The cost of integrated community health services for treating child pneumonia, diarrhoea, and malaria in three African countries: economic research using systematic sampling

Abstract

BackgroundFor universal health coverage to be successful, services must be accessible to all people and should be provided in the most cost-effective 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 affordable 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. MethodsThese 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. FindingsThis 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 fixed costs of establishing and providing these services are high relative to the numbers of services provided. InterpretationThe findings indicate that iCCM services can be provided at low cost provided they are used by sufficient numbers of patients to justify the costs of training, equipping, managing, and supervising the community health workers who provide the services. FundingUnited States Agency for International Development (USAID).