Журнал тропических болезней и общественного здравоохранения

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Cost Benefit Analysis of Use of Community Based Distributors in Promoting Access to Family Planning Services in Rural Communities in North Western Nigeria

Onoriode Ezire, Isa Saidu Babale, Badamasi Usman, Aliyu Guraguri and Omokhudu Idogho

Background: Contraceptive use in Nigeria is still very low (15.5%) while total fertility rate is still very high (5.5). Access and uptake of family planning services in rural communities is lower than the national average. In Nigeria, over 60% of the population resides in rural localities. One of the factors limiting access to family planning services is the very limited number of trained health care providers as ratio of one medical personnel to the population is 1:100,000. Amidst the current resource constraint in the country is the use of community-based distributors (CBD) an effective option in promoting family planning services? Methods: Cost and health benefit data were collected from a project implemented in Nigeria. We defined cost from the provider’s perspective. We estimated health benefit using couple year of protection (CYP) and Disability Adjusted Life Year (DALY). Effectiveness determined using the WHO cost effectiveness threshold. Results: Over 25 million CYP was gained and 39,714 DALY averted. Total cost was around $1.19m with an average cost per person reached, $0.78. We estimated the incremental effectiveness ratio to be $29.94, which is lesser than Nigeria GDP per capital ($3,000). Conclusion: While working on the long-term goal of increasing the number of trained medical staff, the use of CBDs is an effective strategy instead of a do nothing situation. We recommend the use of CBDs in scaling up not just FP but other preventive healthcare needs of rural communities, as it is sustaining, community owned and costeffective.