5147.0: Wednesday, November 15, 2000 - Board 4

Abstract #8965

Cost-effectiveness of alternative models for providing community-based reproductive health services in sub-Saharan Africa

Ian Askew, PhD1, Jane Chege, PhD1, Ndugga Maggwa, MD, MSc1, Barbara Janowitz, PhD2, Rick Homan, PhD2, and Inoussa Kaboré, MD1. (1) Population Council, PO Box 17643, Nairobi, Kenya, 254-2-713480, iaskew@popcouncil.or.ke, (2) Family Health International

Programs that provide information and services on different aspects of reproductive health through community-based agents are now common in many countries throughout sub-Saharan Africa. Evidence exists that, if well-planned and implemented, such programs can substantially increase access to and use of such services. Data are also emerging that suggest an impact on reproductive health behaviors, and specifically fertility, is also possible.

The major question facing those implementing or introducing community-based programs relates to the design of the program. Which is the most cost-effective model to use? For most programs this question revolves around whether to employ agents full-time, or to provide allowances as performance incentives, or to rely on voluntarism (with or without non-financial incentives). This paper will present data to address this issue from a meta-analysis that synthesizes the findings from operations research studies of community-based programs in five sub-Saharan African countries. Although agent remuneration is usually the primary cost concern for managers, this analysis demonstrates that other cost components must also be considered due to their interaction with the employment status of the agents. The paper will also review the different types of effectiveness measures that can be used, and their appropriateness in calculations of cost-effectiveness.

Learning Objectives: "At the conclusion of the session, the participant (learner) in this session will be able to: 1. describe the different cost components and effectiveness measures that can be used to evaluate the cost-effectiveness of a community-based reproductive health program. 2. Understand the role of remuneration in determining the performance of community-based reproductive health agents. 3. contribute to the design of community-based reproductive health programs in sub-Saharan Africa

Keywords: Community Health Programs, Cost Issues

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA