Malaria community health workers in Myanmar: a cost analysis

Malaria Journal

Research

Myat Phone Kyaw¹  Aung Thi²  Thaung Hlaing²  Shwe Sin Kyaw³  Lisa J. White⁴  Yoel Lubell⁴  Tom Drake⁴  Frank M. Smithuis⁵ 

[1] Department of Medical Research, Ministry of Health, Yangon, Myanmar;Department of Public Health, Ministry of Health, Nay Pyi Taw, Myanmar;Mathematical and Economic Modelling, Mahidol-Oxford Tropical Medicine Research Unit, 420/6 Rajvithi Rd, 10400, Bangkok, Thailand;Mathematical and Economic Modelling, Mahidol-Oxford Tropical Medicine Research Unit, 420/6 Rajvithi Rd, 10400, Bangkok, Thailand;Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Medical Action Myanmar, Yangon, Myanmar;Myanmar Oxford Clinical Research Unit, Yangon, Myanmar;

关键词: Community health worker;    Malaria;    Cost;    Cost analysis;    Economic evaluation;   

DOI  :  10.1186/s12936-016-1102-3

 received in 2015-05-23, accepted in 2016-01-14,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundMyanmar has the highest malaria incidence and attributed mortality in South East Asia with limited healthcare infrastructure to manage this burden. Establishing malaria Community Health Worker (CHW) programmes is one possible strategy to improve access to malaria diagnosis and treatment, particularly in remote areas. Despite considerable donor support for implementing CHW programmes in Myanmar, the cost implications are not well understood.MethodsAn ingredients based micro-costing approach was used to develop a model of the annual implementation cost of malaria CHWs in Myanmar. A cost model was constructed based on activity centres comprising of training, patient malaria services, monitoring and supervision, programme management, overheads and incentives. The model takes a provider perspective. Financial data on CHWs programmes were obtained from the 2013 financial reports of the Three Millennium Development Goal fund implementing partners that have been working on malaria control and elimination in Myanmar. Sensitivity and scenario analyses were undertaken to outline parameter uncertainty and explore changes to programme cost for key assumptions.ResultsThe range of total annual costs for the support of one CHW was US$ 966–2486. The largest driver of CHW cost was monitoring and supervision (31–60 % of annual CHW cost). Other important determinants of cost included programme management (15–28 % of annual CHW cost) and patient services (6–12 % of annual CHW cost). Within patient services, malaria rapid diagnostic tests are the major contributor to cost (64 % of patient service costs).ConclusionThe annual cost of a malaria CHW in Myanmar varies considerably depending on the context and the design of the programme, in particular remoteness and the approach to monitoring and evaluation. The estimates provide information to policy makers and CHW programme planners in Myanmar as well as supporting economic evaluations of their cost-effectiveness.

【 授权许可】

CC BY   
© Kyaw et al. 2016