Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis.
File(s)Pitt Senegal SMC.pdf (391.75 KB)
Published version
Author(s)
Type
Journal Article
Abstract
Seasonal Malaria Chemoprevention (SMC) is recommended for children under 5 in the Sahel and sub-Sahel. The burden in older children may justify extending the age range, as has been done effectively in Senegal. We examine costs of door-to-door SMC delivery to children up to 10 years by community health workers (CHWs). We analysed incremental financial and economic costs at district level and below from a health service perspective. We examined project accounts and prospectively collected data from 405 CHWs, 46 health posts, and 4 district headquarters by introducing questionnaires in advance and completing them after each monthly implementation round. Affordability was explored by comparing financial costs of SMC to relevant existing health expenditure levels. Costs were disaggregated by administration month and by health service level. We used linear regression models to identify factors associated with cost variation between health posts. The financial cost to administer SMC to 180 000 children over one malaria season, reaching ∼93% of children with all three intended courses of SMC was $234 549 (constant 2010 USD) or $0.50 per monthly course administered. Excluding research-participation incentives, the financial cost was $0.32 per resident (all ages) in the catchment area, which is 1.2% of Senegal's general government expenditure on health per capita. Economic costs were 18.7% higher than financial costs at $278 922 or $0.59 per course administered and varied widely between health posts, from $0.38 to $2.74 per course administered. Substantial economies of scale across health posts were found, with the smallest health posts incurring highest average costs per monthly course administered. SMC for children up to 10 is likely to be affordable, particularly where it averts substantial curative care costs. Estimates of likely costs and cost-effectiveness of SMC in other contexts must account for variation in average costs across delivery months and health posts.
Date Issued
2017-07-24
Date Acceptance
2017-06-18
Citation
Health Policy and Planning, 2017, 32 (9), pp.1256-1266
ISSN
1460-2237
Publisher
Oxford University Press (OUP)
Start Page
1256
End Page
1266
Journal / Book Title
Health Policy and Planning
Volume
32
Issue
9
Copyright Statement
© 2017 The Author(s). Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/28981665
PII: 4030743
Subjects
Seasonal malaria chemoprevention (SMC)
Sub-Saharan Africa
campaigns
community health workers
cost function
cost variation
intermittent preventive treatment
malaria
mass drug administration
primary health care
1605 Policy And Administration
1117 Public Health And Health Services
Health Policy & Services
Publication Status
Published
Coverage Spatial
England