Costs of promoting exclusive breastfeeding at community level in three sites in South Africa

Lungiswa Leonora Nkonki, Emmanuelle Daviaud, Debra Jackson, Lumbwe Chola, Tanya Doherty, Mickey Chopra, Bjarne Robberstad, Promise-EBF Study Group, Thorkild Tylleskär, Philippe Van de Perre, Eva-Charlotte Ekström, Nicolas Meda, James K Tumwine, Chipepo Kankasa, Debra Jackson, Thorkild Tylleskär, Ingunn M S Engebretsen, Lars Thore Fadnes, Eli Fjeld, Knut Fylkesnes, Jørn Klungsøyr, Anne Nordrehaug-Åstrøm, Øystein Evjen Olsen, Bjarne Robberstad, Halvor Sommerfelt, Philippe Van de Perre, Eva-Charlotte Ekström, Burkina Faso, Nicolas Meda, Hama Diallo, Thomas Ouedrago, Jeremi Rouamba, Bernadette Traoré Germain Traoré, Emmanuel Zabsonré, James K Tumwine, Caleb Bwengye, Charles Karamagi, Victoria Nankabirwa, Jolly Nankunda, Grace Ndeezi, Margaret Wandera, Chipepo Kankasa, Mary Katepa-Bwalya, Chafye Siuluta, Seter Siziya, Lumbwe Chola, Debra Jackson, Mickey Chopra, Mark Colvin, Karin Daniels, Tanya Doherty, Ameena E Googa, Lyness Matizirofa, Lungiswa Nkonki, David Sanders, Wanga Zembe, Lungiswa Leonora Nkonki, Emmanuelle Daviaud, Debra Jackson, Lumbwe Chola, Tanya Doherty, Mickey Chopra, Bjarne Robberstad, Promise-EBF Study Group, Thorkild Tylleskär, Philippe Van de Perre, Eva-Charlotte Ekström, Nicolas Meda, James K Tumwine, Chipepo Kankasa, Debra Jackson, Thorkild Tylleskär, Ingunn M S Engebretsen, Lars Thore Fadnes, Eli Fjeld, Knut Fylkesnes, Jørn Klungsøyr, Anne Nordrehaug-Åstrøm, Øystein Evjen Olsen, Bjarne Robberstad, Halvor Sommerfelt, Philippe Van de Perre, Eva-Charlotte Ekström, Burkina Faso, Nicolas Meda, Hama Diallo, Thomas Ouedrago, Jeremi Rouamba, Bernadette Traoré Germain Traoré, Emmanuel Zabsonré, James K Tumwine, Caleb Bwengye, Charles Karamagi, Victoria Nankabirwa, Jolly Nankunda, Grace Ndeezi, Margaret Wandera, Chipepo Kankasa, Mary Katepa-Bwalya, Chafye Siuluta, Seter Siziya, Lumbwe Chola, Debra Jackson, Mickey Chopra, Mark Colvin, Karin Daniels, Tanya Doherty, Ameena E Googa, Lyness Matizirofa, Lungiswa Nkonki, David Sanders, Wanga Zembe

Abstract

Background: Community-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of settings.

Methods: We conducted a cost analysis of a community cluster randomised-controlled trial (Promise-EBF), aimed at promoting exclusive infant feeding in three sites in South Africa. The costs were considered from the perspective of health service providers. Peer supporters in this trial visited women to support exclusive infant feeding, once antenatally and four times postpartum.

Results: The total economic cost of the Promise-EBF intervention was US$393 656, with average costs per woman and per visit of US$228 and US$52, respectively. The average costs per woman and visit in an operational 'non research' scenario were US$137 and US$32 per woman and visit, respectively. Investing in the promotion of exclusive infant feeding requires substantial financial commitment from policy makers. Extending the tasks of multi-skilled community health workers (CHWs) to include promoting exclusive infant feeding is a potential option for reducing these costs. In order to avoid efficiency losses, we recommend that the time requirements for delivering the promotion of exclusive infant feeding are considered when integrating it within the existing activities of CHWs.

Discussion: This paper focuses on interventions for exclusive infant feeding, but its findings more generally illustrate the importance of documenting and quantifying factors that affect the feasibility and sustainability of community-based interventions, which are receiving increased focus in low income settings.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Black RE, Morris SS, Bryce J (2003) Where and why are 10 million children dying every year? The Lancet 361: 2226–2234.
    1. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS (2003) How many child deaths can we prevent this year? The Lancet 362: 65–71.
    1. WHO/UNICEF/UNAIDS (2000) HIV and Infant feeding counselling:a training course. Trainers' guide.
    1. Bland R, Little K, Coovadia H, Coutsoudis A, Rollins N, et al. (2008) Intervention to promote exclusive breast-feeding for the first 6 months of life in a high HIV prevalence area. AIDS 22: 883–891.
    1. Tylleskär T, Jackson D, Meda N, Engebretsen IMS, Chopra M, et al. (2011) Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. The Lancet 378: 420–427.
    1. Desmond C, Bland RM, Boyce G, Coovadia HM, Coutsoudis A, et al. (2008) Scaling-Up Exclusive Breastfeeding Support Programmes: The Example of KwaZulu-Natal. PLoS ONE 3: e2454.
    1. Schneider H, Hlophe H, van Rensburg D (2008) Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects. Health Policy and Planning 23: 179–187.
    1. Bhutta ZA, Lassi ZS, Pariyo G, Huicho L (2010) Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Scaling Up. Global health workforce alliance: Health workers for all and all for health workers.
    1. Walker D, Jan S (2005) HOW DO WE DETERMINE WHETHER COMMUNITY HEALTH WORKERS ARE COST-EFFECTIVE? SOME CORE METHODOLOGICAL ISSUES. Journal of Community Health 30: 221–229.
    1. Corluka A, Walker D, Lewin S, Glenton C, Scheel I (2009) Are vaccination programmes delivered by lay health workers cost-effective? A systematic review. Human Resources for Health 7: 81.
    1. Chola L, Nkonki L, Kankasa C, Nankunda J, Tumwine J, et al. (2011) Cost of individual peer counselling for the promotion of exclusive breastfeeding in Uganda. Cost Effectiveness and Resource Allocation 9: 11.
    1. Doherty T (2006) HIV and Infant Feeding: Operational Challenges of Achieving Safe Infant Feeding Practices. Sweden: Uppsala University.
    1. Antenatal Survey 2009 (2010) National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa. Pretoria: National Department of Health.
    1. Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL, editors(2005) Methods for the economic evaluation of health care programmes – 3rd edition. . 3rd ed: Oxford University Press.
    1. World Health Organization (2006) Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organisation.
    1. UNAIDS (2000) Costing Guildlines for HIV Prevention Strategies. Geneva: Joint United Nations Programme on HIV/AIDS UNAIDS.
    1. Jan S, Proynk P, Kim J (2008) Accounting for institutional change in health economic evaluation: a programme to tackle HIV/AIDS and gender violence in Southern Africa. Social Science and Medicine 66: 922–932.
    1. Creese A, Parker D (1994) Costing analysis in primary health care: a training manual for programme managers. Geneva: World Health Organisation
    1. Cleary S, McIntyre D, Boulle A (2006) The cost-effectiveness of antiretroviral treatment in Khayelitsha, South Africa—A primary data analysis. Cost Eff Resour Alloc 4: 20.
    1. Adam T, Manzi F, Kakundwa C, Schellenberg J, Mgalula L, et al... (2004) Childhood Illness (IMCI): Analysis Report on the Costs of IMCI in Tanzania. Daresalaam: World Health Organisation.
    1. World Health Organisation (2003) World Health Organisation: Guide to cost-effectiveness analysis.Geneva: World Health Organisation.
    1. Statistics South Africa (2008) Historical CPIX key indicators.
    1. Federal Reserve Statistical Release (2007) Federal Reserve Statistical Release: Foreign Exchange Rates (Annual).
    1. Friedman I, Ramalepe M, Matjuis F, Bhengu LL, Lloyd B, et al. (2007) Morning Towards Best Practice: Documenting and Learning from Existing Community Health/Care Worker Programmes. Durban Health Systems Trust
    1. Daviaud E (2007) Remuneration and integration of community based workers involved in HIV/TB work. Health Systems and Antiretroviral access. University of the Free state, Bloemfontein
    1. Expanded Public Works Programme (2005) Expanded Public Works Programme. Forth quartely report the period 1 April 2005 to 31 March 2006.
    1. Health Systems Trust (2007) Available: .
    1. Makan B, Bachman M (1997) AN ECONOMIC ANALYSIS OF COMMUNITY HEALTHWOKERS. PROGRAMMES IN THE WESTRN CAPE PROVINCE. Durban Health Systems Trust
    1. Nkonki L, Daniels K (2010) PROMISE-EBF study group (2010) Selling a service: experiences of peer supporters while promoting exclusive infant feeding in three sites in South Africa. International Breastfeeding Journal 5: 17.
    1. Fiedler JL, Chuko T (2008) The cost of Child Health Days: a case study of Ethiopia's Enhanced Outreach Strategy (EOS). Health Policy Plan 23: 222–233.
    1. Tenerio A, Saunero R, Sinani J, Lafuente L, Gutierrez F (2009) Extending the Duration of Exclusive Breastfeeding in El Alto, Bolvia through a Community-based Approach and the Provision of Health Services.
    1. Bland RM, Little KE, Coovadia HM, Coutsoudis A, Rollins NC, et al. (2008) Intervention to promote exclusive breast-feeding for the first 6 months of life in a high HIV prevalence area. AIDS 22: 883–891.
    1. Lewin SA, Dick J, Pond P, Zwarenstein M, Aja G, et al. (2005) Lay health workers in primary and community health care. Cochrane Database Syst Rev CD004015.
    1. Bhattacharyya K, Winch P, LeBan K, Tien M (2001) Community Health Worker Incentives and Disincentives: How They Affect Motivation, Retention, and Sustainability. Virgian Basics II
    1. Nor B, Zembe Y, Daniels K, Doherty T, Jackson D, et al. (2009) “Peer but Not Peer”: Considering the Context of Infant Feeding Peer Counseling in a High HIV Prevalence Area. J Hum Lact 25: 427–434.
    1. Daniels K, Nor B, Jackson D, Ekström E-C, Doherty T (2010) Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study. BioMed Central Ltd
    1. Chola L, Robberstad B (2009) Estimating average inpatient and outpatient costs and childhood pneumonia and diarrhoea treatment costs in an urban health centre in Zambia. Cost Effectiveness and Resource Allocation 7: 16.

Source: PubMed

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