Financial and economic costs of infrastructure improvements and clinical equipment
We estimated the financial and wider economic costs of the essential resources provided to the five neonatal units to allow them to implement iKMC safely. Financial costs reflect actual monies paid (or expenditure). Economic costs reflect the full value of all resources used; they therefore encompass both financial costs and the value of donated resources and volunteer time. Costs were estimated from a health service provider perspective. Data on resource use and unit and total costs were collected from hospital records and the project and accounting records of the OMWaNA trial at MRC/UVRI, then collated into an Excel-based costing tool for each hospital. We costed inputs and resources used for: 1) planning and design, 2) infrastructure improvements, 3) clinical equipment, and 4) training hospital staff on KMC and clinical guidelines (Table Cost categoriesTo estimate the economic costs of time spent by hospital and MRC staff during planning, design, and training activities, key informants were interviewed at MRC/UVRI and at the hospitals. We assumed that the opportunity cost of staff members’ time was equivalent to their pro-rated salaries in terms of hours spent conducting the planning, design, and training activities. The duration of time spent by hospital and MRC staff was based on the MRC engineer’s records of meetings and other activities. Salaries were obtained from project accounts for MRC staff and the Uganda Health Service Commission Circular No. 8 salary scale (2020) for hospital staff. We assumed an 8-h workday and 22 working days per month. The financial costs charged to the project for planning and design activities were estimated using a rate of United States Dollars (USD) $21 per person-hour. The financial costs of using MRC/project vehicles were estimated at a rate of $1.22 per kilometre travelled to and from the hospital sites. The rate covered fuel and maintenance while the opportunity cost was assumed to be equal to the cost of hire, fuel, and maintenance for comparable vehicles. The opportunity cost of renting training rooms was estimated at a daily rate of $41 per room, using the Uganda Public Procurement and Disposal of Public Assets price list (2020).Floor space at the five hospitals was expanded in different ways. Where a new neonatal unit or extension to an existing unit was constructed, the financial costs of these building works were considered also to reflect the economic costs of this investment. Where existing space within the hospital was reallocated to the neonatal unit, this renovated space did not incur a financial cost; we therefore estimated the total economic costs based on the financial cost per mWe present the total financial costs and annualised economic costs of improvements per hospital, per neonatal bed, and per annual neonatal admission. Understanding total financial costs is important for planning and understanding budget impact. Annualised economic costs take into account the depreciation of capital inputs as well as the value of alternative (foregone) opportunities for using the resources tied up in the capital inputs (i.e., opportunity cost) [Costs are presented in 2020 USD and Ugandan Shillings (UGX; see Supplementary Table 1, Additional file 