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Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.

Mulligan JA, Yukich J, Hanson K - Malar. J. (2008)

Bottom Line: The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established.The cost-effectiveness results are within the benchmarks set by other malaria prevention studies.The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Economics and Financing Programme, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. jo.mulligan@lshtm.ac.uk

ABSTRACT

Background: The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established. International focus has now moved on to how best to scale up coverage and what financing mechanisms might be used to achieve this. The approach in Tanzania has been to deliver a targeted subsidy for those most vulnerable to the effects of malaria while at the same time providing support to the development of the commercial ITN distribution system. In October 2004, with funds from the Global Fund to Fight AIDS Tuberculosis and Malaria, the government launched the Tanzania National Voucher Scheme (TNVS), a nationwide discounted voucher scheme for ITNs for pregnant women and their infants. This paper analyses the costs and effects of the scheme and compares it with other approaches to distribution.

Methods: Economic costs were estimated using the ingredients approach whereby all resources required in the delivery of the intervention (including the user contribution) are quantified and valued. Effects were measured in terms of number of vouchers used (and therefore nets delivered) and treated nets years. Estimates were also made for the cost per malaria case and death averted.

Results and conclusion: The total financial cost of the programme represents around 5% of the Ministry of Health's total budget. The average economic cost of delivering an ITN using the voucher scheme, including the user contribution, was $7.57. The cost-effectiveness results are within the benchmarks set by other malaria prevention studies. The Government of Tanzania's approach to scaling up ITNs uses both the public and private sectors in order to achieve and sustain the level of coverage required to meet the Abuja targets. The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.

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Breakdown of provider financial costs.
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Figure 2: Breakdown of provider financial costs.

Mentions: Over the first two years (2004–2006), the total provider financial costs of the TNVS programme were $10,680,516 (Table 4). Figure 2 provides a graphical breakdown of provider costs with staff costs making up the biggest component, followed by promotion activities and the costs of the ITNs themselves. Including the user contribution takes the total to $11,837,838. Economic costs include the user top up plus donated inputs in the form of ANC clinic time and user travel time. Capital costs are also annualized to reflect the annual equivalent value in use. The economic costs of the programme are $10,599,367 (see Table 5).


Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets.

Mulligan JA, Yukich J, Hanson K - Malar. J. (2008)

Breakdown of provider financial costs.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2279140&req=5

Figure 2: Breakdown of provider financial costs.
Mentions: Over the first two years (2004–2006), the total provider financial costs of the TNVS programme were $10,680,516 (Table 4). Figure 2 provides a graphical breakdown of provider costs with staff costs making up the biggest component, followed by promotion activities and the costs of the ITNs themselves. Including the user contribution takes the total to $11,837,838. Economic costs include the user top up plus donated inputs in the form of ANC clinic time and user travel time. Capital costs are also annualized to reflect the annual equivalent value in use. The economic costs of the programme are $10,599,367 (see Table 5).

Bottom Line: The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established.The cost-effectiveness results are within the benchmarks set by other malaria prevention studies.The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Economics and Financing Programme, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. jo.mulligan@lshtm.ac.uk

ABSTRACT

Background: The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established. International focus has now moved on to how best to scale up coverage and what financing mechanisms might be used to achieve this. The approach in Tanzania has been to deliver a targeted subsidy for those most vulnerable to the effects of malaria while at the same time providing support to the development of the commercial ITN distribution system. In October 2004, with funds from the Global Fund to Fight AIDS Tuberculosis and Malaria, the government launched the Tanzania National Voucher Scheme (TNVS), a nationwide discounted voucher scheme for ITNs for pregnant women and their infants. This paper analyses the costs and effects of the scheme and compares it with other approaches to distribution.

Methods: Economic costs were estimated using the ingredients approach whereby all resources required in the delivery of the intervention (including the user contribution) are quantified and valued. Effects were measured in terms of number of vouchers used (and therefore nets delivered) and treated nets years. Estimates were also made for the cost per malaria case and death averted.

Results and conclusion: The total financial cost of the programme represents around 5% of the Ministry of Health's total budget. The average economic cost of delivering an ITN using the voucher scheme, including the user contribution, was $7.57. The cost-effectiveness results are within the benchmarks set by other malaria prevention studies. The Government of Tanzania's approach to scaling up ITNs uses both the public and private sectors in order to achieve and sustain the level of coverage required to meet the Abuja targets. The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.

Show MeSH
Related in: MedlinePlus