What will it cost to prevent violence against women and girls in low- and middle-income countries? Evidence from Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia

Abstract

Violence against women and girls (VAWG) is a global problem with profound consequences. Although there is a growing body of evidence on the effectiveness of VAWG prevention interventions, economic data are scarce. We carried out a cross-country study to examine the costs of VAWG prevention interventions in low- and middle-income countries. We collected primary cost data on six different pilot VAWG prevention interventions in six countries: Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia. The interventions varied in their delivery platforms, target populations, settings and theories of change. We adopted a micro-costing methodology. We calculated total costs and a number of unit costs common across interventions (e.g. cost per beneficiary reached). We used the pilot-level cost data to model the expected total costs and unit costs of five interventions scaled up to the national level. Total costs of the pilots varied between ∼US $208 000 in a small group intervention in South Africa to US $2 788 000 in a couples and community-based intervention in Rwanda. Staff costs were the largest cost input across all interventions; consequently, total costs were sensitive to staff time use and salaries. The cost per beneficiary reached in the pilots ranged from ∼US $4 in a community-based intervention in Ghana to US $1324 for one-to-one counselling in Zambia. When scaled up to the national level, total costs ranged from US $32 million in Ghana to US $168 million in Pakistan. Cost per beneficiary reached at scale decreased for all interventions compared to the pilots, except for school-based interventions due to differences in student density per school between the pilot and the national average. The costs of delivering VAWG prevention vary greatly due to differences in the geographical reach, number of intervention components and the complexity of adapting the intervention to the country. Cost-effectiveness analyses are necessary to determine the value for money of interventions.

Justice for George Floyd and a reckoning for global mental health

“…Examples of whole-of-society wraparound approaches to violence in global mental health can be found in Derrick Silove's ADAPT model (2013) for post-conflict societies as well as the work of Mike Wessells (2009) and Theresa Betancourt (2020) on rehabilitating child soldiers. Recent efforts in preventing gender-based violence in the global context should also be a role model (Torres-Rueda et al , 2020). Similarly, HIV researchers have increasingly focused on the impact of violence on HIV prevention and care, including especially gender-based violence HIV and intimate partner violence (Maman et al ., 2000; Meskele et al , 2019; Rwafa et al , 2019).…”

Cost-effectiveness analysis of an intimate partner violence prevention intervention targeting men, women and couples in rural Ethiopia: evidence from the Unite for a Better Life randomised controlled trial

“…A recent analysis of six pilot projects targeting violence against women and girls similarly found evidence of declines in unit costs between 20% and 40% when interventions were scaled up. 21 In order to ensure comparability across trials, this discussion has used the higher estimate derived from the trial phase. However, scale-up of UBL may similarly lead to a rapid increase in estimated cost-effectiveness.…”

“…19 A recent analysis of six pilots targeting violence against women and girls reported unit costs ranging from $4 to $1324. 21 The estimated cost per case of IPV averted was 2004 US$813 for IMAGE and 2011 US$485 for SASA! Comparing UBL to IMAGE and SASA!, in general the cost per direct beneficiary and per year of IPV averted for direct beneficiaries is higher.…”

“…19 20 One recent paper published an estimate of unit costs of pilot interventions targeting violence against women and girls in six countries (Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia). 21 Unite for a Better Life (UBL) is a gender-transformative, participatory intervention delivered to men, women and couples in Ethiopia in the context of the coffee ceremony, a traditional forum for community-based discussion. The programme aims to reduce physical and sexual IPV and HIV risk behaviours as well as promote healthier, more equitable relationships.…”

“… 19 20 One recent paper published an estimate of unit costs of pilot interventions targeting violence against women and girls in six countries (Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia). 21 …”