Meeting Abstracts

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The cost of integrated community health services for treating child pneumonia, diarrhoea, and malaria in three African countries: economic research using systematic samplingDavid H Collins, Zina Jarrah, Katherine D Wright, Angela C Lee

AbstractBackground For universal health coverage to be successful, services must be accessible to all people and should be provided in the most cost-eff ective ways. A key approach to addressing both these challenges is that of community-based services, which are provided closer to where people live and are deemed to be more aff ordable and sustainable through use of volunteers or low-cost community workers. In 2011 and 2012, studies were carried out in Malawi, Rwanda, and Senegal to determine the cost of providing integrated community case management (iCCM) services for pneumonia, diarrhoea, and malaria.

Methods These studies were carried out by the authors in the countries and involved interviews with health workers in samples of health centres and communities. A new iCCM costing methodology and tool was developed for this purpose. The studies looked at direct costs, such as drugs and provider time, as well as indirect costs, such as supervision and training.

Findings This work compares the results of the three studies, which suggest that, even though the iCCM programme costs were relatively low, the average cost per service was not as low as expected. This is because fi xed costs of establishing and providing these services are high relative to the numbers of services provided.

Interpretation The fi ndings indicate that iCCM services can be provided at low cost provided they are used by suffi cient numbers of patients to justify the costs of training, equipping, managing, and supervising the community health workers who provide the services.

Funding United States Agency for International Development (USAID).

Contributors DHC was the principal investigator and abstract author. ZJ developed the model, participated in analysis, and led the research. KDW and ACL

participated in fi eld research and data gathering.

Confl icts of interest We decla re that we have no confl icts of interest.

Acknowledgments We would like to acknowledge the contributions of government counterparts and organisational partners in the three countries and the contributions

of partners from USAID’s TRAction Project.

Published OnlineJune 17, 2013

Centre for Health Systems, Management Sciences for Health, Cambridge, MA, USA (D H Collins FCA, Z Jarrah MPH, K D Wright MPH, A C Lee MPH)

Correspondence to:David H Collins, Centre for Health Systems, Management Sciences for Health, 784 Memorial Drive, Cambridge, MA 02139, USA dcollins@msh.org