Analyzing the Cost-Effectiveness of Interventions to Benefit Orphans and Vulnerable Children: Evidence from Kenya and Tanzania

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

Background
Key Questions
Evaluation Design & Data Collection
Results
Conclusions

1. Cost-effectiveness Analysis
Step 1: Estimate how effective a program is in achieving its stated goals
Step 2: Estimate the value of resources (i.e. costs) to implement the programs
Step 3: Link costs to effectiveness
Step 4: Make policy recommendations
Generally prefer programs that achieve a bigger “bang for the buck”

OVC Programs Program Integrated AIDS Program Kilifi OVC Project Tumaini Project 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. Individual Counseling Kids’ Clubs √ √ √ √ √ √ √ √ √ √ √ √ √ √ √

2. Key Questions
What is the impact of …
… Kids’ Clubs , individual counseling and home visiting on children’s psychosocial outcomes?
… educational support on children’s educational outcomes?
… school-based HIV interventions on children’s HIV knowledge levels?
What does it cost to achieve improvements in OVC psychosocial , educational and HIV knowledge outcomes?

3. Evaluation Design
Post-test study: programs on-going for at least one year
Focus only on OVC aged 8-14 years
Survey administered to OVC and their caregivers
Program Integrated AIDS Program Kilifi OVC Project Tumaini Project Salvation Army Sample of 8-14 year olds 3,423 1,036 1,104 564

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)

4. Results
Costs per beneficiary
Costs per improvement in outcome

Costs Per Beneficiary

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?” Pro-social behavior Is child considerate of other peoples’ feelings? Does child try to help if someone is hurt, sick or upset?

Cost–Effectiveness of Home Visiting Family Self- Esteem (CRS) Social Isolation (Allamano) Self-Esteem (Salvation Army)

Results – Kids’ Clubs
$6.43 per marginal increase in an OVC’s measure of family self-esteem (Tumaini)
No measurable effect for other outcomes

Results – School-based HIV Education
Cost-effectiveness of school-based HIV Education
Integrated AIDS Program: $2.61 per incremental change in knowledge
Cath. Relief Services: $0.09 per incremental change in knowledge

Results
Educational Support
Little difference in educational outcomes across all programs
Programs ensure that educational achievement is at least as good among OVC as non-OVC
Counseling
$0.36 per incremental change in pro-social behaviors (Catholic Relief Services)
No measurable effect for other programs.

5. Conclusions (Policy)
OVC interventions can be effective AND cost-effective in improving OVC welfare across multiple dimensions
School-based HIV education programs can substantially increase knowledge at low cost
Cost data, collected concurrent with program implementation, can provide a powerful tool for planners

5. Conclusions (Analysis)
Collect data on outcomes at baseline so as to measure changes
Try (as hard as possible) to have equivalent comparison groups
Measures of mental well-being should be standardized and more widely used

Acknowledgements
Staff from
The Salvation Army
Mama Mkubwa & Kids Club program
Allamono
CARE
Tanzania – Tumaini Project
Kilifi OVC Porject
Pathfinder
The Community Based Care and Support Program (COPHIA)
The Constella Futures Group (MEASURE): Florence Nyangara
USAID: Jerusha Karuthiru, Kate Vorley, Washington Omwomo (Kenya); Elizabeth Lema, Susan Monaghan (Tanzania); Rick Berzon; John Novak, Kathleen Handley, and Scott Stewart (DC)
USG OVC Technical Working Group
Innumerable volunteers and local leaders in Kenya and Tanzania

If you are interested in the full paper, please refer to:
http://www.cpc.unc.edu/measure/publications/pdf/sr-09-51.pdf
Contact Info:
Paul L. Hutchinson
Tulane University School of Public Health and Tropical Medicine
Department of International Health and Development
1440 Canal Street, Suite 2200-TB46
New Orleans, LA 70112
USA
Email: phutchin@tulane.edu

Analyzing the Cost-Effectiveness of Interventions to Benefit Orphans and Vulnerable Children: Evidence from Kenya and Tanzania

by MEASURE Evaluation on Oct 19, 2009

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Analyzing the Cost-Effectiveness of Interventions to Benefit Orphans and Vulnerable Children: Evidence from Kenya and Tanzania — Presentation Transcript