Transformative Education
for Health Professionals

Estimating the Cost of Educating and Training Nurses and Midwives: Balancing Quantity and Quality

Sophie Faye (Abt Associates), Rebecca Bailey (IntraHealth International), Sr. Azeb Admassu (Federal Ministry of Health Ethiopia), Yemesrach Adamu (Fed

Knowledge about the cost of educating and training health workers is needed to support education program planning and management and to inform advocacy for increased investment. Ethiopia’s federal ministries of health and education collaborated with CapacityPlus and the Nursing Education Partnership Initiative to conduct a cost analysis of the nursing and midwifery programs at two colleges. The objectives were to estimate the cost of producing a graduate; identify fixed-asset constraints to scaling up the quantity and/or improving quality of graduates; and simulate the new cost per graduate for interventions to increase the quality of graduates. 

Full project description: 

Ethiopia faces challenges related to the quantity and distribution of qualified health workers. To fill this gap, the federal government, through its Health Sector Development Program, set ambitious goals to scale up the number and quality of health workers. However, knowledge about the cost of educating and training health workers is needed to support education program planning and management at college and government agency levels, and to inform advocacy for increased investment in preservice education.

 

Ethiopia’s federal ministries of health and education collaborated with the USAID- funded CapacityPlus project, led by IntraHealth International, and the PEPFAR-funded Nursing Education Partnership Initiative (NEPI) to conduct a cost analysis of the nursing and midwifery programs at two colleges: the four-year bachelor programs at the University of Gondar College of Medicine and Health Sciences (UGCMHS) and the three-year diploma programs at Arbaminch College of Health Sciences (AMCHS).

 

The objectives were to: 1) estimate the current cost to the educational institution and its associated clinical practice facilities of producing a nursing and midwifery graduate; 2) identify current fixed-asset constraints to scaling up the quantity of graduates and/or improving their quality; and 3) simulate the new cost per graduate if a scenario of interventions were introduced to increase the quality of graduates. 

 

We used a retrospective (academic year 2011–2012) top-down costing approach (Figure 1). Expenditures were allocated down to individual programs so as to obtain the cost per graduate per academic year and course. The analysis included the financial cost of all resources used in producing a graduate and reported by the educational institution and its associated clinical practice facilities, regardless of funding source.

 

The current estimated costs per graduate for the two programs (nursing and midwifery) from the same college were very similar. Both colleges follow a traditional approach to health sciences education, concentrating on classroom learning in the first years of the program and shifting to clinical topics and experiences in the later years of study. At UGCMHS pre-intervention costs ranged from $1,714 for a nursing graduate to $1,733 for a midwifery graduate. At AMCHS pre-intervention costs ranged from $1,051 for a nursing graduate to $1,117 for a midwifery graduate.  

 

Both colleges were operating at/or above capacity with their physical infrastructure, leaving no room for improving the efficiency of fixed asset usage. Furthermore, the availability and use of key fixed assets such as space, materials, and teaching faculty did not adhere to national or school-level standards. For example, the number of students per demonstration session was beyond recommended standards, the ratio of teachers to students in those sessions did not always meet college standards, and the rooms lacked a variety of required clinical practice materials and equipment. We gathered the market costs of a scenario of interventions designed to overcome the majority of these constraints, including procuring materials for demonstration rooms, and recalculated the estimated cost per graduate taking into consideration the budgeted interventions. Implementing the budgeted interventions would increase the cost per nursing graduate by around 31% in UGCMHS and 16% in AMCHS. It would increase the cost per midwifery graduate by 37% in UGCMHS and 21% in AMCHS (table 1). 

 

It is important to note that the post-interventions costs do not take into consideration the full set of possible interventions that could be applied to overcome the college’s educational constraints; this is a limitation of the study. Nevertheless, the results can be used to guide policy and decision-making, especially related to scaling up the quality of nursing and midwifery graduates in Ethiopia. 

 

This case study relates to:

Case study addresses:

Quality: 
Yes
Quantity: 
Yes
Relevance: 
Yes
Sustainability: 
Yes