Academic journal article Bulletin of the World Health Organization

Global Cost of Child Survival: Estimates from Country-Level validation/Cout Global De la Survie De L'enfant: Estimations a Partir De la Validation Au Niveau Du pays/Coste Mundial De la Supervivencia Infantil: Calculos Procedentes De Las Validaciones Nacionales

Academic journal article Bulletin of the World Health Organization

Global Cost of Child Survival: Estimates from Country-Level validation/Cout Global De la Survie De L'enfant: Estimations a Partir De la Validation Au Niveau Du pays/Coste Mundial De la Supervivencia Infantil: Calculos Procedentes De Las Validaciones Nacionales

Article excerpt

Introduction

In keeping with the fourth Millennium Development Goal (MDG4), nations have pledged to reduce child mortality by two-thirds between 1990 and 2015. This calls for a scale-up of child survival interventions, whose global cost the World Health Organization (WHO) recently estimated for 75 countries that have a high burden of mortality among children aged less than five years. (1) In an effort to support the countries in greatest need, WHO's Department of Child and Adolescent Health and Development (CAH) has identified 33 countries (Appendix A, available at: http://www.who.int/choice/publications/p_2011_cost_validation_webannexes.pdf) that together contribute 78% of all deaths among children under 5 years of age.

Updated and improved global data on child health have recently become available. Also available now are updated estimates on the prevalence of malnutrition; new intervention coverage estimates made available by Countdown-to-2015 (2); updated price estimates from the WHO-CHOICE project (3) and updated estimates of the resources needed to scale up immunization, (4) malaria (5) and prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) programmes. (6)

Although global price estimates for the scale-up of packages of selected child health interventions are regularly published, (7,8) to our knowledge none has been empirically validated against existing country data. (9) Empirical validation differs from the type of conceptual validation by experts that we first conducted. (1) This paper reports on the results of this country-level empirical validation process, for which we use country feedback data in conjunction with new, published global data on epidemiology and prices. It presents a validated and revised global price tag for the scale-up of child survival interventions required to attain MDG4 and serves as an investment guide for governments and their development partners.

Methods

We used the original cost projection developed by WHO to derive the 2007 global price tag for child survival. The validation comprised only the key interventions included in the CAH model, including the management of pneumonia, diarrhoea and severe malnutrition, as well as nutrition counselling (complete list available in Appendix B, available at: http://www.who.int/choice/ publications/p_2011 cost validation_webannexes.pdf).

We identified major cost drivers by country and then sent a validation questionnaire covering these cost drivers to 32 countries with high child mortality. Each data input category for the costing model (disease incidence, intervention coverage and prices and input volumes for individual-level and programme-level activities) was validated against local data. Original assumptions were replaced by local data or by recent updated estimates on incidence, coverage and price. Additional costs were calculated through nine model scenarios that assessed the effects of: (i) the validation and of updated epidemiologic and coverage data; (ii) population change and scale-up sensitivity ranges; and (iii) updated unit price estimates. These cross-validated results were subsequently extrapolated to 75 countries. Lastly, these final estimates were combined with published estimates of the resources needed to scale up immunization, malaria interventions and PMTCT to compute a revised total global price tag.

Cost drivers

We retained the components of the original price tag, which included interventions addressing the major causes of death among children aged less than 5 years: (10,11) newborn sepsis, pneumonia, diarrhoea, malaria, PMTCT and malnutrition. As in our original study, (12) we based cost estimates on an ingredients approach, and we focused on validating input assumptions using patient-level and programme-level costs.

Patient costs refer to the costs of an intervention at the point where services (e. …

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