Online Program

Cost-Effectiveness of an Economic Empowering Intervention for AIDS-Affected Orphans in Uganda

Tuesday, November 3, 2015 : 1:22 p.m. - 1:35 p.m.

Julia Shu-Huah Wang, Columbia University School of Social Work, New York, NY
Fred Ssewamala, PhD, Director, International Center for Child Health & Asset Development, Columbia University, New York, NY
Christopher Damulira, International Center for Child Health & Asset Development, New York, NY
Joseph Kato Bakulu, Father, Diocese of Masaka, New York, NY
Sarah Meyer, MSW, International Center for Child Health and Asset Development, Columbia University, New York, NY
Abel Mwebembezi, Reach the Youth, Uganda
In sub-Saharan Africa, an estimated 15 million children under age 18 have lost one or both parents to AIDS. Effective interventions are urgently needed to improve the life chances of these children. Given scarce economic resources, the region needs interventions that are cost-effective with multidimensional benefits. This study uses data from an NICHD-funded randomized controlled trial, Bridges to the Future, to examine the cost-effectiveness of this economic empowering intervention on AIDS-affected children’s multidimensional wellbeing in Uganda. The study recruited children in grade 5/6 from 48 randomly selected primary schools, and 1,410 orphans met the inclusion criteria. The 48 schools were randomly assigned to three study arms: Usual Care (n=496), Bridges (n=402), and Bridges PLUS (n=512). Children in all study arms receive usual care for AIDS-orphaned children in the study area, including counseling, school lunches and scholastic materials. Each child in Bridges and Bridges PLUS arms additionally receives a Child Development Account; regular mentorship meetings with undergraduate students; and income-generating activity training. Bridges PLUS participants receive a 1:2 match-rate on savings while Bridges participants receive a 1:1 match-rate. This study examines cost-effectiveness during the two intervention years. We measure program costs on a per person basis, and costs data were drawn from the management information system for savings and project administrative records. We assess program effectiveness in areas of health and mental health, sexual risk-taking intentions, and actual savings. Data are drawn from interviews and banks administrative records. The per-person costs of Bridges and Bridges PLUS is divided by relevant effect sizes to produce cost-effectiveness ratios. Findings show that the intervention improves children’s mental health and savings behaviors. Although Bridges PLUS intervention is slightly more costly than Bridges due to its higher savings match-rate, it does not solicit better outcomes other than higher account opening rates and higher number of deposits.

Learning Areas:

Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Public health or related education
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the design of an innovative family economic strengthening intervention targeting AIDS-affected orphans in Uganda, with a goal to promote health and mental health as well as educational outcomes. Explain a cost-effectiveness analysis (CEA) method and offer an empirical example carrying out a CEA under a randomized controlled trial context. Assess multidimensional impacts as well as cost-effectiveness of a family economic strengthening intervention in areas of health, mental health, sexual health, educational performance, and economic wellbeing from baseline to 12- and 24-month follow-up.

Keyword(s): Child Health, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the research coordinator of the cost-effectiveness evaluation of this intervention.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4238.0: HIV/AIDS