Comparing costs and cost‐efficiency of platforms for micronutrient powder (MNP) delivery to children in rural Uganda

Abstract

Micronutrient powder (MNP) can reduce iron deficiency in young children, which has been well established in efficacy trials. However, the cost of different delivery platforms has not been determined. We calculated the cost and cost-efficiency of distributed MNP through community-based mechanisms and in health facilities in a primarily rural district in Uganda. An endline survey (n = 1072) identified reach and adherence. During the 9-month pilot, 37,458 (community platform) and 12,390 (facility platform) packets of MNP were distributed. Each packet consisted of 30 MNP sachets. In 2016, total costs were $277,082 (community platform, $0.24/sachet) and $221,568 (facility platform, $0.59/sachet). The cost per child reached was lower in the community platform ($53.24) than the facility platform ($65.97). The cost per child adhering to a protocol was $58.08 (community platform) and $72.69 (facility platform). The estimated cost of scaling up the community platform pilot to the district level over 3 years to cover approximately 17,890 children was $1.23 million (scale-up integrated into a partner agency program) to $1.62 million (government scale-up scenario). Unlike previous estimates, these included opportunity costs. Community-based MNP delivery costs were greater, yet more cost-efficient per child reached and adhering to protocol than facility-based delivery. However, total costs for untargeted MNP delivery under program settings are potentially prohibitive.

The cost-effectiveness of small-quantity lipid-based nutrient supplements for prevention of child death and malnutrition and promotion of healthy development: modeling results for Uganda

“…Our estimate of $52 per child for SQ-LNS falls within this range. There was wide variation in the percent of the total cost per child attributed to the cost of the product itself, ranging from 18% for MNP based on the Schott, Richardson (8) study, to 77% for complementary food. Our model indicated that product costs represent 42% of the cost of delivering SQ-LNS.…”

“…The cost model was developed based on an actual costing study conducted in one rural district in Uganda (Namubumba District) to estimate the cost of providing MNP to children 6-24 months of age (8). The MNP costing study was designed to compare the cost and cost-efficiency of delivering MNP via community-versus facility-based platforms.…”

“…We estimated economic costs from a societal perspective, meaning all costs were accounted for, regardless of who incurred them and including both the costs needed to finance the program as well as opportunity costs (e.g., the opportunity cost of caregivers’ time to participate in the intervention and volunteer health worker time). Following the activity-based approach used in Schott, Richardson (8), we estimated the cost of one year of start-up activities (primarily social and behavior change communication (SBCC) and capacity building) and recurring activities over a 10-year time horizon, which included caregiver opportunity costs, SBCC, logistics, capacity building, operational monitoring and evaluation (M&E) costs, overhead and capital, VHT incentives, SQ-LNS product costs, SQ-LNS international shipping and handling and customs clearance, and domestic SQ-LNS transport, storage, and handling.…”

“…All other cost estimates were adapted from the MNP costing study (8) by first identifying the base cost of each input (personnel, transport, materials, in-kind incentives) for each activity (plus overhead and capital costs) based on the costs actually incurred in Namutumba. We converted all base costs to 2020 US dollars using the Bureau of Economic Analysis implicit price deflators for gross domestic product (Supplemental Table 1).…”

“…Our goal was to develop a modeling framework to estimate the potential effects, costs, and cost-effectiveness of SQ-LNS. We selected rural Uganda for this first modeling exercise because detailed data were available on the costs of delivering a similar product, micronutrient powder (MNP), to young children in that setting (8). Our specific objectives were to 1) develop a cost model, adapted from the MNP study, to estimate the annual total cost and cost per child of providing SQ-LNS, 2) develop an effectiveness model to estimate the effects of SQ-LNS on child mortality, anemia, developmental disability, stunting, and wasting and 3) translate those effects into cost per disability-adjusted life years (DALYs) averted, per death averted, and per case of anemia, developmental disability, stunting, and wasting averted in rural Uganda.…”