Impact of COVID-19 program adaptations on costs and cost-effectiveness of community management of acute malnutrition program in South Sudan

Abstract

Objective: We assessed the impact of the COVID-19 pandemic and the protocol adaptations on cost and cost-effectiveness of CMAM program in South Sudan. Design: Retrospective program expenditure-based analysis of NGO CMAM program for COVID-19 period (April 2020-December 2021) in respect to pre-COVID period (January 2019-March 2020) Setting: Study was conducted as part of a bigger evaluation study in South Sudan Participants: International and national non-governmental organizations (NG0s) operating CMAM programs under the Nutrition cluster participated in the study. Results: The average cost per child recovered from the program declined by 20% during COVID from $133 (range: $34-1,174) pre-COVID to $107 (range: $20-333) during COVID. The cost per child recovered was negatively correlated with program size (pre-COVID r-squared=0.58; during COIVD r-squared=0.50). Programs with higher enrollment were cheaper compared to those with low enrolment. Salaries, Ready to Use Food, and community activities accounted for over two-thirds of the cost per recovery during both pre-COVID (69%) and COVID (79%) periods. While cost per child recovered decreased during COVID period, it did not negatively impact on the program outcome. Enrolment increased by an average of 19.8% and recovery rate by 4.6% during COVID period. Conclusions: Costs reduced with no apparent negative implication on recovery rates after implementing the COVID CMAM protocol adaptations with a strong negative correlation between cost and program size. This suggests that investing in capacity, screening, and referral at existing CMAM sites to enable expansion of caseload maybe a preferable strategy to increasing the number of CMAM sites in South Sudan.