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