Cost-Effectiveness of a Savings-Led Economic Empowerment Intervention for AIDS-Affected Adolescents in Uganda: Implications for Scale-up in Low-Resource Communities

Abstract

Purpose Nearly 12 million children and adolescents in Sub-Saharan Africa (SSA) have lost one or both parents to AIDS. Within SSA, Uganda has been greatly impacted, with an estimated 1.2 million orphaned children, nearly half of which have experienced parental loss due to the epidemic. Cost-effective and scalable interventions are needed to improve developmental outcomes for these children, most of whom are growing up in poverty. This paper examines the direct impacts and cost-effectiveness of a savings-led family economic empowerment intervention, Bridges to the Future, that employed varying matched savings incentives to encourage investment in Ugandan children orphaned by AIDS. Methods Using data from 48 primary schools in southwestern Uganda, we calculate per-person costs in each of the two treatment arms - Bridges (1:1 match savings) vs Bridges PLUS (1:2 match savings); estimate program effectiveness across outcomes of interest; and provide the ratios of per-person costs to their corresponding effectiveness. Results At the 24-month post-intervention initiation, children in the two treatment arms showed better results in health, mental health and education when compared to the Usual Care condition, however, no statistically significant differences were found between treatment arms with the exception of school attendance rates which were higher for those in Bridges PLUS. Due to the minimal cost difference between the Bridges and Bridges PLUS arms, we did not find substantial cost-effectiveness differences across the two treatment arms. Conclusion After 24 months, an economic intervention that incorporated matched savings yielded positive results on critical development outcomes for adolescents orphaned by AIDS in Uganda. The 1:1 and 1:2 match rates did not demonstrate variable levels of cost-effectiveness at 24-month follow-up, suggesting that governments intending to incorporate savings-led interventions within their social protection frameworks may not need to select a higher match rate to see positive developmental outcomes in the short-term. Further research is required to understand intervention impacts and cost-effectiveness after a longer follow-up period.

A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial

“…During the intervention, women will have direct access to both their personal savings deposited in the accounts and the match provided by the study. This is different from our prior studies that required the participants’ own savings and the match to be kept in separate accounts and to get approval by the research team to access the match [46, 47, 63, 78, 84–89]. This added unconditional component provides women with a safety net to address short-term consumption needs and financial emergencies if they arise.…”

Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda

“…Adolescents in the intervention group received the BSOC as well as an economic empowerment intervention consisting of a Child Savings Account (CSA), matched at a rate of 1:1 and from which financial savings could be used for medical related expenses, family small business development or education related expenses (including school lunches and fees). As part of the CSA package, the intervention group also received four workshops blending financial management and life skills with topics including asset building, small business development, goal setting, and risk mitigation, components previously tested among adolescents in the region [34, 35]. …”

Effects of Financial Incentives on Saving Outcomes and Material Well‐Being: Evidence From a Randomized Controlled Trial in Uganda

“…In Ssewamala et al. (), the effectiveness and cost‐effectiveness of savings incentives on child developmental outcomes were examined. These developmental outcomes include health, mental health, self‐concept, self‐efficacy, sexual health, and education.…”