title: Child Health Week in Zambia: costs, efficiency, coverage and a reassessment of need.
abstract: Child Health Weeks (CHWs) are semi-annual, campaign-style, facility- and outreach-based events that provide a package of high-impact nutrition and health services to under-five children. Since 1999, 30% of the 85 countries that regularly implement campaign-style vitamin A supplementation programmes have transformed their programmes into CHW. Using data drawn from districts' budget, expenditures and salary documents, UNICEF's CHW planning and budgeting tool and a special purposive survey, an economic analysis of the June 2010 CHW's provision of measles, vitamin A and deworming was conducted using activity-based costing combined with an ingredients approach. Total CHW costs were estimated to be US$5.7 million per round. Measles accounted for 57%, deworming 22% and vitamin A 21% of total costs. The cost per child was US$0.46. The additional supplies and personnel required to include measles increased total costs by 42%, but reduced the average costs of providing vitamin A and deworming alone, manifesting economies of scope. The average costs of covering larger, more urban populations was less than the cost of covering smaller, more dispersed populations. Provincial-level costs per child served were determined primarily by the number of service sites, not the number of children treated. Reliance on volunteers to provide 60% of CHW manpower enables expanding coverage, shortening the duration of CHWs and reduces costs by one-third. With costs of $1093 per life saved and $45 per disability-adjusted life-year saved, WHO criteria classify Zambia's CHWs as 'very cost-effective'. The continued need for CHWs is discussed.
authors.affiliation: HarvestPlus/IFPRI, 2033 K Street NW, Washington, DC 20006, USA. E-mail: j.fiedler@cgiar.org.
authors.forename: John L
authors.initials: JL
authors.lastname: Fiedler
authors.forename: Freddie
authors.initials: F
authors.lastname: Mubanga
authors.forename: Ward
authors.initials: W
authors.lastname: Siamusantu
authors.forename: Mofu
authors.initials: M
authors.lastname: Musonda
authors.forename: Kabaso F
authors.initials: KF
authors.lastname: Kabwe
authors.forename: Charles
authors.initials: C
authors.lastname: Zulu
mesh_terms: D002648:Child; D002669:Child Welfare / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019587:Dietary Supplements / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration; D006801:Humans; D020380:Needs Assessment; D014801:Vitamin A / Q000627:therapeutic use; D015024:Zambia / Q000453:epidemiology
chemical_list: D014801:Vitamin A