A cost-analysis of conducting population-based prevalence surveys for the validation of the elimination of trachoma as a public health problem in Amhara, Ethiopia

Background: Trachoma prevalence surveys, including impact surveys (TIS) and surveillance surveys (TSS), provide information to program managers on the impact of the SAFE (surgery, antibiotics, facial cleanliness, and environmental improvement) strategy and current burden of disease, and they provide a crucial component of the evidence base necessary for the validation of the elimination of trachoma as a public health problem. The prevalence surveys included in this analysis are multi-level cluster random surveys that provide population-based estimates for program planning. This study conducted an analysis of the cost of 8 rounds of TIS/TSS executed in Amhara, Ethiopia, 2012–2016, comprising 232,357 people examined over 1,828 clusters in 187 districts. Methodology and findings: Cost data were collected retrospectively from accounting and procurement records from the implementing partner, The Carter Center, and coded by survey activity (i.e. training and field work) and input category (i.e. personnel, transportation, supplies, venue rental, and other). Estimates of staff time were obtained from The Carter Center Ethiopia. Data were analyzed by activity and input category. The mean total cost per cluster surveyed was $752 (standard deviation $101). Primary cost drivers were personnel (39.6%) and transportation (49.2%), with costs increasing in the last 3 rounds of TIS/TSS. Conclusion: Despite the considerable cost of conducting TIS and TSS, these surveys provide necessary information for program managers. Limited options are available to reduce the costs of TIS/TSS and gain economies of scale, as the surveys must be designed to achieve their designated sample size. However, surveys must also be designed in a way that is possible to be executed given the financial resources, personnel, and time required. Program managers can use these findings to improve estimates of the total cost of a survey and its components to ensure that sufficient resources are budgeted accordingly. Author summary: Population-based trachoma surveys are necessary to determine the impact of interventions and to build the case for the validation of elimination of trachoma as a public health problem. Many trachoma-endemic areas are currently receiving mass drug administration, which will require trachoma impact surveys (TIS) and trachoma surveillance surveys (TSS). We analyzed the costs accrued by the implementing non-governmental organization during 8 rounds of trachoma surveys in Amhara, Ethiopia, that included 187 districts surveyed over four years. The costs were sorted by activity (i.e. training and field work) and input category (i.e. transportation, personnel, venue rental, supplies, and other). Field work was the most expensive activity for trachoma surveys, with transportation and personnel as the most significant drivers of cost. As the global trachoma program matures, these surveys must be executed given the financial resources, personnel, and time available. Program managers can use these findings to improve total cost estimates of trachoma surveys and survey components to ensure that sufficient resources are being budgeted accordingly. Additionally, managers in hyperendemic settings can use these findings to better understand the drivers in cost of repeated surveys in a single geography.