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Costs of implementing integrated community case management (iCCM) in six African countries: implications for
Emmanuelle Daviaud1, Donnela Besada1, Natalie Leon1
1Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
Insights
Integrated community case management (iCCM) offers a low-cost solution to reduce child mortality in Sub-Saharan Africa. Improving iCCM service utilization is crucial for maximizing its impact and ensuring a sound investment in child health.
Area of Science:
- Global Health
- Health Economics
- Public Health Interventions
Background:
- Sub-Saharan Africa faces the highest under-five mortality rates globally.
- Integrated community case management (iCCM) aims to improve access to essential child health services.
- iCCM utilizes community health workers (CHWs) for diagnosing and treating malaria, pneumonia, and diarrhea in children aged 2-59 months.
Purpose of the Study:
- To present an economic analysis of iCCM implementation from a provider's perspective.
- To assess the costs associated with iCCM services in UNICEF-supported regions across six countries.
- To evaluate the implications of scaling up iCCM at a country level.
Main Methods:
- Combined annualized set-up and one-year implementation costs to determine per-treatment economic and financial costs.
- Assessed program affordability by comparing per capita financial cost to public health expenditure.
- Modeled the impact of a 30% increase in utilization and country-wide scale-up for rural under-five populations.
Main Results:
- iCCM service utilization varied significantly, from 0.05 to over 1 treatment per under-five child annually.
- Economic cost per treatment ranged from US$2 to US$13, heavily influenced by utilization rates.
- Country-scale iCCM implementation was estimated at under US$0.8 per capita, representing a small fraction of public health expenditure.
Conclusions:
- iCCM is a cost-effective intervention addressing unmet needs and impacting under-five mortality.
- The low per capita cost signifies a sound investment, but low utilization requires urgent strategies to boost demand.
- Sustained donor support and integration into national health systems are essential for the long-term success of iCCM.
Background:
Sub-Saharan Africa still reports the highest rates of under-five mortality. Low cost, high impact interventions exist, however poor access remains a challenge. Integrated community case management (iCCM) was introduced to improve access to essential services for children 2-59 months through diagnosis, treatment and referral services by community health workers for malaria, pneumonia and diarrhea. This paper presents the results of an economic analysis of iCCM implementation in regions supported by UNICEF in six countries and assesses country-level scale-up implications. The paper focuses on costs to provider (health system and donors) to inform planning and budgeting, and does not cover cost-effectiveness.
Methods:
The analysis combines annualised set-up costs and 1 year implementation costs to calculate incremental economic and financial costs per treatment from a provider perspective. Affordability is assessed by calculating the per capita financial cost of the program as a percentage of the public health expenditure per capita. Time and financial implications of a 30% increase in utilization were modeled. Country scale-up is modeled for all children under 5 in rural areas.
Results:
Utilization of iCCM services varied from 0.05 treatment/y/under-five in Ethiopia to over 1 in Niger. There were between 10 and 603 treatments/community health worker (CHW)/y. Consultation cost represented between 93% and 22% of economic costs per treatment influenced by the level of utilization. Weighted economic cost per treatment ranged from US$ 13 (2015 USD) in Ghana to US$ 2 in Malawi. CHWs spent from 1 to 9 hours a week on iCCM. A 30% increase in utilization would add up to 2 hours a week, but reduce cost per treatment (by 20% in countries with low utilization). Country scale up would amount to under US$ 0.8 per capita total population (US$ 0.06-US$0.74), between 0.5% and 2% of public health expenditure per capita but 8% in Niger.
Conclusions:
iCCM addresses unmet needs and impacts on under 5 mortality. An economic cost of under US$ 1/capita/y represents a sound investment. Utilization remains low however, and strategies must be developed as a priority to improve demand. Continued donor support is required to sustain iCCM services and strengthen its integration within national health systems.
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