Analyzing the Cost-Effectiveness of Interventions to Benefit Orphans and Vulnerable Children: Evidence from Kenya and Tanzania
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Analyzing the Cost-Effectiveness of Interventions to Benefit Orphans and Vulnerable Children: Evidence from Kenya and Tanzania
- 1. Analyzing the Cost-Effectiveness of Interventions to Benefit Orphans and Vulnerable Children: Evidence from Kenya and Tanzania Paul L. Hutchinson, Ph.D. Tonya R. Thurman, MPH, Ph.D. Tulane University
- 14. OVC Programs with Demonstrated Effects Program Integrated AIDS Program Kilifi OVC Project Allamano Mama Mkubwa & Kid’s Clubs Country Kenya Kenya Tanzania Tanzania Implementing Org. Pathfinder Cath. Relief Services Allamano, CARE, FHI Salvation Army Home Visiting & Care Educational Support School-based HIV Educ. Kids’ Clubs Guardian Support Groups Food Support Income Generation √ √ √ √ √ √ √ √ √ √ √ √ √ √
- 17. Evaluation Design Program begins; OVC enrolled & start Receiving services Intervention Group (OVCs) Time Comparison Group 1 (OVCs) Year 0 Survey Administered Year 1 Comparison OVCs start receiving services Comparison Group 2 (non-OVCs) (IAP)
- 20. Costs Per Beneficiary - OVC
- 21. Costs Per Beneficiary - Guardian
- 22. Psychosocial Outcomes (Indexes) Outcome Examples Self-esteem “ You are happy with yourself as a person.” “ You like being just the way you are.” Family self-esteem “ Your family pays enough attention to you.” “ You feel OK about how important you are to your family.” Social isolation “ How often do kids pick on you?” “ Do you have at least one good friend?” Family Functioning “ In times of crisis, you can turn to each other for support.” “ You can express feelings to each other.” Pro-social behavior Is child considerate of other peoples’ feelings? Does child try to help if someone is hurt, sick or upset?
- 23. Cost–Effectiveness of Home Visiting - OVCs Family Self- Esteem (CRS) Social Isolation (Allamano) Self-Esteem (The Salvation Army)
- 31. Food Security A 10% reduction the probability of food insecurity could be achieved for…? All fairly low cost Which is more sustainable?
Notas do Editor
- What have we accomplished? Evaluation Programmatic, potentially at multiple points over the life cycle of a project Advocacy
- We need to count up all inputs and assign appropriate monetary values to them. A large portion of our costs are shared – administration, staff, vehicles – across the different program areas. We need to come up with appropriate allocation rules to apportion a share of those inputs to each of our different outputs.
- Many items have costs and benefits across time. We need to account for different prices of inputs at different points in time. We need to address costs not just in the current period but also costs potentially occurring at points in the future. We tend to value immediate gratification over delayed gratification, so we need some way to discount benefits experienced in the future. A large portion of our inputs may not have market prices – labor time, free food, other donations. That is, their financial costs are 0. But that does not mean that they do not have values. We need to assign values that reflect the full opportunity costs of those items, their value in alternative uses. i.e. the economic costs
- Mostly want to collect cost info where it corresponds with our survey data 2. If we have an intervention that encourages condom use and consistent condom use means that some proportion of our children do not become HIV positive and therefore do not incur the lifetime costs of ARVs, then is that something we want to incorporate in our analysis. Or if the program distributes bednets and this prevents a certain number of malaria episodes then do we want to incorporate these medical care cost savings into our calculations? Or if condom use prevents infections in other individuals outside of our survey population, then do we want to incorporate the cost savings from avoidance of those infections? 3. We want information on all costs that are relevant for current or recent OVC outcomes. So if service delivery today is dependent upon the establishment of the sunk costs of infrastructure a year ago or earlier, then we need some measure of those costs in our analysis.
- Mostly want to collect cost info where it corresponds with our survey data 2. If we have an intervention that encourages condom use and consistent condom use means that some proportion of our children do not become HIV positive and therefore do not incur the lifetime costs of ARVs, then is that something we want to incorporate in our analysis. Or if the program distributes bednets and this prevents a certain number of malaria episodes then do we want to incorporate these medical care cost savings into our calculations? Or if condom use prevents infections in other individuals outside of our survey population, then do we want to incorporate the cost savings from avoidance of those infections? 3. We want information on all costs that are relevant for current or recent OVC outcomes. So if service delivery today is dependent upon the establishment of the sunk costs of infrastructure a year ago or earlier, then we need some measure of those costs in our analysis.
- Mostly want to collect cost info where it corresponds with our survey data 2. If we have an intervention that encourages condom use and consistent condom use means that some proportion of our children do not become HIV positive and therefore do not incur the lifetime costs of ARVs, then is that something we want to incorporate in our analysis. Or if the program distributes bednets and this prevents a certain number of malaria episodes then do we want to incorporate these medical care cost savings into our calculations? Or if condom use prevents infections in other individuals outside of our survey population, then do we want to incorporate the cost savings from avoidance of those infections? 3. We want information on all costs that are relevant for current or recent OVC outcomes. So if service delivery today is dependent upon the establishment of the sunk costs of infrastructure a year ago or earlier, then we need some measure of those costs in our analysis.
- Cost information is not complete – we don’t have information on the distribution of food assistance, quantity or value.
- Life skillsGames, songs, dances Learn health/nutritionLearned HIV preventionLearns body hygieneLearn about chores at homeLearn good behaviorStigma and discriminationPsychosocial/community counseling Discuss OVC needs
- Life skillsGames, songs, dances Learn health/nutritionLearned HIV preventionLearns body hygieneLearn about chores at homeLearn good behaviorStigma and discriminationPsychosocial/community counseling Discuss OVC needs
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- Cost-Effectiveness Results: Consistent food parcels Allamano - 10% reduction in probability of food insecurity at cost of $0.74 per beneficiary IGAs cheap for achievable outcomes CRS - SILC training 10% reduction in food insecurity at cost of $1.61 per beneficiary Allamano - Training in bio-intensive gardening = 10% reduction in food insecurity at cost of $9.17 per beneficiary These initiatives provided cost-effective and viable economic opportunities to guardians, building their capacity to care for selves and children. Bar Graph displaying cost-effectiveness of the three effective interventions (Two IGA, 1 consistent food support): CRS: IGA, $1.61, 10% reduction in probability of food insecurity Allamano: IGA, $9.17, 10% reduction in probability of food insecurity; Consistent food support, $0.74, 10% reduction in probability of food insecurity