PT  - JOURNAL ARTICLE
AU  - Cichon, Bernardette
AU  - López-Ejeda, Noemí
AU  - Mampindu, Magloire Bunkembo
AU  - Bagayoko, Aliou
AU  - Samake, Mahamadou
AU  - Cuellar, Pilar Charle
TI  - Integration of Acute Malnutrition Treatment Into Integrated Community Case Management in Three Districts in Southern Mali: An Economic Evaluation
AID  - 10.9745/GHSP-D-23-00431
DP  - 2024 Jun 27
TA  - Global Health: Science and Practice
PG  - e2300431
VI  - 12
IP  - 3
4099  - http://www.ghspjournal.org/content/12/3/e2300431.short
4100  - http://www.ghspjournal.org/content/12/3/e2300431.full
SO  - GLOB HEALTH SCI PRACT2024 Jun 27; 12
AB  - Key FindingsThis study analyzed the costs associated with 3 levels (basic, medium, and high) of support to and supervision of acute malnutrition treatment at community health worker (CHW) sites and community health centers. The medium and high level of supervision significantly increased total program costs and cost per child treated compared to the basic level of supervision.However, as cure rates were significantly higher in the districts with medium or high levels of supervision, differences in cost per child cured were small with overlapping uncertainty ranges.Results suggest that, despite the higher costs, additional supervision is needed to achieve better treatment outcomes and that additional supervision has the potential to be a cost-effective strategy if efficiencies are made in its delivery.Key ImplicationAcute malnutrition treatment access, coverage, and health outcomes could be improved if adequate training, supervision, and technical support are in place and the best and most efficient way to deliver the additional supervision is carefully considered and is context specific to ensure cost-effectiveness and sustainability.Background:Enabling community health workers (CHWs) to treat acute malnutrition improves treatment access and coverage. However, data on the cost and cost-effectiveness of this approach is limited. We aimed to cost the treatment at scale and determine the cost-effectiveness of different levels of supervision and technical support.Methods:This economic evaluation was part of a prospective nonrandomized community intervention study in 3 districts in Mali examining the impact of different levels of CHW and health center supervision and support on treatment outcomes for children with severe acute malnutrition. Treatment admission and outcome data were extracted from the records of 120 participating health centers and 169 CHW sites. Cost data were collected from accountancy records and through key informant interviews. Results were presented as cost per child treated and cured. Modeled scenario sensitivity analyses were conducted to determine how cost-efficiency and cost-effectiveness estimates change in an equal scale scenario and/or if the supervision had been done by government staff.Results:In the observed scenario, with an unequal number of children, the average cost per child treated was US$203.40 in Bafoulabé where a basic level of supervision and support was provided, US$279.90 in Kayes with a medium level of supervision, and US$253.9 in Kita with the highest level of supervision. Costs per child cured were US$303.90 in Bafoulabé, US$324.90 in Kayes, and US$311.80 in Kita, with overlapping uncertainty ranges.Conclusion:Additional supervision has the potential to be a cost-effective strategy if supervision costs are reduced without compromising the quality of supervision. Further research should aim to better adapt the supervision model and associated tools to the context and investigate where efficiencies can be made in its delivery.