Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Edinburgh University Global Health Society
Abstract
BACKGROUND Sub–Saharan Africa still reports the highest rates of under–
five mortality. Low cost, high impact interventions exist, however
poor access remains a challenge. Integrated community case management
(iCCM) was introduced to improve access to essential services
for children 2–59 months through diagnosis, treatment and referral
services by community health workers for malaria, pneumonia and diarrhea.
This paper presents the results of an economic analysis of iCCM
implementation in regions supported by UNICEF in six countries and
assesses country–level scale–up implications. The paper focuses on
costs to provider (health system and donors) to inform planning and
budgeting, and does not cover cost–effectiveness.
METHODS The analysis combines annualised set–up costs and 1 year
implementation costs to calculate incremental economic and financial
costs per treatment from a provider perspective. Affordability is assessed
by calculating the per capita financial cost of the program as a
percentage of the public health expenditure per capita. Time and financial
implications of a 30% increase in utilization were modeled.
Country scale–up is modeled for all children under 5 in rural areas.
RESULTS Utilization of iCCM services varied from 0.05 treatment/y/under–
five in Ethiopia to over 1 in Niger. There were between 10 and
603 treatments/community health worker (CHW)/y. Consultation cost
represented between 93% and 22% of economic costs per treatment
influenced by the level of utilization. Weighted economic cost per treatment
ranged from US$ 13 (2015 USD) in Ghana to US$ 2 in Malawi.
CHWs spent from 1 to 9 hours a week on iCCM. A 30% increase in
utilization would add up to 2 hours a week, but reduce cost per treatment
(by 20% in countries with low utilization). Country scale up
would amount to under US$ 0.8 per capita total population (US$
0.06–US$0.74), between 0.5% and 2% of public health expenditure
per capita but 8% in Niger.
CONCLUSIONS iCCM addresses unmet needs and impacts on under 5
mortality. An economic cost of under US$ 1/capita/y represents a sound
investment. Utilization remains low however, and strategies must be
developed as a priority to improve demand. Continued donor support
is required to sustain iCCM services and strengthen its integration
within national health systems.
Description
Keywords
Sub–Saharan Africa, Under– five mortality, Integrated community case management (iCCM), Access, Essential services
Citation
Daviaud, E. et al. (2017). Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability. Journal of Global Health, 7(1): 010403.