Abstract
BackgroundBetween May 2010 and October 2012, approximately 12.5 million long-lasting insecticidal nets (LLINs) were distributed through a national universal mass distribution campaign in Ghana. The campaign included pre-registration of persons and sleeping places, door-to-door distribution of LLINs with ‘hang-up’ activities by volunteers and post-distribution ‘keep-up’ behaviour change communication activities. Hang-up activities were included to encourage high and sustained use.MethodsThe cost and cost-effectiveness of the LLIN Campaign were evaluated using a before-after design in three regions: Brong Ahafo, Central and Western. The incremental cost effectiveness of the ‘hang-up’ component was estimated using reported variation in the implementation of hang-up activities and LLIN use. Economic costs were estimated from a societal perspective assuming LLINs would be replaced after three years, and included the time of unpaid volunteers and household contributions given to volunteers.ResultsAcross the three regions, 3.6 million campaign LLINs were distributed, and 45.5% of households reported the LLINs received were hung-up by a volunteer. The financial cost of the campaign was USD 6.51 per LLIN delivered. The average annual economic cost was USD 2.90 per LLIN delivered and USD 6,619 per additional child death averted by the campaign. The cost-effectiveness of the campaign was sensitive to the price, lifespan and protective efficacy of LLINs.Hang-up activities constituted 7% of the annual economic cost, though the additional financial cost was modest given the use of volunteers. LLIN use was greater in households in which one or more campaign LLINs were hung by a volunteer (OR = 1.57; 95% CI = 1.09, 2.27; p = 0.02). The additional economic cost of the hang-up activities was USD 0.23 per LLIN delivered, and achieved a net saving per LLIN used and per death averted.ConclusionIn this campaign, hang-up activities were estimated to be net saving if hang-up increased LLIN use by 10% or more. This suggests hang-up activities can make a LLIN campaign more cost-effective.
Highlights
Between May 2010 and October 2012, approximately 12.5 million long-lasting insecticidal nets (LLINs) were distributed through a national universal mass distribution campaign in Ghana
A total of 1,327,601 LLINs were delivered to households in Brong Ahafo, 996,023 in Central, and 1,340,404 in Western regions; in each region, this represented over 99% of the LLINs procured
The financial cost per LLIN delivered by the Ghana LLIN Campaign was comparable to that reported by the evaluation of another recent national universal campaign conducted in Tanzania in 2010–11 at around United States Dollars (USD) 6.10 per LLIN delivered [5]
Summary
Between May 2010 and October 2012, approximately 12.5 million long-lasting insecticidal nets (LLINs) were distributed through a national universal mass distribution campaign in Ghana. Substantial gains have been made in moving towards the goal of universal coverage, in large part due to mass campaign distributions through which hundreds of millions of LLIN have been distributed in subSaharan Africa since 2002 [3]. A reasonable evidence base exists for the cost effectiveness of LLINs delivered through campaigns targeted at biologically vulnerable groups (either stand-alone or integrated with other child health interventions) or continuous distribution channels such as antenatal or immunization clinics [4]. It is recognized that inclusion of hang-up activities requires additional resources (both financial and human) and there is particular interest in the cost effectiveness of the ‘hang-up’ component of LLIN campaigns
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