Costs of setting up and maintaining home based management of fever in Kumi District
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Introduction Prompt and effective treatment of malaria in the under five year old children is essential in malaria control. Death often results from complications of malaria if treatment is not given within 24 hours. In order to achieve effective treatment of malaria, Uganda started on Home based management of fever (HE3MF) using pre-packed combination of chloroquin CQ and pyrimethaminel sulphamethoxazole SP (Homapak) in June 2002. Community drug distributors under the supervision of trained medical workers, diagnose, treat and refer children with simple malaria. In Kumi district, reduction in outpatient attendance and mortality due to malaria as a result of HBMF has been evidenced by reports from the Health Management Information Systems (HMIS). However, sustainability of the intervention is threatened by irregular drug supplies, inadequate support supervision and poor motivation of the drug distributors due to inadequate funding. The full resource and costs required for its operation and sustainability was deemed important and hence the need for this kind of study. Objectives General objective • To estimate the total cost of setting up and maintaining HBMF in Kurni • District and provide information that would assist the DHT to budget and plan for appropriate financing to sustain HBMF. Specific objectives • To determine the capital costs of setting up the HBMF in Kumi district • To establish the operational/current costs of the intervention for the period June 2002 to July 2003. • To assess the utilization of HBMF in Kumi District. • To determine the average and marginal cost of HBMF in Kumi District for the period June 2002 to July 2003. Methodology A descriptive retrospective study using 'ingredients approach' in which all inputs and activities in the programme were identified for costing was conducted. The financial costs were obtained from the accounts records in the district and health sub districts (HSDs). Interviews were conducted to provide additional information not available on records. The costs were expressed in local currency and the economic costs calculated by annualizing capital costs and valuing the donated inputs. Quality and validity of data was ensured through pre testing the methodology and data collection tools and triangulation of data collection methods and sources. Analysis was done on Microsoft Excel computer programme. Results The study revealed that start up costs amounted to UG Shs 33,264,620 constituting 17.2% of the total costs. A total amount of UG Shs 160,384,498 were the annual ongoing costs for providing HBMF in Kumi District out of which 58.4% were for procurement of drugs (Homapak). Health development partners contributed 8 1.3% of the total costs mainly for drug procurement and start up activities indicating high donor dependency. The ratio of recurrent to capital costs (r coefficient) was 4.3 indicating inefficiency in the investment. The study found that HBMF in Kurni district had attained 58% coverage and that there was a direct relationship between availability of drugs in the health unit and the number of episodes treated. The average cost for providing the service was found to be 593.7 UG Shs (0.34 US$). The average cost at the higher level of activity (in November 2002) was lower than in September 2002 and the incremental cost between the two levels of activity was UG Shs 329.2 (0.19 US$). Conclusions and recommendations The study showed that a large part (81.3%) of the total costs of providing HBMF in Kurni District was contributed by development partners mainly to purchase drugs. This means that long term sustainability will be difficult to achieve unless strategies for more internal sources of financing are developed and applied. The drug cost was the major determinant of the overall cost of the intervention. This indicates that the intervention relies heavily on availability of drugs at the lowest point of use for its success. Consequently, an effective system of drug procurement, storage and distribution is critical to the success of the intervention. Operating HBMF at a higher level of output (number of episodes of fever treated) was found to be more cost effective because of the lower average cost compared to a lower output. This allows for expansion of services. However for the long term sustainability of the intervention, the DHT should design strategies to mobilize more internal resources to address the disproportion in funding between the external and internal sources. The results of this study should assist the DHT work out a budget that it could use as a tool for resource mobilization.
Keywords
Costs, Malaria, Home based management of fever, Treatment of malaria, Kumi District, Mortality, Health management information systems