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Health Policy Plan. 2014 Jan;29(1):12-29. doi: 10.1093/heapol/czs129. Epub 2012 Dec 14.

Child Health Week in Zambia: costs, efficiency, coverage and a reassessment of need.

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1
HarvestPlus/IFPRI, 2033 K Street NW, Washington, DC 20006, USA. E-mail: j.fiedler@cgiar.org.

Abstract

Child Health Weeks (CHWs) are semi-annual, campaign-style, facility- and outreach-based events that provide a package of high-impact nutrition and health services to under-five children. Since 1999, 30% of the 85 countries that regularly implement campaign-style vitamin A supplementation programmes have transformed their programmes into CHW. Using data drawn from districts' budget, expenditures and salary documents, UNICEF's CHW planning and budgeting tool and a special purposive survey, an economic analysis of the June 2010 CHW's provision of measles, vitamin A and deworming was conducted using activity-based costing combined with an ingredients approach. Total CHW costs were estimated to be US$5.7 million per round. Measles accounted for 57%, deworming 22% and vitamin A 21% of total costs. The cost per child was US$0.46. The additional supplies and personnel required to include measles increased total costs by 42%, but reduced the average costs of providing vitamin A and deworming alone, manifesting economies of scope. The average costs of covering larger, more urban populations was less than the cost of covering smaller, more dispersed populations. Provincial-level costs per child served were determined primarily by the number of service sites, not the number of children treated. Reliance on volunteers to provide 60% of CHW manpower enables expanding coverage, shortening the duration of CHWs and reduces costs by one-third. With costs of $1093 per life saved and $45 per disability-adjusted life-year saved, WHO criteria classify Zambia's CHWs as 'very cost-effective'. The continued need for CHWs is discussed.

KEYWORDS:

Child Health Week; Zambia; activity-based costing; cost analysis; cost-effectiveness analysis; deworming; implementation; micronutrients; policy analysis; supplementation; vitamin A

PMID:
23242696
DOI:
10.1093/heapol/czs129
[Indexed for MEDLINE]
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