Cost and Effective Analysis of the LINKAGES ... - Linkages Project

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4.7. Comparability and Applicability of this StudyThere have been few studies of the cost effectiveness of breastfeeding and LAM interventions indeveloping countries, and no studies of programs that are similar to LINKAGES’ model ofintegrating LAM into the Ministry of Health (MOH) family planning service delivery system throughcapacity building of the local health professionals. It is therefore difficult to provide results that aredirectly comparable with other studies. This study does not address the question of whetherLINKAGES’ interventions are more or less cost effective than others. However, the methodologydeveloped can be used to analyze other breastfeeding, child survival and reproductive healthinterventions and is applicable across LINKAGES’ program countries.4.8. Limitations of the StudyAs discussed earlier, the measures of cost effectiveness are based solely on a comparison of theresults of the baseline and outcome data. These measures are accurate to the extent that the ratesestimated through data collection by the MOH Logistics Project represent behaviors in LINKAGES’target areas. While LINKAGES has provided technical assistance and to the extent possiblemonitored data collection, we rely on the Logistics Project for accurate data collection.The LAM user rate underestimates the uptake of LAM by eligible women – women with infants lessthan 6 months. The Logistics system includes all women of reproductive age, and thus LAM usecannot be calculated for this specific group of eligible women. The LAM user rate refers to theproportion of all women of reproductive age who use LAM within this catchment population.The exclusive breastfeeding rate was not measured within the project catchment areas and thereforecannot be included as an outcome measure. This study therefore does not reflect the cost effectivenessof the entire intervention, but LAM promotion activities only. Breastfeeding activities comprise 67%of total program costs and LAM activities comprise 33% of total program costs. It is likely that thissplit is reflective of project’s early years as well, because project activities focused on breastfeedingas an “entry point” for LAM.The study is limited to one LAM indicator – LAM User Rate. Data to complete analysis by the otherLAM indicator - Couple of Years of Protection (CYP) for LAM, were not sufficient. CYP is theestimated protection provided by family planning services during a one-year period and yields anestimate of the duration of contraceptive protection provided per unit of the method, in this case,LAM. To calculate CYP for LAM, data on CYP for each method of family planning included in theLogistics Project reports for December’01 and December’02 are required but not available.LINKAGES’ intervention is targeted to women served by the MCH for antenatal and postpartumservices. The data do not include women who use other family planning services. While these datareflect actual behavior, the outcomes of the LINKAGES/Jordan program may not be representative ofoutcomes if all women used MCH services for family planning services.Because the cost effectiveness analysis is conducted over a limited time period, the results may not berepresentative of cost effectiveness over a longer time period. Interventions may become moreefficient (increasing cost effectiveness) or it may be increasingly difficult to sustain high rates of thetargeted behaviors (reducing cost effectiveness).12 4. Methodology LINKAGES Project/AED
Lastly, this study is not able to distinguish LAM that satisfies unmet demand for family planningfrom LAM that substitute for other family planning methods or LAM that provides a transition toother family planning methods. In each case the impact on fertility would be different.LINKAGES Project/AED 4. Methodology 13
Page 1 and 2: Cost and Effective Analysisof the L
Page 5 and 6: AbstractThis study analyzes cost ef
Page 7 and 8: ContentsExecutive Summary .........
Page 9 and 10: Executive SummaryIntroductionThe La
Page 11 and 12: activities conducted in support of
Page 13 and 14: activities will allow spreading tho
Page 15 and 16: 1. Background to the StudyIn an eff
Page 17 and 18: 3. Description of LINKAGES and Part
Page 19: of MCH services are mostly women of
Page 22 and 23: the administrative and overhead str
Page 24 and 25: activities were implemented. This i
Page 29 and 30: 5. Financial Data Collection5.1. LI
Page 31 and 32: 6. FindingsThe findings presented a
Page 33 and 34: Table 6: Relationship Between Costs
Page 35 and 36: 6.2.3. Cost Effectiveness and Targe
Page 37 and 38: Table 11 shows the classification o
Page 39 and 40: some portion of the costs are fixed
Page 41 and 42: 7. Discussion and Conclusions7.1. R
Page 43 and 44: Annex A: List of All LINKAGES Activ
Page 45 and 46: LINKAGES' LAM Activity Costs by Ele
Page 47 and 48: Detailed MOH/MCH' LAM Activity Cost
Page 49 and 50: Percentage of Each Activity Allocat
Page 51 and 52: III. LAM Indicator Data by RegionLA
Page 53 and 54: LAM User Rate Calculations - CENTER
Page 55 and 56: 36. Al-Muwaqar37. Al-Faisaliya (Eas
Page 57 and 58: 118. Southern Al-Twa’l (Al-Dayat)
Page 59 and 60: 196. Jiffien197. Izma’lBani Kinan
Page 61 and 62: Kayak Health Directorate276. Al-Rab
Page 63: LINKAGES Project/AEDAnnex B: Detail

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