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Integrated community case management (iCCM) of malaria, diarrhea, and pneumonia is a comprehensive, equitybased strategy to improve treatment access for underserved children under five years old. This paper presents data on cost of iCCM and incremental costs of mHealth enhanced supervision and supply chain management in Zambia. We collected cost data using three questionnaires applied at national, district, health facility and community levels. We interviewed 40 health facility supervisors and 75 community health workers. A provider perspective and an ingredient costing method was used. We entered and analyzed data in a customized excel costing tool. The result shows that total iCCM cost per patient contact was USD 18.43. The incremental cost of using the mHealth intervention per child contact for all iCCM conditions was USD 11.35. The incremental cost per treatment of diarrhea, pneumonia, and malaria with mHealth intervention was USD 9.58, USD 10.37 and USD 12.82. Program costs accounted for 67% of the total, and the largest share was associated with supervision estimated at 36%, followed by supply chain management at 27%. This study has provided valuable information to policy makers on how much it costs to implement iCCM program using mHealth interventions. [ABSTRACT FROM AUTHOR]

Background Mortality from cryptoccocal meningitis remains high. The ACTA trial demonstrated that, compared with 2 weeks of amphotericin B (AmB) plus flucystosine (5FC), 1 week of AmB and 5FC was associated with lower mortality and 2 weeks of oral flucanozole (FLU) plus 5FC was non-inferior. Here, we assess the cost-effectiveness of these different treatment courses. Methods Participants were randomized in a ratio of 2:1:1:1:1 to 2 weeks of oral 5FC and FLU, 1 week of AmB and FLU, 1 week of AmB and 5FC, 2 weeks of AmB and FLU, or 2 weeks of AmB and 5FC in Malawi, Zambia, Cameroon, and Tanzania. Data on individual resource use and health outcomes were collected. Cost-effectiveness was measured as incremental costs per life-year saved, and non-parametric bootstrapping was done. Results Total costs per patient were US $1442 for 2 weeks of oral FLU and 5FC, $1763 for 1 week of AmB and FLU, $1861 for 1 week of AmB and 5FC, $2125 for 2 weeks of AmB and FLU, and $2285 for 2 weeks of AmB and 5FC. Compared to 2 weeks of AmB and 5FC, 1 week of AmB and 5FC was less costly and more effective and 2 weeks of oral FLU and 5FC was less costly and as effective. The incremental cost-effectiveness ratio for 1 week of AmB and 5FC versus oral FLU and 5FC was US $208 (95% confidence interval $91–1210) per life-year saved. Clinical Trials Registration ISRCTN45035509. Conclusions Both 1 week of AmB and 5FC and 2 weeks of Oral FLU and 5FC are cost-effective treatments. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the mean costs of cataract surgery and refractive error correction at a faith-based eye hospital in Zambia. Methods: Out-of-pocket expenses for user fees, drugs and transport were collected from 90 patient interviews; 47 received cataract surgery and 43 refractive error correction. Overhead and diagnosis-specific costs were determined from micro-costing of the hospital. Costs per patient were calculated as the sum of out-of-pocket expenses and hospital costs, excluding user fees to avoid double counting. Results: From the perspective of the hospital, overhead costs amounted to US$31 per consultation and diagnosis-specific costs were US$57 for cataract surgery and US$36 for refractive error correction. When including out-of-pocket expenses, mean total costs amounted to US$128 (95% confidence interval [CI] US$96--168) per cataract surgery and US$86 (95% CI US$67--118) per refractive error correction. Costs of providing services corresponded well with the user fee levels established by the hospital. Conclusion: This is the first paper to report on the costs of eye care services in an African setting. The methods used could be replicated in other countries and for other types of visual impairments. These estimates are crucial for determining resources needed to meet global goals for elimination of avoidable blindness. [ABSTRACT FROM AUTHOR]

Objective To estimate the cost-effectiveness of cataract surgery and refractive error/presbyopia correction in Zambia. Methods Primary data on costs and health related quality of life were collected in a prospective cohort study of 170 cataract and 113 refractive error/presbyopia patients recruited from three health facilities. Six months later, follow-up data were available from 77 and 41 patients who had received cataract surgery and spectacles, respectively. Costs were determined from patient interviews and micro-costing at the three health facilities. Utility values were gathered by administering the EQ-5D quality of life instrument immediately before and six months after cataract surgery or acquiring spectacles. A probabilistic state-transition model was used to generate cost-effectiveness estimates with uncertainty ranges. Results Utility values significantly improved across the patient sample after cataract surgery and acquiring spectacles. Incremental costs per Quality Adjusted Life Years gained were US$ 259 for cataract surgery and US$ 375 for refractive error correction. The probabilities of the incremental cost-effectiveness ratios being below the Zambian gross national income per capita were 95% for both cataract surgery and refractive error correction. Conclusion In spite of proven cost-effectiveness, severe health system constraints are likely to hamper scaling up of the interventions. [ABSTRACT FROM AUTHOR]

Background VISION 2020 is a global initiative launched in 1999 to eliminate avoidable blindness by 2020. The objective of this study was to undertake a situation analysis of the Zambian eye health system and assess VISION 2020 process indicators on human resources, equipment and infrastructure. Methods All eye health care providers were surveyed to determine location, financing sources, human resources and equipment. Key informants were interviewed regarding levels of service provision, management and leadership in the sector. Policy papers were reviewed. A health system dynamics framework was used to analyse findings. Results During 2011, 74 facilities provided eye care in Zambia; 39% were public, 37% private forprofit and 24% owned by Non-Governmental Organizations. Private facilities were solely located in major cities. A total of 191 people worked in eye care; 18 of these were ophthalmologists and eight cataract surgeons, equivalent to 0.34 and 0.15 per 250,000 population, respectively. VISION 2020 targets for inpatient beds and surgical theatres were met in six out of nine provinces, but human resources and spectacles manufacturing workshops were below target in every province. Inequalities in service provision between urban and rural areas were substantial. Conclusion Shortage and maldistribution of human resources, lack of routine monitoring and inadequate financing mechanisms are the root causes of underperformance in the Zambian eye health system, which hinder the ability to achieve the VISION 2020 goals. We recommend that all VISION 2020 process indicators are evaluated simultaneously as these are not individually useful for monitoring progress. [ABSTRACT FROM AUTHOR]

Introduction: A rapid assessment of avoidable blindness (RAAB) was conducted in Southern Zambia to establish the prevalence and causes of blindness in order to plan effective services and advocate for support for eye care to achieve the goals of VISION 2020: the right to sight. Methods: Cluster randomisation was used to select villages in the survey area. These were further subdivided into segments. One segment was selected randomly and a survey team moved from house to house examining everyone over the age of 50 years. Each individual received a visual acuity assessment and simple ocular examination. Data was recorded on a standard proforma and entered into an established software programme for analysis. Results: 2.29% of people over the age of 50 were found to be blind (VA <3/60 in the better eye with available correction). The major cause of blindness was cataract (47.2%) with posterior segment disease being the next main cause (18.8%). 113 eyes had received cataract surgery with 30.1% having a poor outcome (VA <6/60) following surgery. Cataract surgical coverage showed that men (72%) received more surgery than women (65%). Discussion: The results from the RAAB survey in Zambia were very similar to the results from a similar survey in Malawi, where the main cause of blindness was cataract but posterior segment disease was also a significant contributor. Blindness in this part of Zambia is mainly avoidable and there is a need for comprehensive eye care services that can address both cataract and posterior segment disease in the population if the aim of VISION 2020 is to be achieved. Services should focus on quality and gender equity of cataract surgery. [ABSTRACT FROM AUTHOR]