This study estimated the costs associated with the adoption of IMCI at the first level health care facilities. Data were collected in a rural community in Bangladesh on illnesses of children who sought care from the Community Health Workers (CHWs) or the paramedics over a period of four months. More than 5,500 children sought care at the CHW and sub-center levels. Cough and fever represented about two-third (64%) of all reported complaints. Almost 75% of the symptoms are directly related to the IMCI target illnesses. More than half (52%) of the children were malnourished according to weight-for-age Z-scores. Referral of patients to higher facilities varied from 3% for the paramedics and 77% for the CHWs. If IMCI module was followed, the proportion of children needing referral should have been around 8%. There were significant differences between IMCI recommended drug treatment and the current practice followed by the paramedics and the CHWs. In fact, adoption of IMCI will save about seven million dollars on drugs alone compared to the current practice of prescribing. However, proper implementation of IMCI will require employment of additional health workers at the first level facilities and additional employment cost of the workers will be about US$2.7 million. At the current level of utilization, introduction of IMCI will save more than four million dollars. If the utilization of services increases to the level observed in fully functional health centers, IMCI will require an additional allocation of US$12.7 million, or about US$ 0.81 per child per year.
Learning Objectives: Demonstrate a method of estimating incremental cost of a new program using existing cost parameters of the health system
Keywords: Child Health, Cost Issues
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