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

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The implementation costs for the complete package of LINKAGES’ activities aimed at improvingboth breastfeeding and LAM indicators is $206,420, out of which $54,552 to the subset of LAMpromotion activities and the $151,868 are associated with breastfeeding interventions.It should be made clear that this section examines only the cost of replicating activities in Jordan.Difference in local costs should be taken into consideration in order to estimate replication costs inother countries, even in ones with similar programs. Further, costs in this study are expressed innominal terms, i.e. actual expenses at the time of the study period. Costs will need to be adjusted toreflect inflation if replicated.It is worth mentioning that substantial part of the costs during the study period was incurred forcapacity building of the MCH staff. Later in the life of such projects when most of the staff is trainedcosts will be decreased since staff will be available to provide the services, without the cost of thetraining. This is an important factor for MCH in estimating costs of further expansion of LAMservices in Jordan. If replicated, costs will need to be adjusted to reflect diminished need for trainingdepending on the local staff capacity.6.3.2. Cost Effectiveness of ReplicationIn addition to examining the cost of replicating these activities, it is also useful to examine the costeffectiveness of replicating these activities. As described in the previous section, the cost ofreplicating these activities is limited to implementation costs only. Thus to measure costeffectiveness of replication, total implementation costs are compared with the number of newacceptors of the targeted behavior, e.g. LAM User Rate - to calculate the implementation cost per newacceptor.Table 13 presents the cost effectiveness of replicating activities to promote the use of LAM. The costper new LAM acceptor, if LAM interventions were replicated, is estimated to be $29.83. There is asignificant regional variation in cost effectiveness. The cost per new LAM acceptor is the highest inthe South ($69.38) as compared with the Center ($36.11) and the North ($18.60).Table 13: Cost Effectiveness of Promoting LAM, LINKAGES and Partner Implementation CostsNorth Center South TotalLINKAGES and Partner Costs (US$) $22,308 $32,358 $13,737 $68,403Target Population/Total Beneficiaries 17,693 20,065 6,042 43,800Percent Difference between Baseline andOutcome Rate6.78% 4.47% 3.28% 5.07%Est. Number of New LAM Acceptors 1,199 896 198 2,293Cost per New LAM Acceptor (US$) $18.6 $36.11 $69.38 $29.83It should be noted that there are likely economies of scale to the integrated package of activitiesconducted by LINKAGES and its partners, such that the cost of targeting individual behaviors inisolation is likely higher. That is, if LINKAGES were to implement a program aimed at only LAMbehavior change, the cost per new acceptor would likely be higher than what is shown here because24 6. Findings LINKAGES Project/AED
some portion of the costs are fixed (for example, office space for administration), and would not bereduced if only one behavior were targeted.6.4. How Can LINKAGES Improve its Cost Effectiveness?Overall Finding: Activity costs, baseline and outcome behavior rates, and size oftarget population are three factors that influence cost effectiveness. LINKAGES maybe able to improve its cost effectiveness by mainstreaming LAM interventions intocomprehensive MCH reproductive health programs. Spreading costs of a singleintervention through implementing integrated package of MCH activities lower costand leads to higher cost effectiveness.Due to insufficient data, recommendations on the impact of target population arelimited. Nevertheless, there appears to be an optimal size of population thatintervention activities should target. Determining an optimal population level atwhich economies of scale are realized and a different package of activities aimed atincreasing outcome behavior change in the current size of population is neededwould be a key task to improve cost effectiveness of future interventions. Furtheranalysis is needed to make concrete recommendations.More data and further analysis of the impact of the mix of activities is needed tobetter inform cost effective program design.Table 17 shows the target populations, together with baseline and outcome behavior rates and thecost per new acceptor.Table 17: Cost Effectiveness of Promoting LAM, LINKAGES and Partner Total CostsNorth Center South TotalLINKAGES and Partner Costs (US$) $33,755 $43,909 $19,323 $96,988Target Population/Total Beneficiaries 17,693 20,065 6,042 43,800Percent Difference between Baseline andOutcome Rate6.78% 4.47% 3.28% 5.07%Est. Number of New LAM Acceptors 1,199 896 198 2,293Cost per New LAM Acceptor (US$) $28 $49 $98 $42Overall, low costs in the North together with this high increase in the LAM behavior changeoutcomes result in the lowest cost per new acceptor and therefore the highest cost effectiveness. Forthe North and Center, where the size of the target population is relatively similar, the behavior rateschange is the major factors that determined cost effectiveness. These same factors help explain whythe South region, which shows the South is less cost effective than the other regions. Additionally, thecost per new acceptor is more than 3.5 times higher in the South than in the North and two timeshigher than in the Center. This is explained by the other factor – target population, which issignificantly lower in the South than in the North or Center. In this case, the targeted behavioroutcomes and the size of the target population together impact cost effectiveness. These data showthat while each of the factors alone does not explain cost effectiveness, the interplay of these factorsdoes provide suggestions for improving cost effectiveness.Linkages Project/AED 6. Findings 25
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 26 and 27: 4.7. Comparability and Applicabilit
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: Table 11 shows the classification o
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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