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

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.

The cost of improving nutritional outcomes through food‐assisted maternal and child health and nutrition programmes in Burundi and Guatemala

“…Reducing the duration of food assistance did not substantially reduce the cost of programme activities (only the cost of food), as food distributions still required similar logistical and managerial inputs, even though fewer beneficiaries were attending any given distribution. This is consistent with findings that costs of child health days were largely driven by the number of sites, not the number of children treated (Fiedler et al, ).…”

The politics of reducing malnutrition: building commitment and accelerating progress

“…102 Examples of such research have been emerging in the form of feasibility studies and formative research, [103][104][105][106] operations research and process evaluations, [107][108][109][110][111] and costing studies. [112][113][114] However, the scientifi c literature about implementation through delivery platforms, such as community-based or health-facility-based programmes, is more developed than is that of the use of mass media or market-based approaches to scale up interventions. 115,116 Much implementation research is from small-scale interventions, as opposed to large-scale programmes or interventions, for which the challenges to ensurance of quality, intensity, equity, and coverage are diff erent and need various factors to operate in concert.…”

Using Agriculture to Improve Child Health: Promoting Orange Sweet Potatoes Reduces Diarrhea

“…The cost per DALY would likely be lower in high VAD contexts such as Mozambique, due to the higher potential for impact. In comparison to biofortification, the estimated cost effectiveness of VAS is $73 per DALY gained (estimated in Zambia; Fiedler et al, 2012). Given the lower cost and potential for spillovers of agriculture-based diet change across both geographical space and generations, diet change through biofortified crops seems to be a viable complement to current supplementation strategies and a sustainable solution in the longer term for increasing micronutrient intake and improving child health.…”