Cost Analysis Series 2: Continuous Distribution – Zanzibar

Following mass distribution of LLINs and expansion of IRS, Zanzibar has embarked on a three-pronged approach to continuous distribution of LLINs to maintain coverage between periodic mass campaigns. Across the archipelago, nets are distributed through three main channels: Antenatal Care (ANC), the expanded Programme for Immunization (EPI), and a community mechanism. The cost analysis was conducted to estimate both the economic and financial costs of net distribution through these three mechanisms from the provider perspective during the 2014-2015 Fiscal Year. Data on costs were collected retrospectively from financial and operational records and through stakeholder interviews at the national level. Additionally, survey instruments were used to collect resource use and expenditure information at the district and health facility and shehia levels. Four districts, 13 health facilities, and 8 shehia were included in a convenience sample for this data collection conducted alongside a process evaluation of the CD system. The economic cost per LLIN delivered was estimated to be USD 9.90 per LLIN, while the financial cost was USD 8.34 per LLIN. Financial cost to international donors to fully fund the procurement and distribution was estimated to be USD 4.37 per LLIN. The remainder of these costs were contributed financially or in-kind by the Zanzibari Government. The cost-effectiveness of long-lasting insecticidal nets in reducing morbidity and mortality is now well documented. The cost analysis followed existing guidelines for the cost evaluation of LLIN programs, as well as methodologies similar to previous studies in order to maximize comparability. A description of the intervention was developed based on direct observation, document reviews, and key informant interviews with stakeholders at the ZAMEP and partner organizations, and the results of a process evaluation conducted during FY 2016. Data collected on costs and outputs covered the time period between October 1, 2014, and September 30, 2015. The study uses the provider perspective and covers a three-year time frame, though all financial costs were incurred in a one-year period. As the costs were analyzed from the provider perspective, household-level costs were not included. All direct costs of the Zanzibar continuous distribution channels to the provider were included, including the cost of commodities, health promotion, transport, payment of salaries, and volunteer time.