Abstract
BackgroundGhana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions.MethodsA cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey.ResultsAppropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region.ConclusionsIntegrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing strategies should be explored including potential inclusion in the National Health Insurance Scheme (NHIS) benefit package. An acceptability study of including iCCM in the NHIS should be conducted.
Highlights
Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management and the community-based health planning and services (CHPS)
Unit cost for treating a malaria, diarrhoea and suspected pneumonia case from integrated community case management (iCCM), CHPS, and households Average iCCM programme costs in the Volta Region were lower when compared with those of the Northern Region: diagnosing and treating a malaria case costs US$1.54 and US$7.77, a diarrhoea case costs US$0.38 and US$6.72 and a suspected pneumonia case cost US$1.12 and US$7.80 in the Volta and Northern Region, respectively (Table 2)
The much higher iCCM costs in the Northern Region when compared with those of the Volta Region was mainly due to (1) higher costs for training and for the incentive package in the Northern Region; (2) a lower number of visits to sick children in the Northern Region (17,898 and 30,839 visits in the Northern Region and Volta Region) and (3) a much lower number of IEC activities (177,484 and 99 IEC activities conducted in the Volta Region and the Northern Region)
Summary
Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). In December 2014 a new global coalition of more than 500 leading health and development organizations worldwide was launched to urge governments to accelerate reforms that ensure everyone, everywhere, can access quality health services without being forced into poverty [1]. This global coalition, called the Universal Health Coverage (UHC), comprises two main components: quality essential health service coverage and financial coverage—both extended to the whole population [2]. With UHC on the global health agenda, governments of many low and middle-income countries are under pressure to scale up essential health services to meet the needs of their people This means that governments need to prioritize effective interventions to scale up.
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