Table 4 Summary of the features of reviewed decision support tools
Tool | Lives Saved Tool | MANDATE model | OneHealth Tool | Discrete Event Simulation |
|---|---|---|---|---|
Purpose | Estimate the impact of introducing or increasing coverage of maternal, neonatal and child health interventions on mortality [23, 25,26,27] | Guide users to prioritize allocation of resources towards interventions that have greatest impact in reducing maternal, fetal and neonatal mortality [23, 24, 28, 29] | Enable users to conduct integrated health system planning and costing for various disease programs [23, 25, 30] | Enable users to assess the efficiency of a healthcare delivery system and to forecast the potential impact of implementing changes in the healthcare delivery system [22, 31] |
Preloaded Data | a) List of maternal, neonatal and child health interventions [23, 26, 32] b) Estimated baseline coverage of interventions at national level [23, 26, 27, 33, 34] c) Recent estimate of the effectiveness of interventions that are introduced or scaled up [26, 33] d) Population risk factors and causes of death relating to maternal, neonatal and child health [26, 34, 35] | a) List of main clinical conditions that contribute to maternal, fetal and neonatal mortality [24, 29] b) Clinically proven methods to prevent, diagnose and treat maternal, fetal and neonatal conditions [29] c) Baseline estimates of utilization, penetration and efficacy of interventions at a national or international level [24, 36] | a) Epidemiological and demographic data for various countries [37] | Not specified |
Required Input | a) Geographical region where interventions will be applied [38] b) Projected coverage of interventions to be assessed [26, 34, 39] c) Measures of maternal, neonatal and child health status at national level [26] | a) Timeframe of assessment [40] b) Geographical region where intervention will be applied [40] c) Intended levels of utilization, penetration and efficacy in different settings, either at home, clinic and or in hospital [40] | a) Geographical region for which integrated planning and costing is conducted [37] b) Current state of the building blocks of the health system [30, 37] c) Coverage targets and disease program costs [30] d) Settings in which interventions will be implemented, whether it is through community based programs, community health centers, hospitals or national level [37, 41] | Current operational state of the health system [22] a) Number of service stations b) Number of health professionals available in each service station c) Medical resources available d) Arrival rates e) Service times |
Generated output | a) Estimated number of lives that could be saved by introducing or by increasing coverage of maternal, neonatal and child interventions [9, 35, 42, 43] | Estimated number of lives saved by increasing utilization and penetration of maternal, fetal and neonatal interventions [24, 29, 36, 44, 45] | a) Number of health care professionals needed to implement intervention(s) [30, 37] b) Medical resources needed for implementation of interventions [30, 37] c) Expected costs necessary for proper implementation of interventions [25, 30, 37] d) Number of lives that could be saved by implementing interventions [30, 37] | Performance measures specified by the user such as patient throughput, timeliness of care and resource utilization [22] |
Assumptions | a) Mortality rates and causes of death would not change considerably from the baseline estimates [23] b) Estimated impact of interventions on mortality are solely due to the increase in coverage [23, 46] c) Quality of care is maintained while increasing coverage [47] | Efficacy of interventions is the same in different levels of care (i.e. home, clinic or hospital) [28, 44] | Interventions applied in one or more of the following settings: a) Community b) Outreach c) Clinic d) Hospital [41] | |
Strengths | a) Provides accurate predictions of neonatal and child mortality in diverse geographical settings [35, 50,51,52] b) Models the impact of a single or integrated interventions [23, 26, 53] c) Avoids overestimating the impact of interventions by considering multiple potential causes of deaths and risk factors within one group of deaths [23] | a) Evaluates the impact of single and integrated interventions [36] b) Evaluates the impact of different types of interventions (preventative, diagnostic and treatment) [24, 28, 36, 44, 54] c) Assesses the impact of transferring mothers and neonates between different levels of care [24, 28, 36, 44] | a) Enables a consolidated analysis across programs while considering financial capacity of the health system [30] b) Incorporates costing of selected non-health sector factors that may have an impact on health outcomes [37] | a) Shows how processes interact as a whole in the system, providing a macro-level view [22] b) Models several processes that occur simultaneously in a health care system [55] c) Effective in allocating scarce resources while minimizing healthcare delivery costs [31] |
Limitations | Assessment of impact of interventions is limited to the predefined age intervals which do not cover the perinatal period exclusively [26] | Output does not distinguish whether neonatal deaths occurred within the first 7 days of life or later, as a result the impact of interventions on perinatal outcomes cannot be measured [40] | Output does not distinguish whether neonatal deaths occurred within the first 7 days of life or later, as a result the impact of interventions on perinatal outcomes cannot be measured [37] | Not specified |
Settings where tool has been applied | Low- and middle-income countries [9, 33,34,35, 42, 46, 47, 50,51,52,53, 56,57,58] | |||
Level of application | Country, provincial and district level [9, 33, 34, 42, 46, 47, 50,51,52,53, 56,57,58] |