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Cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya

McPake, Barbara, Edoka, Ijeoma, Witter, Sophie, Kielmann, Karina, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Dieleman, Marjolein, Vaughan, Kelsey, Gama, Elvis, Kok, Maryse, Datiko, Daniel, Otiso, Lillian, Ahmed, Rukhsana, Squires, Neil, Suraratdecha, Chutima and Cometto, Giorgio (2015) 'Cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya'. Bulletin of the World Health Organization, Vol 93, 631-639A.

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Abstract

Objective
To assess the cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.

Methods
Incremental cost–effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value.

Findings
The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective.

Conclusion
Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 21.5 Allied health personnel. Allied health professions
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.2471/BLT.14.144899
Depositing User: Jessica Jones
Date Deposited: 08 Mar 2016 10:29
Last Modified: 06 Feb 2018 13:12
URI: http://archive.lstmed.ac.uk/id/eprint/5732

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