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Economic evaluation of Health Extension Program packages in Ethiopia

Author

Listed:
  • Lelisa Fekadu Assebe
  • Wondesen Nigatu Belete
  • Senait Alemayehu
  • Elias Asfaw
  • Kora Tushune Godana
  • Yibeltal Kiflie Alemayehu
  • Alula M Teklu
  • Amanuel Yigezu

Abstract

Background: Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equitable community-level healthcare services through Health Extension Workers. Despite the program’s being a flagship initiative, there is limited evidence on whether investment in the program represents good value for money. This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia. Methods: Twenty-one health care interventions were selected under the hygiene and sanitation, family health services, and disease prevention and control sub-domains. The ingredient bottom-up and top-down costing method was employed. Cost and cost-effectiveness were assessed from the provider perspective. Health outcomes were measured using life years gained (LYG). Incremental cost per LYG in relation to the gross domestic product (GDP) per capita of Ethiopia (US$852.80) was used to ascertain the cost-effectiveness. All costs were collected in Ethiopian birr and converted to United States dollars (US$) using the average exchange rate for 2018 (US$1 = 27.67 birr). Both costs and health outcomes were discounted by 3%. Result: The average unit cost of providing selected hygiene and sanitation, family health, and disease prevention and control services with the HEP was US$0.70, US$4.90, and US$7.40, respectively. The major cost driver was drugs and supplies, accounting for 53% and 68%, respectively, of the total cost. The average annual cost of delivering all the selected interventions was US$9,897. All interventions fall within 1 times GDP per capita per LYG, indicating that they are very cost-effective (ranges: US$22–$295 per LYG). Overall, the HEP is cost-effective by investing US$77.40 for every LYG. Conclusion: The unit cost estimates of HEP interventions are crucial for priority-setting, resource mobilization, and program planning. This study found that the program is very cost-effective in delivering community health services.

Suggested Citation

  • Lelisa Fekadu Assebe & Wondesen Nigatu Belete & Senait Alemayehu & Elias Asfaw & Kora Tushune Godana & Yibeltal Kiflie Alemayehu & Alula M Teklu & Amanuel Yigezu, 2021. "Economic evaluation of Health Extension Program packages in Ethiopia," PLOS ONE, Public Library of Science, vol. 16(2), pages 1-16, February.
    • Handle: RePEc:plo:pone00:0246207
    DOI: 10.1371/journal.pone.0246207
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    References listed on IDEAS

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    1. Lucy Cunnama & Edina Sinanovic & Lebogang Ramma & Nicola Foster & Leigh Berrie & Wendy Stevens & Sebaka Molapo & Puleng Marokane & Kerrigan McCarthy & Gavin Churchyard & Anna Vassall, 2016. "Using Top‐down and Bottom‐up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 53-66, February.
    2. Daniel G Datiko & Bernt Lindtjørn, 2010. "Cost and Cost-Effectiveness of Treating Smear-Positive Tuberculosis by Health Extension Workers in Ethiopia: An Ancillary Cost-Effectiveness Analysis of Community Randomized Trial," PLOS ONE, Public Library of Science, vol. 5(2), pages 1-7, February.
    3. Lucy Cunnama & Edina Sinanovic & Lebogang Ramma & Nicola Foster & Leigh Berrie & Wendy Stevens & Sebaka Molapo & Puleng Marokane & Kerrigan McCarthy & Gavin Churchyard & Anna Vassall, 2016. "Using Top‐down and Bottom‐up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale," Health Economics, John Wiley & Sons, Ltd., vol. 25, pages 53-66, February.
    4. Assefa Admassie & Degnet Abebaw & Andinet Woldemichael, 2009. "Impact evaluation of the Ethiopian Health Services Extension Programme," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 1(4), pages 430-449.
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