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Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya
Joel Amenya Machuki1, Dickens S Omondi Aduda2, Abong'o B Omondi3,4
1Department of Research, Kenya Medical Research Institute, Kisumu, Kenya.
Insights
Community health worker management of childhood pneumonia is significantly more cost-effective than facility-based treatment. This approach reduces household expenses, highlighting the importance of strengthening community case management programs for better access to care.
Area of Science:
- Global Health
- Pediatrics
- Health Economics
Background:
- Pneumonia is a leading cause of death in children under 5 globally, with Kenya having a high prevalence.
- Less than 50% of children with pneumonia receive adequate antibiotic treatment.
- Community case management for pneumonia was implemented in Homa-Bay County, Kenya, in 2014.
Purpose of the Study:
- To compare the patient-level costs of home-based pneumonia treatment by community health workers (CHWs) with facility-based treatment.
- To identify the main cost drivers for both treatment modalities in Suba Subcounty.
Main Methods:
- A cross-sectional study design was employed.
- Quantitative data were collected from 208 caregivers using a structured questionnaire.
- Costs included direct (consultation, medicine, transportation) and indirect (opportunity cost) expenses.
Main Results:
- Home-based management cost KSh 122.65 ($1.29) per patient, while facility-based treatment cost KSh 447.46 ($4.71), a four-fold difference.
- Opportunity costs were the primary driver for home treatment (KSh 88.25).
- Medicine costs were the main cost driver for facility treatment (KSh 126.16).
Conclusions:
- Home-based pneumonia management is substantially more cost-effective than facility-based care.
- Strengthening and scaling up community case management is crucial.
- Addressing cost barriers can improve access to timely pneumonia treatment for children.
Background:
Globally, pneumonia accounted for 16% of deaths among children under 5 years of age and was one of the major causes of death overall in 2018. Kenya is ranked among the top 15 countries with regard to pneumonia prevalence and contributed approximately 74% of the world's annual pneumonia cases in 2018. Unfortunately, less than 50% of children with pneumonia receive appropriate antibiotics for treatment. Homa-Bay County implemented pneumonia community case management utilizing community health workers, as recommended by the World Health Organization (WHO), in 2014. However, since implementation of the program, the relative patient-level cost of home-based and facility-based treatment of pneumonia, as well as the main drivers of these costs in Suba Subcounty, remain uncertain. Therefore, the main objective of this study was to compare the patient-level costs of home based treatment of pneumonia by a community health worker with those of health facility-based treatment.
Methods And Findings:
Using a cross-sectional study design, a structured questionnaire was used to collect quantitative data from 208 caregivers on the direct costs (consultation, medicine, transportation) and indirect costs (opportunity cost) of pneumonia treatment. The average household cost for the community managed patients was KSH 122.65 ($1.29) compared with KSh 447.46 ($4.71), a 4-fold difference, for those treated at the health facility. The largest cost drivers for home treatment and health facility treatment were opportunity costs (KSH 88.25 ($ 0.93)) and medicine costs (KSH 126.16 ($ 1.33)), respectively.
Conclusion:
This study demonstrates that the costs incurred for home-based pneumonia management are considerably lower compared to those incurred for facility-based management. Opportunity costs (caregiver time and forgone wages) and the cost of medication were the key cost-drivers in the management of pneumonia at the health facility and at home, respectively. These findings emphasize the need to strengthen and scale community case management to overcome barriers and delays in accessing the correct treatment for pneumonia for sick children under 5 years of age.
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