Improving maternal and newborn care: cost-effectiveness of an innovation to rebrand traditional birth attendants in Sierra Leone.

OBJECTIVES: This paper evaluates the cost-effectiveness of rebranding former traditional birth attendants (TBAs) to conduct health promotion activities and refer women to health facilities. METHODS: The project used 200 former TBAs, 100 of whom were also enrolled in a small income generating business. The evaluation had a three-arm, quasiexperimental design with baseline and endline household surveys. The three arms were: (a) Health promotion (HP) only; (b) Health promotion plus business (HP+); and (c) the comparison group. The Lives Saved Tool is used to estimate the number of lives saved. RESULTS: The HP+ intervention had a statistically significant impact on health facility delivery and four or more antenatal care (ANC) visits during pregnancy. The cost-effectiveness ratio was estimated at US$4130 per life year saved in the HP only arm, and US$1539 in the HP+ arm. Therefore, only the HP+ intervention is considered to be cost-effective. CONCLUSIONS: It is critical to prioritize cost-effective interventions such as, in the case of rural Sierra Leone, community-based strategies involving rebranding TBAs as health promoters and enrolling them in health-related income generating activities.

The cost-effectiveness of health communication programs: what do we know?

While a considerable body of evidence has emerged supporting the effectiveness of communication programs in augmenting health, only a very small subset of studies has examined also whether these programs are cost-effective, that is, whether they achieve greater health gains for available financial resources than alternative interventions. In this article, we examine the available literature on the cost-effectiveness of health behavior change communication programs, focusing on communication interventions involving mass media, and, to a lesser extent, community mobilization and interpersonal communication or counseling. Our objective is to identify the state of past and current research efforts of the cost-effectiveness of behavior change communication programs. This review makes three principal conclusions. First, the analysis of the cost-effectiveness of health communication programs commonly has not been performed. Second, the studies reviewed here have utilized a considerable diversity of methods and have reflected varying levels of quality and adherence to standard cost-effectiveness methodologies. This leads to problems of transparency, comparability, and generalizability. Third, while the available studies generally are indicative of the cost-effectiveness of communication interventions relative to alternatives, the evidence base clearly needs to be expanded by additional rigorous cost-effectiveness analyses.

Measuring the cost-effectiveness of a national health communication program in rural Bangladesh.

In this article we examine the cost-effectiveness of the Smiling Sun multichannel media campaign, which was undertaken in Bangladesh from 2001 to 2003 and involved a nationally broadcast television serial drama supported by radio, television, newspaper, and billboard advertisements and local promotion activities. The goal was to encourage the use of a package of family health services at NGO (nongovernmental organization) Service Delivery Program (NSDP) providers. This analysis relates the costs of the Smiling Sun campaign at the national and local level to measures of change in the use of health services, namely, antenatal care and childhood immunizations. Effectiveness is measured using data from cross-sectional surveys conducted in 2001 and 2003 in NSDP catchment areas in rural Bangladesh. The statistical approach, bivariate probit estimation, controls for nonrandom exposure to the program's media messages, advertisements, and signs. Using national-level data, we find that the Smiling Sun campaign was both effective and cost-effective, inducing higher levels of service utilization for only $0.05 per additional antenatal care (ANC) user and only $0.30 and $0.36 for each additional child vaccinated for measles and DPT3, respectively. With respect to local promotion activities, the cost per attributable behavior change was considerably higher--nearly $8 per new ANC user, $37 per new DPT3 vaccination, and $32 per new measles vaccination.