Cost-effectiveness.
malaria, ARI
MALARIA, INTESTINAL PARASITES
Our evaluation of the cost-effectiveness of SGHPs focused only on the three most common conditions: ARI, malaria, and intestinal parasites. The cost per DALYs averted as a result of these conditions provided at the SGHPs was $101, indicating that SGHPs are highly cost-effective compared with Rwanda’s GDP per capita of $798 in 2020.Because SGHPs proved cost-effective in the Bugesera District, policymakers may wish to examine their potential expansion both within Rwanda and to other sub-Saharan African countries. Within Rwanda, any part of a district that is not well served by the existing health-care infrastructure would be a good location. These are locations relatively far from existing health centers requiring considerable time and/or expense to access care, but with a sufficient population size to make an SGHP financially viable for the operator.When considering expansion to other countries, the WHO Health Systems Building Blocks provides a useful framework.Because Rwanda’s system of Other countries interested in SGHPs may need a different financing model. This could be based on some system of results-based financing with incentive payments from governments and/or donors, or direct grants from the national government. Although our favorable cost-effectiveness results indicate that government funding can be economically sound in principle, a budget impact analysis is needed to assess the feasibility of government funding in practice. If existing health facilities do not appear to be funded adequately, additional facilities could be expected to suffer similar shortfalls and would not fulfill their public health objectives. However, if a country’s publicly funded facilities have adequate supplies, functioning equipment, and reliably paid staff, then it is likely that the country could afford the modest increases needed to support SGHPs.