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

7. Discussion and Conclusions7.1. Review of Key Research QuestionsReview of the cost data and cost effectiveness ratios allows us to answer some key questions aboutLINKAGES’ work:• How do costs and outcomes compare across the study regions?Comparing costs on a per beneficiary basis (defined as the total number of antenatal andpostpartum women served by the MCH clinics), there appears to be no relationship betweencosts and LAM behavior change outcomes. Total cost of LAM activities (LINKAGES andMOH/MCH costs) across all three regions is $96,988 and cost per beneficiary is $2.21. On aregional basis, the total cost is $33,755 in the North, $43,909 in the Center, and $19,323 inthe South. Costs on a per beneficiary basis are $1.91 in the North, $2.19 in the Center, and$3.20 in the South.• What are the determinants of costs and cost effectiveness across the study districts?The cost of training activities and IE&C are the key cost drivers. The key factorsaffecting cost effectiveness includes baseline and outcome behavior change rates andthe size of target population. Total activity costs do not appear to be a major factor inthis study impacting cost effectiveness, because it focuses only on LAM activities.• What would it cost to replicate these activities in Jordan and is it cost effective?The cost of replicating LINKAGES’ activities to promote LAM is $68,403. The total cost perbeneficiary to replicate this set of activities is $1.56. The total cost per new LAM acceptor is$29.83.• How can LINKAGES improve its cost effectiveness?Activity costs, baseline behavior rates and size of target population are three factors thatinfluence cost effectiveness. 1) LINKAGES may be able to improve its cost effectiveness bymainstreaming LAM interventions into comprehensive MCH reproductive health program.Spreading costs of a single intervention by implementing an integrated package of MCHactivities will lower costs and lead to higher cost effectiveness. 2) Targeting areas with lowerbaseline rates will improve cost effectiveness. 3) Limited data suggest that there may beeconomies of scale up to a certain threshold population, after which no further economies canbe realized. Determining an optimal population level at which economies of scale are realizedand a different package of activities aimed at increasing behavior change outcomes in thecurrent size of target population is needed, would be a key task to improve the costeffectiveness of future interventions. If this threshold level is not reached, however, andeconomies of scale can be gained, increasing target population will improve costeffectiveness.More data and further analysis of the impact of the mix of activities is needed to better informa cost effective program design.LINKAGES Project/AED 7. Discussion and Conclusions 27