title: Cost analysis of school-based sexuality education programs in six countries.
abstract: BACKGROUND
  Policy-makers who are making decisions on sexuality education programs face important economic questions: what are the costs of developing sexuality education programs; and what are the costs of implementing and scaling them up? This study responds to these questions by assessing the costs of six school-based sexuality education programs (Nigeria, Kenya, Indonesia, India, Estonia and the Netherlands).
  
  
  METHODS
  Cost analyses were carried out in schools that were fully implementing a SE program, as this best reflects the resources needed to run an effective program. The costs were analyzed from the program perspective, meaning that all costs borne by the governmental and (international) non-governmental organizations supporting the program were included. Cost analyses were based on financial records, interviews and school surveys.We distinguished costs in three consecutive program phases: development, update and implementation. Recommendations on the most efficient program characteristics and scale-up pathways were drawn from results of three fully scaled up programs (Estonia, Nigeria and the Netherlands), scale-up scenarios of two pilot programs (Kenya and Indonesia), and an implementation plan (India), The costs of the programs were compared by converting cost per student reached in US dollars (US$) to international dollars (I$).
  
  
  RESULTS
  Findings revealed a range of costs and coverage of sexuality education programs. Costs per student reached were; US$7 in Nigeria, US$13.50 in India, US$33 in Estonia and the Netherlands, US$50 in Kenya, and US$160 in Indonesia.
  
  
  CONCLUSIONS
  Intra-curricular sexuality education programs have, because of their compulsory nature, the most potential to be scaled up and are therefore most efficient. Extra-curricular sexuality education programs have lower potential to be scaled up and are therefore less efficient. In terms of class size and number of lessons, countries need to strike a balance between the quality (demanding smaller classes and many lessons) and the costs (demanding larger classes and fewer lessons). Advocacy was a significant cost component.
authors.affiliation: Qalys Health Economics, Middenweg 239 I, 1098AP, Amsterdam, Netherlands.
authors.forename: Jari
authors.initials: J
authors.lastname: Kivela
authors.affiliation: Nijmegen International Center for Health Systems Research and Education (NICHE), Department of Primary and Community Care, Radboud University Nijmegen Medical Center, 9101, Nijmegen, 6500HB, Netherlands.
authors.forename: Evert
authors.initials: E
authors.lastname: Ketting
authors.affiliation: Nijmegen International Center for Health Systems Research and Education (NICHE), Department of Primary and Community Care, Radboud University Nijmegen Medical Center, 9101, Nijmegen, 6500HB, Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Baltussen
references.citation: Cost Eff Resour Alloc. 2013 Aug 01;11(1):17
references.pmid: 23915254