Cost and cost-effectiveness analysis of a community mobilisation intervention to reduce intimate partner violence in Kampala, Uganda

Christine Michaels-Igbokwe, Tanya Abramsky, Karen Devries, Lori Michau, Tina Musuya, Charlotte Watts, Christine Michaels-Igbokwe, Tanya Abramsky, Karen Devries, Lori Michau, Tina Musuya, Charlotte Watts

Abstract

Background: Intimate partner violence (IPV) poses a major public health concern. To date there are few rigorous economic evaluations of interventions aimed at preventing IPV in low-income settings. This study provides a cost and cost effectiveness analysis of SASA!, a community mobilisation intervention to change social norms and prevent IPV.

Methods: An economic evaluation alongside a cluster randomised controlled trial. Both financial and economic costs were collected retrospectively from the provider's perspective to generate total and unit cost estimates over four years of intervention programming. Univariate sensitivity analysis is conducted to estimate the impact of uncertainty in cost and outcome measures on results.

Results: The total cost of developing the SASA! Activist Kit is estimated as US$138,598. Total intervention costs over four years are estimated as US$553,252. The annual cost of supporting 351 activists to conduct SASA! activities was approximately US$389 per activist and the average cost per person reached in intervention communities was US$21 over the full course of the intervention, or US$5 annually. The primary trial outcome was past year experience of physical IPV with an estimated 1201 cases averted (90% CI: 97-2307 cases averted). The estimated cost per case of past year IPV averted was US$460.

Conclusion: This study provides the first economic evaluation of a community mobilisation intervention aimed at preventing IPV. SASA! unit costs compare favourably with gender transformative interventions and support services for survivors of IPV.

Trial registration: ClinicalTrials.gov # NCT00790959.

Figures

Fig. 1
Fig. 1
Tornado diagram showing sensitivity of cost per case of past year physical intimate partner violence averted to key assumptions

References

    1. Devries K, Mak J, Garcia-Moreno C, Petzold M, Child J, Falder G, Lim S, Bacchus L, Engell R, Rosenfeld L. The global prevalence of intimate partner violence against women. Science. 2013;340(6140):1527–8.
    1. Uganda Bureau of Statistics (UBOS) and ICF International Inc: Uganda Demographic and Health Survey 2011. In. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc.; 2012
    1. Devries K, Watts C, Yoshihama M, Kiss L, Schraiber LB, Deyessa N, Heise L, Durand J, Mbwambo J, Jansen H. Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women’s health and domestic violence against women. Soc Sci Med. 2011;73(1):79–86.
    1. Ellsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C. Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study. Lancet. 2008;371(9619):1165–72. doi: 10.1016/S0140-6736(08)60522-X.
    1. McCollister KE, French MT, Fang H. The cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug Alcohol Depend. 2010;108(1):98–109. doi: 10.1016/j.drugalcdep.2009.12.002.
    1. Fearson J, Hoeffler A. Copenhagen Consensus Centre. 2014. Conflict and Violence Assessment Paper: Benefits and Costs and of the Conflict and Violence Targets for the Post-2015 Development Agenda.
    1. Remme M, Siapka M, Vassall A, Heise L, Jacobi J, Ahumada C, Gay J, Watts Cl. The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review. J Int AIDS Soc. 2014;17:19228.
    1. Michau L. The SASA! Activist Kit for Preventing Violence against Women and HIV. Kampala: Raising Voices; 2008.
    1. Abramsky T, Devries K, Kiss L, Francisco L, Nakuti J, Musuya T, Kyegombe N, Starmann E, Kaye D, Michau L. A community mobilisation intervention to prevent violence against women and reduce HIV/AIDS risk in Kampala, Uganda (the SASA! Study): study protocol for a cluster randomised controlled trial. Trials. 2012;13(1):96–6.
    1. Francisco L, Abramsky T, Kiss L, Michau L, Musuya T, Kerrigan D, Kaye D, Watts C. Violence Against Women and HIV Risk Behaviors in Kampala, Uganda: Baseline Findings from the SASA! Study. Violence Against Women. 2013;19:814.
    1. Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, Kaye D, Michau L. Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Med. 2014;12(1):122.
    1. OANDA. Historical Exchange Rates, 2013. []. Accessed 24 June 2013.
    1. World Bank. World Development Indicators, United States. . Accessed 11 November 2014.
    1. Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. New York: Oxford University Press; 2005.
    1. Wong FK, Chau J, So C, Tam SK, McGhee S. Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients. BMC Health Serv Res. 2012;12:479. doi: 10.1186/1472-6963-12-479.
    1. Borghi J, Thapa B, Osrin D, Jan S, Morrison J, Tamang S, Shrestha BP, Wade A, Manandhar DS, Costello AM. Economic assessment of a women’s group intervention to improve birth outcomes in rural Nepal. Lancet. 2005;366(9500):1882–4.
    1. Conteh L, Patouillard E, Kweku M, Legood R, Greenwood B, Chandramohan D. Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine & artesunate or sulphadoxine-pyrimethamine in Ghanaian children. PLoS ONE. 2010;5(8):e12223. doi: 10.1371/journal.pone.0012223.
    1. Datiko DG, Lindtjorn B. Cost and cost-effectiveness of smear-positive tuberculosis treatment by Health Extension Workers in Southern Ethiopia: a community randomized trial. PLoS ONE. 2010;5(2):e9158. doi: 10.1371/journal.pone.0009158.
    1. Jan S, Ferrari G, Watts CH, Hargreaves JR, Kim JC, Phetla G, Morison LA, Porter JD, Barnett T, Pronyk PM. Economic evaluation of a combined microfinance and gender training intervention for the prevention of intimate partner violence in rural South Africa. Health Policy Plan. 2011;26(5):366–72.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever