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. 2021 Feb 2;16(2):e0246207.
doi: 10.1371/journal.pone.0246207. eCollection 2021.

Economic evaluation of Health Extension Program packages in Ethiopia

Lelisa Fekadu Assebe  1   2   3 , Wondesen Nigatu Belete  1   2   3 , Senait Alemayehu  3   4 , Elias Asfaw  3   5 , Kora Tushune Godana  6 , Yibeltal Kiflie Alemayehu  3   6   7 , Alula M Teklu  3 , Amanuel Yigezu  3   4
Affiliations

Economic evaluation of Health Extension Program packages in Ethiopia

Lelisa Fekadu Assebe et al. PLoS One. .

Abstract

Background: Ethiopia launched the Health Extension Program (HEP) in 2004, aimed at ensuring equitable community-level healthcare services through Health Extension Workers. Despite the program's being a flagship initiative, there is limited evidence on whether investment in the program represents good value for money. This study assessed the cost and cost-effectiveness of HEP interventions to inform policy decisions for resource allocation and priority setting in Ethiopia.

Methods: Twenty-one health care interventions were selected under the hygiene and sanitation, family health services, and disease prevention and control sub-domains. The ingredient bottom-up and top-down costing method was employed. Cost and cost-effectiveness were assessed from the provider perspective. Health outcomes were measured using life years gained (LYG). Incremental cost per LYG in relation to the gross domestic product (GDP) per capita of Ethiopia (US$852.80) was used to ascertain the cost-effectiveness. All costs were collected in Ethiopian birr and converted to United States dollars (US$) using the average exchange rate for 2018 (US$1 = 27.67 birr). Both costs and health outcomes were discounted by 3%.

Result: The average unit cost of providing selected hygiene and sanitation, family health, and disease prevention and control services with the HEP was US$0.70, US$4.90, and US$7.40, respectively. The major cost driver was drugs and supplies, accounting for 53% and 68%, respectively, of the total cost. The average annual cost of delivering all the selected interventions was US$9,897. All interventions fall within 1 times GDP per capita per LYG, indicating that they are very cost-effective (ranges: US$22-$295 per LYG). Overall, the HEP is cost-effective by investing US$77.40 for every LYG.

Conclusion: The unit cost estimates of HEP interventions are crucial for priority-setting, resource mobilization, and program planning. This study found that the program is very cost-effective in delivering community health services.

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Conflict of interest statement

The authors declare that they have no competing interests. YKA and AMT are employees of MERQ Consultancy PLC. EA is an employee of EAZ Consultancy and Research Service. This does not alter our adherence to PLOS one policies on sharing data and materials.

Figures

Fig 1
Fig 1. Percentage distribution of family health services unit costs by ingredients.
Fig 2
Fig 2. Percentage distribution of DPC unit costs by ingredient.
Fig 3
Fig 3. Incremental cost-effectiveness ratio of selected HEP interventions in Ethiopia, 2018.
Fig 4
Fig 4. One-way sensitivity analysis showing cost-effectiveness ratio of TT injections over a range of key parameters.
Fig 5
Fig 5. One-way sensitivity analysis showing cost-effectiveness ratio of pneumonia treatment over a range of key parameters.
See this image and copyright information in PMC

References

    1. Assefa Y, Gelaw YA, Hill PS, Taye BW, Van Damme W. Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services. Globalization and Health. 2019;15(1):24 10.1186/s12992-019-0470-1 - DOI - PMC - PubMed
    1. Federal Democratic Republic of Ethiopia, Ministry of Health. Health Sector Transformation Plan II. 2020/21-2024/25. Addis Ababa. Ethiopia. 2020.
    1. Federal Democratic Republic of Ethiopia, Ministry of Health. Health and health related indicators 2009 EFY (2016/2017).
    1. Federal Democratic Republic of Ethiopia, Ministry of Health. Revised National Health Extension program implementation guideline. 2013. Addis Ababa, Ethiopia.
    1. Federal Democratic Republic of Ethiopia, Ministry of Health. Essential health Service Package for Ethiopia. Addis Ababa: Artistic printing Enterprise; 2005.

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