Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia

Malaria Journal

Research

Kristian Schultz Hansen¹  Jayne Webster²  Jane Bruce²  Blanca Escribano Ferrer³  Solomon A. Narh Bana⁴  Margaret Gyapong⁴  Constance Bart-Plange⁵  Naa-Charity Azantilow⁵  Roland Glover⁵  Naa-Korkor Allotey⁵  Isabella Sagoe-Moses⁶  Clement T. Narh⁷ 

[1] Department of Public Health, University of Copenhagen, Copenhagen, Denmark;Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK;Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK;Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana;Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana;National Malaria Control Programme, Ghana Health Service, Accra, Ghana;Reproductive and Child Health Department, Ghana Health Service, Accra, Ghana;School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana;

关键词: Home- based care;    Integrated community case management (iCCM);    Malaria;    Diarrhoea;    Pneumonia;    Children under-five;    Cost-effectiveness analysis;   

DOI  :  10.1186/s12936-017-1906-9

 received in 2016-10-19, accepted in 2017-06-26,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundGhana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions.MethodsA cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey.ResultsAppropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region.ConclusionsIntegrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing strategies should be explored including potential inclusion in the National Health Insurance Scheme (NHIS) benefit package. An acceptability study of including iCCM in the NHIS should be conducted.

【 授权许可】

CC BY   
© The Author(s) 2017