Cost Analysis Series 4: Health Facility and School Distribution in Ghana, 2015-2016

The campaign distributed over 12.4 million long-lasting ITNs in all 10 regions. A replacement campaign was scheduled for 2014-2015 in 9 of the 10 regions, but a fire at the central medical stores (CMS) in January 2015 forced the National Malaria Control Program (NMCP) to adjust the distribution schedule and extend the rolling campaign into 2016. To mitigate the decline in ITN coverage, Ghana instituted several continuous distribution mechanisms following the 2012 mass distribution campaign. These included the free distribution of ITNs to pregnant women during their first antenatal care (ANC) visits, distribution of ITNs through the Expanded Programme on Immunization (EPI) at child welfare clinics (CWCs), and distribution of ITNs to specific classes of primary school children through schools. The school nets were initially distributed primarily in grades P2 and P6. The study analyzed cost data from both the provider perspective and the international donor perspective. The provider perspective included all costs associated with provision of the health care intervention, including government costs, health care workers, international donors, and philanthropic organizations. The international donor perspective included only costs paid for by international donors, such as VectorWorks, USAID | DELIVER, the U.S. President's Malaria Initiative (PMI), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). The study used a three-year time frame, although all financial costs were incurred in a two-year period (2015 and 2016). The types of costs included in the analysis were direct costs of the program to the provider, including the cost of commodities, health promotion, transportation, payment of salaries, and volunteer costs. The study also analyzed costs per person-year of protection and costs per treated-net year. The results of the study showed that the continuous distribution activities had successfully slowed the rate of decline in ITN coverage levels after the 2012 mass campaign. The study found that the costs of the continuous distribution activities were significant, with total costs paid by international donors amounting to $13.4 million. The cost per person-year of protection was $1.43, and the cost per treated-net year was $1.15. The study also conducted sensitivity analysis to test the robustness of the results. The findings indicated that the continuous distribution activities were cost-effective and contributed to maintaining ITN coverage levels in Ghana. The study concluded that the continuous distribution mechanisms were an effective way to maintain ITN coverage levels and prevent a rapid decline in coverage levels after the mass distribution campaign.