title: Cost of providing injectable contraceptives through a community-based social marketing program in Tigray, Ethiopia.
abstract: To provide a cost analysis of an injectable contraceptive program combining community-based distribution and social marketing in Tigray, Ethiopia.
  
  
  
  We conducted a cost analysis, modeling the costs and programmatic outcomes of the program's initial implementation in 3 districts of Tigray, Ethiopia. Costs were estimated from a review of program expense records, invoices, and interviews with health workers. Programmatic outcomes include number of injections and couple-year of protection (CYP) provided. We performed a sensitivity analysis on the average number of injections provided per month by community health workers (CHWs), the cost of the commodity, and the number of CHWs trained.
  
  
  
  The average programmatic CYP was US $17.91 for all districts with a substantial range from US $15.48-38.09 per CYP across districts. Direct service cost was estimated at US $2.96 per CYP. The cost per CYP was slightly sensitive to the commodity cost of the injectable contraceptives and the number of CHWs. The capacity of each CHW, measured by the number of injections sold, was a key input that drove the cost per CYP of this model.
  
  
  
  With a direct service cost of US $2.96 per CYP, this study demonstrates the potential cost of community-based social marketing programs of injectable contraceptives. The findings suggest that the cost of social marketing of contraceptives in rural communities is comparable to other delivery mechanisms with regards to CYP, but further research is needed to determine the full impact and cost-effectiveness for women and communities beyond what is measured in CYP.
authors.affiliation: Bixby Center for Population, Health and Sustainability, University of California at Berkeley, School of Public Health, 50 University Hall, Berkeley, CA, 94720-6390, United States of America. Electronic address: ndola@berkeley.edu.
authors.forename: Ndola
authors.initials: N
authors.lastname: Prata
authors.affiliation: Bixby Center for Population, Health and Sustainability, University of California at Berkeley, School of Public Health, 50 University Hall, Berkeley, CA, 94720-6390, United States of America.
authors.forename: Janelle
authors.initials: J
authors.lastname: Downing
authors.affiliation: Bixby Center for Population, Health and Sustainability, University of California at Berkeley, School of Public Health, 50 University Hall, Berkeley, CA, 94720-6390, United States of America.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bell
authors.affiliation: Bixby Center for Population, Health and Sustainability, University of California at Berkeley, School of Public Health, 50 University Hall, Berkeley, CA, 94720-6390, United States of America.
authors.forename: Karen
authors.initials: K
authors.lastname: Weidert
authors.affiliation: Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia.
authors.forename: Hagos
authors.initials: H
authors.lastname: Godefay
authors.affiliation: Department of Gynecology and Obstetrics, Mekelle University College of Health Sciences, Mekelle, Ethiopia.
authors.forename: Amanuel
authors.initials: A
authors.lastname: Gessessew
mesh_terms: D000282:Administration, Intravaginal; D003150:Community Health Workers; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D005002:Ethiopia; D005193:Family Planning Services / Q000191:economics*; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000191:economics*; D012424:Rural Population; D040241:Social Marketing
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
keywords: Community-based distribution; Cost-analysis; Couple-year of protection; Ethiopia; Injectable contraceptives; Social marketing