The cost-effectiveness of orthopaedic clinical officers in Malawi

Caris Grimes, Nyengo Mkandawire, Michael Billingsley, Christopher Ngulube, James Cobey

    Research output: Contribution to journalArticlepeer-review

    20 Citations (Scopus)


    In Malawi the orthopaedic clinical officer (OCO) training programme trains non-physician clinicians in musculoskeletal care. We studied the cost-effectiveness of this program. Hospital logbooks were reviewed for data pertaining to activity in seven district hospitals over a 6-month period. The total costs were divided by the total effectiveness, calculated as disability adjusted life years (DALYs) averted. The total cost-effectiveness of providing orthopaedic care through the OCO training programme was US$92.06 per DALY averted. The mean per hospital was US$138.75 (95% CI: US$69.58–207.91) per DALY averted which is very cost-effective when compared with other health interventions. Of the 837 patients treated 63% were aged <15 years and 36% were in the ‘economically active’ demographic of ages 15–74 years. Training of clinical officers in orthopaedic surgery is very cost-effective and allows transfer of skills into rural areas. The demographics suggest that failure to provide such care would have a negative economic impact.

    Original languageEnglish
    Pages (from-to)128-134
    Number of pages7
    Issue number3
    Publication statusPublished - Jul 2014


    • Cost-effectiveness
    • Orthopaedic clinical officers
    • Task shifting


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