title: Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda.
abstract: BACKGROUND
  In Uganda, long-lasting insecticidal nets (LLIN) have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC) services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda.
  
  
  METHODS
  Household surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY). These effects were calculated for the total number of LLINs delivered and for those retained and used.
  
  
  RESULTS
  After 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja) and 99% (ANC Adjumani) were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja). Economic cost for ANC distribution were considerably higher (USD 2.27) compared to campaign costs (USD 1.23) in Adjumani.
  
  
  CONCLUSIONS
  Targeted campaigns and routine ANC services can both achieve high LLIN retention and use among the target population. The comparatively higher economic cost of delivery through ANC facilities was at least partially due to the relatively short time this system had been in existence. Further studies comparing the cost of well-established ANC delivery with LLIN campaigns and other delivery channels are thus encouraged.
authors.affiliation: Malaria Consortium - Africa Regional Office, PO Box 8045, Plot 2, Sturrock Road, Kampala, Uganda. jan.kolaczinski@lshtm.ac.uk
authors.forename: Jan H
authors.initials: JH
authors.lastname: Kolaczinski
authors.forename: Kate
authors.initials: K
authors.lastname: Kolaczinski
authors.forename: Daniel
authors.initials: D
authors.lastname: Kyabayinze
authors.forename: Daniel
authors.initials: D
authors.lastname: Strachan
authors.forename: Matilda
authors.initials: M
authors.lastname: Temperley
authors.forename: Nayantara
authors.initials: N
authors.lastname: Wijayanandana
authors.forename: Albert
authors.initials: A
authors.lastname: Kilian
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003256:Community Participation; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D009032:Mosquito Control / Q000191:economics* / Q000379:methods; D010342:Patient Acceptance of Health Care; D017150:Public Sector; D040241:Social Marketing; D011795:Surveys and Questionnaires; D014454:Uganda
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