Determining the cost-effectiveness of SGHPs.
malaria, respiratory illness, ARIs, ARI, febrile illness
MALARIA, ACUTE RESPIRATORY INFECTIONS, FEBRILE ILLNESS
Determining the cost-effectiveness of SGHPs entailed estimating the effect not only of the services they provide, but also how they impact services at other facilities in Rwanda’s health system. Second-generation health posts can potentially affect both the quantity and quality of primary care services. By seeking to bring quality services closer to the population, SGHPs can potentially increase access to primary care for routine curative services (To quantify this impact, we relied on a systematic cost-effectiveness analysis of quality services for one of Rwanda’s major health problems: malaria.We extended the malaria model to another major primary care problem: acute respiratory infections (ARIs), including both upper and lower respiratory conditions. When a patient with a febrile illness seeks medical care, the clinician will not immediately know whether the problem is malaria, a respiratory illness that might respond to antibiotics, or some other condition. The preferred treatment strategy is to use a rapid test to test and treat for malaria if positive, but otherwise treat with an antibiotic as a first-line attempt to manage the illness.To estimate baseline levels of health burden, we used data for Rwanda for 2019 (the latest data available) from the Institute of Health Metrics and Evaluation.Our cost-effectiveness analysis was based on results of systematic reviews published by the World Bank.A key question was whether the episodes treated at SGHPs would otherwise have been treated by alternative providers. Such options included CHWs, who can perform some rudimentary primary care services and operate throughout the Bugesera District, and professional health center staff. We performed DID analyses to examine substitution from health center treatment. The cost-effectiveness of SGHPs, expressed as the cost per DALY averted, was calculated by dividing the annual expenditures of SGHPs per person by the DALYs saved from malaria and ARI health-care services provided at SGHPs.