, Clinton Health Access Initiative -CHAI, Nairobi, Kenya
• ⁵Department of Global Health, University of Washington, Seattle, United States
• ⁶University of Washington Department of Epidemiology, Seattle, United States
• ⁷Department of Pediatrics Research laboratory, University of Nairobi, Nairobi, Kenya
• ⁸Kenya Medical Research Institute, Nairobi, Kenya
• ⁹Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
• ¹⁰Department of Microbiology, Infectiology and Immunology, University of Montreal, Montreal, Canada
• ¹¹Department of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, United States
• ¹²Clinical Information Network ,Neonatal research, Kenya Medical Research Institute-Wellcome Trust, Nairobi, Kenya
• ¹³Kenya Pediatrics Research Consortium, Nairobi, Kenya
• ¹⁴Africa Center for Population Health and Research, Nairobi, Kenya
• ¹⁵Department of Global Health ,Epidemiology, University of Washington, Seattle, United States

The World Health Organization (WHO) and UNICEF recommend at least two postnatal home visits by a health provider within the first two weeks of life to improve newborn survival. Kenya's Universal Health Coverage (UHC) initiative includes a home visit strategy to advance Sustainable Development Goal (SDG) 3.2: reducing neonatal mortality to below 12 per 1,000 live births. We estimated the costs of starting a postnatal home visit program in a level three health facility in Kenya based on recommendations from Kenya's Ministry of Health policymakers. We compared the program's per-visit costs of utilizing different healthcare provider cadres. We used an ingredients-based costing method to determine the actual costs of home visits incurred during a research project in 2019, then estimated program costs from the government's perspective as the payer for different staffing scenarios. Per-visit costs were calculated for three staffing approaches: Community Health Promoter (CHP), Registered Nurse (RN), and a Combined model where two providers visited each home together (RN+CHP). Staff salaries and transportation costs were the main drivers of recurrent program expenses. The CHP approach had the lowest total cost at $27,302 ($24.46 per visit), followed by the RN-only approach at $36.45 per visit, while the Combined model (RN+CHP) was the most expensive at $52.10 per visit. Discussions with policymakers noted that the RN+CHP approach was least feasible and scalable. They proposed an alternative "Hybrid" model in line with current programs being scaled up: weekly RN visits during the first month of life (neonatal period), and quarterly CHP visits thereafter. We thus present a costing tool and generalizable formula that policymakers can use to estimate program costs based on different facility characteristics and needs and to scale up postnatal home visits to improve maternal and newborn health outcomes in Kenya.