title: Costing commodity and human resource needs for integrated community case management in thie differing community health strategies of Ethiopia, Kenya and Zambia.
abstract: BACKGROUND
  To ensure correct and appropriate funding is available, there is a need to estimate resource needs for improved planning and implementation of integrated Community Case Management (iCCM).
  
  
  OBJECTIVE
  To compare and estimate costs for commodity and human resource needs for iCCM, based on treatment coverage rates, bottlenecks and national targets in Ethiopia, Kenya and Zambia from 2014 to 2016.
  
  
  METHODS
  Resource needs were estimated using Ministry of Health (MoH) targets fronm 2014 to 2016 for implementation of case management of pneumonia, diarrhea and malaria through iCCM based on epidemiological, demographic, economic, intervention coverage and other health system parameters. Bottleneck analysis adjusted cost estimates against system barriers. Ethiopia, Kenya and Zambia were chosen to compare differences in iCCM costs in different programmatic implementation landscapes.
  
  
  RESULTS
  Coverage treatment rates through iCCM are lowest in Ethiopia, followed by Kenya and Zambia, but Ethiopia had the greatest increases between 2009 and 2012. Deployment of health extension workers (HEWs) in Ethiopia is more advanced compared to Kenya and Zambia, which have fewer equivalent cadres (called commu- nity health workers (CHWs)) covering a smaller proportion of the population. Between 2014 and 2016, the propor- tion of treatments through iCCM compared to health centres are set to increase from 30% to 81% in Ethiopia, 1% to 18% in Kenya and 3% to 22% in Zambia. The total estimated cost of iCCM for these three years are USD 75,531,376 for Ethiopia, USD 19,839,780 for Kenya and USD 33,667,742 for Zambia. Projected per capita expen- diture for 2016 is USD 0.28 for Ethiopia, USD 0.20 in Kenya and USD 0.98 in Zambia. Commodity costs for pneumonia and diarrhea were a small fraction of the total iCCM budget for all three countries (less than 3%), while around 80% of the costs related to human resources.
  
  
  CONCLUSIONS
  Analysis of coverage, demography and epidemiology data improves estimates of fimding requirements for iCCM. Bottleneck analysis adjusts cost estimates by including system barriers, thus reflecting a more accurate estimate of potential resource utilization. Adding pneumonia and diarrhea interventions to existing large scale community-based malaria case management programs is likely to require relatively small and nationally affordable investments. iCCM can be implemented for USD 0.09 to 0.98 per capita per annum, depending on the stage of scale-up and targets set by the MoH.
authors.forename: Rory
authors.initials: R
authors.lastname: Nefdt
authors.forename: Eric
authors.initials: E
authors.lastname: Ribaira
authors.forename: Khassoum
authors.initials: K
authors.lastname: Diallo
mesh_terms: D002202:Capital Financing; D019090:Case Management / Q000191:economics*; D018672:Community Health Planning; D003153:Community Health Services / Q000191:economics*; D019033:Delivery of Health Care, Integrated / Q000191:economics; D005002:Ethiopia; D017048:Health Care Costs; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D007630:Kenya; D015024:Zambia