title: Cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.
abstract: OBJECTIVE
  To assess the cost-effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.
  
  
  METHODS
  Incremental cost-effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value.
  
  
  RESULTS
  The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective.
  
  
  CONCLUSIONS
  Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.
authors.affiliation: Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia .
authors.forename: Barbara
authors.initials: B
authors.lastname: McPake
authors.affiliation: Institute for International Health & Development, Queen Margaret University, Queen Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland .
authors.forename: Ijeoma
authors.initials: I
authors.lastname: Edoka
authors.affiliation: Institute for International Health & Development, Queen Margaret University, Queen Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland .
authors.forename: Sophie
authors.initials: S
authors.lastname: Witter
authors.affiliation: Institute for International Health & Development, Queen Margaret University, Queen Margaret Drive Musselburgh, Edinburgh EH21 6UU, Scotland .
authors.forename: Karina
authors.initials: K
authors.lastname: Kielmann
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England .
authors.forename: Miriam
authors.initials: M
authors.lastname: Taegtmeyer
authors.affiliation: Royal Tropical Institute, Amsterdam, Netherlands .
authors.forename: Marjolein
authors.initials: M
authors.lastname: Dieleman
authors.affiliation: Royal Tropical Institute, Amsterdam, Netherlands .
authors.forename: Kelsey
authors.initials: K
authors.lastname: Vaughan
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England .
authors.forename: Elvis
authors.initials: E
authors.lastname: Gama
authors.affiliation: Royal Tropical Institute, Amsterdam, Netherlands .
authors.forename: Maryse
authors.initials: M
authors.lastname: Kok
authors.affiliation: REACHOUT, Hidase Hulentenawi Agelglot Yebego Adragot Mahber, Awassa, Ethiopia .
authors.forename: Daniel
authors.initials: D
authors.lastname: Datiko
authors.affiliation: REACHOUT, LVCT Health, Nairobi, Kenya .
authors.forename: Lillian
authors.initials: L
authors.lastname: Otiso
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, England .
authors.forename: Rukhsana
authors.initials: R
authors.lastname: Ahmed
authors.affiliation: Public Health England, North of England Region, England .
authors.forename: Neil
authors.initials: N
authors.lastname: Squires
authors.affiliation: United States Agency for International Development, Washington, DC, United States of America .
authors.forename: Chutima
authors.initials: C
authors.lastname: Suraratdecha
authors.affiliation: Global Health Workforce Alliance, World Health Organization, Geneva, Switzerland .
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cometto
mesh_terms: D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D005002:Ethiopia; D006268:Health Facilities / Q000191:economics; D006282:Health Personnel; D007214:Indonesia; D007630:Kenya; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000191:economics