costs vary can help in assessing the degree to which cost and
cost-effectiveness estimates can be reliably extrapolated across
different settings, and can also enable health planners and policy makers to discern what drives costs and to plan future budgets (Drummond et al. 1992; O’Brien 1997; Bryan and
Brown 1998; Spath et al. 1999; Drummond and Pang 2001; Walker et al. 2004). This understanding is particularly important for global health programmes which implement a common health package in a range of settings. For example, a number of initiatives are now underway which seek to control a number of tropical diseases, including those caused by parasitic helminth (worm) infections (Albonico et al. 2006; Boatin and Richards 2006; Fenwick et al. 2006; Ottesen 2006). staff, also need information on how costs change as the programmes are gradually scaled-up. In economics, changes in the level of output may change average costs; as output increases, average costs either remain constant (constant returns to scale), decrease (economies of scale) or increase (diseconomies of scale) (Folland et al. 2004). Many studies assume constant returns to scale, and take average costs per recipient and multiply them by projected output levels (e.g. Fenwick et al. 2005; Brady et al. 2006). In practice, however, available studies demonstrate that average costs vary at different levels of output (Over 1998;
工业洗衣机远程监控系统+结构图+硬件框图Mansley et al. 2002; Valdmanis et al. 2003; Elbasha and Messonnier 2004).
There is a clear need for empirical evidence to better understand variations in cost and cost-effectiveness, particularly in the context of large-scale control programmes. This paper assesses the variation in costs and cost-effectiveness of a nationwide helminth control programme, and the effect of scaling-up on costs. The specific aims are to: (1) investigate the intra-country variation in the cost and cost-effectiveness of a national school-based schistosomiasis and soil-transmitted helminth (STH) control programme in Uganda, (2) determine the effects of scaling-up on costs and cost-effectiveness, and (3) identify the main determinants of average costs.
Description of the control programme In 2003, the Ugandan Ministry of Health (MoH) launched its national schistosomiasis and STH control programme (Kabatereine et al. 2006a,b). Implemented vertically through the Vector Control Division (VCD) in Kampala, the programme provides anthelmintic (deworming) treatment to schools and communities at risk of morbidity due to helminth infection. In brief, the programme comprises the following activities: community sensitization, training of teachers and community drug distributors (CDDs), and school-based delivery of two anthelmintic drugs. Mass treatment with praziquantel to treat schistosomiasis and with albendazole to treat soil-transmittedhelminths was given to all s本文来自优.文~论^文·网原文请找腾讯3249.114 chools and communities in targeted areas. Treatment in schools is carried out by teachers and in communities by CDDs. The programme manager and VCD headquarters staff have overall responsibility for the programme and regularly visit districts to monitor progress. Implementation of the programme at the district level is undertaken by District Vector Control Officers (DVCOs) and district health teams. To help create awareness and political engagement, a series of national workshops were held in Kampala between 2001 and 2005 (two in 2001, two in 2002 and one each in 2004 and
2005). The implementation of control began with a pilot phase from April to October 2003 targeting 400 000 people, with one sub-county selected for mass treatment in each of the 18 most affected districts (Kabatereine et al. 2006a). In 2004 the number of sub-counties targeted in each of the
KEY MESSAGES
In Uganda, the costs and cost-effectiveness of delivering anthelmintics through schools as part of a nationwide
helminth control programme varied significantly for different years and for different districts. Average costs decreased with increasing total number of children treated in each district, indicating the existence of economies of scale as the programme was rolled-out.
Using a single estimate of cost and cost-effectiveness is misleading and may lead to inaccurate cost projections in policy
and planning. It is important to carefully consider which costs can be reliably extrapolated across different settings.
VARIATION IN COSTS AND COST-EFFECTIVENESS OF HELMINTH CONTROL 18 districts was increased, and in 2005 the programme was expanded to include 23 districts, targeting 2.3 million people (Kabatereine et al. 2006b). In each district, training workshops provided teachers and CDDs with a basic understanding of schistosomiasis and STH, and of how to complete record forms and to administer tablets. The design of training and number of participants varied between districts. Health education messages were delivered through posters, booklets and audio and film media. All
浅析家的n次方中女人与女人的不同 the Uganda National Medical Stores, who transported them to VCD headquarters. Drugs and IEC material were either transported to the districts by VCD or collected by the districts during routine visits to Kampala. Drug registration and treatment included compiling school enrolment data and community census information to determine the target population and drug needs. The number of tablets provided to each school was calculated on the basis of treatment registers completed by head teachers and CCDs. The drugs were delivered to each school by the DVCOs and were received by
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