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Comparative Study
. 2024 May 15;23(1):147.
doi: 10.1186/s12936-024-04962-7.

Cost-effectiveness of village health worker-led integrated community case management (iCCM) versus health facility based management for childhood illnesses in rural southwestern Uganda

Edgar Mulogo  1 , Moses Ntaro  2 , Andrew Wesuta  3 , Jane Namusisi  4 , Peter Kawungezi  2 , Vincent Batwala  2   5 , Michael Matte  3
Affiliations
Comparative Study

Cost-effectiveness of village health worker-led integrated community case management (iCCM) versus health facility based management for childhood illnesses in rural southwestern Uganda

Edgar Mulogo et al. Malar J. .

Abstract

Background: In Uganda, village health workers (VHWs) manage childhood illness under the integrated community case management (iCCM) strategy. Care is provided for malaria, pneumonia, and diarrhoea in a community setting. Currently, there is limited evidence on the cost-effectiveness of iCCM in comparison to health facility-based management for childhood illnesses. This study examined the cost-effectiveness of the management of childhood illness using the VHW-led iCCM against health facility-based services in rural south-western Uganda.

Methods: Data on the costs and effectiveness of VHW-led iCCM versus health facility-based services for the management of childhood illness was collected in one sub-county in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of under-five children appropriately treated. The Incremental Cost-Effectiveness Ratio (ICER) was calculated from the provider perspective.

Results: Based on the decision model for this study, the cost for 100 children treated was US$628.27 under the VHW led iCCM and US$87.19 for the health facility based services, while the effectiveness was 77 and 71 children treated for VHW led iCCM and health facility-based services, respectively. An ICER of US$6.67 per under five-year child treated appropriately for malaria, pneumonia and diarrhoea was derived for the provider perspective.

Conclusion: The health facility based services are less costly when compared to the VHW led iCCM per child treated appropriately. The VHW led iCCM was however more effective with regard to the number of children treated appropriately for malaria, pneumonia and diarrhoea. Considering the public health expenditure per capita for Uganda as the willingness to pay threshold, VHW led iCCM is a cost-effective strategy. VHW led iCCM should, therefore, be enhanced and sustained as an option to complement the health facility-based services for treatment of childhood illness in rural contexts.

Keywords: Cases treated; Cost effectiveness; Facility based services; Integrated community case management; Uganda; Village health workers.

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Conflict of interest statement

The authors declare that there are no competing interests.

Figures

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Fig. 1
Decision analysis model
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References

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    1. WHO/United Nations Children’s Fund . Institutionalizing integrated community case management (iCCM) to end preventable child deaths. Geneva: World Health Organization; 2019.

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