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Costs and Cost-Effectiveness of a Mobile Phone Text-Message Reminder Programmes to Improve Health Workers' Adherence to Malaria Guidelines in Kenya

Author

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  • Dejan Zurovac
  • Bruce A Larson
  • Raymond K Sudoi
  • Robert W Snow

Abstract

Background: Simple interventions for improving health workers' adherence to malaria case-management guidelines are urgently required across Africa. A recent trial in Kenya showed that text-message reminders sent to health workers' mobile phones improved management of pediatric outpatients by 25 percentage points. In this paper we examine costs and cost-effectiveness of this intervention. Methods/Findings: We evaluate costs and cost-effectiveness in 2010 USD under three implementation scenarios: (1) as implemented under study conditions in study areas; (2) if the intervention was routinely implemented by the Ministry of Health (MoH) in the same areas; and (3) if the intervention was scaled up nationally. Under study conditions, intervention costs were 19,342 USD, of which 45% were for developing and pretesting text-messages, 12% for developing text-message distribution system, 29% for collecting health workers' phone numbers, and 13% were costs of sending text-messages and monitoring of the system. If the intervention was implemented in the same areas by the MoH, the costs would be 28% lower (13,920 USD) due to lower costs of collecting health workers' numbers. The cost of national scale-up would be 97,350 USD, and the majority of these costs (66%) would be for sending text-messages. The cost per additional child correctly managed was 0.50 USD under study conditions, 0.36 USD if implemented by the MoH in the same area, and estimated at only 0.03 USD if implemented nationally. Even if the effect size was only 5% or the cost on the national scale was 400% higher than estimated, the cost per additional child correctly managed would be only 0.16 USD. Conclusions: A simple text-messaging intervention improving health worker adherence to malaria guidelines is effective and inexpensive. Further research is justified to optimize delivery of the intervention and expand targets beyond children and malaria disease.

Suggested Citation

  • Dejan Zurovac & Bruce A Larson & Raymond K Sudoi & Robert W Snow, 2012. "Costs and Cost-Effectiveness of a Mobile Phone Text-Message Reminder Programmes to Improve Health Workers' Adherence to Malaria Guidelines in Kenya," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-6, December.
    • Handle: RePEc:plo:pone00:0052045
    DOI: 10.1371/journal.pone.0052045
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    Cited by:

    1. Sarah J Iribarren & Kenrick Cato & Louise Falzon & Patricia W Stone, 2017. "What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-20, February.
    2. Elyssa Wiecek & Fernanda S Tonin & Andrea Torres-Robles & Shalom I Benrimoj & Fernando Fernandez-Llimos & Victoria Garcia-Cardenas, 2019. "Temporal effectiveness of interventions to improve medication adherence: A network meta-analysis," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-16, March.
    3. Youngji Jo & Amnesty E LeFevre & Katherine Healy & Neelu Singh & Kelsey Alland & Sucheta Mehra & Hasmot Ali & Saijuddin Shaikh & Rezawanul Haque & Parul Christian & Alain B Labrique, 2019. "Costs and cost-effectiveness analyses of mCARE strategies for promoting care seeking of maternal and newborn health services in rural Bangladesh," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-13, October.
    4. Emily R Mangone & Smisha Agarwal & Kelly L’Engle & Christine Lasway & Trinity Zan & Hajo van Beijma & Jennifer Orkis & Robert Karam, 2016. "Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-12, January.

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