The Costs of Training for Obstetric Emergency Care

The costs of training is generally difficult to assess. From Myanmar, Pakistan and Sri Lanka we know that that 2.5 to 3 nurses can be trained for the costs of training one physician (World Bank 1993). In Bangladesh the total costs of the training of one doctor is around 2,500 US$ and the total cost of training one nurse is around 300 US$ (Shaheen pers. comm.). In Tanzania the 2 years training for an assistant medical officer is estimated at 1,000 US$ per person (Mbaruku pers. comm.). In addition the trainees receive their monthly salary. The newly installed 6 months training course for general practitioners in Ethiopia costs 2,000 US$ per person not counting the salary for two expatriate obstetricians (teaching and supervision). The highest proportion of cost was due to per diems paid to course participants (Loutfi et al. 1995).

The follow-up costs must not be neglected. Supervision of newly acquired skills is absolutely necessary. For example replacing senior house officers in neonatal care by specially trained nurses in Bristol, UK, showed a complex balance sheet. The savings for one group were offset by the higher degree of supervision required in the other (Hopkins et al . 1995).