2003年-世界发展银行全球_A_Cost_Analysis_of_the_Honduras_Community-based_Integrated_Child_Care_Program_106页_8mb

Summary of the Honduras Community-Based Integrated Child Care Program (AIN-C) Cost Analysis

Core Content

The document presents a comprehensive cost analysis of the Honduras Community-Based Integrated Child Care Program (Atencion Integral a la Niñez-Comunitaria, AIN-C), a preventive health and nutrition initiative implemented by the Ministry of Health (MOH) in Honduras. The program relies on community volunteers to monitor and maintain the growth of children under two years of age, and provides curative care for children under five who are ill. It is designed to improve child-rearing practices, including feeding, hygiene, and care-seeking behaviors.

The study was conducted to provide detailed cost estimates for program implementation and long-term maintenance, offering a financial planning tool for Honduras and other countries interested in adopting a similar model. The findings are based on extensive interviews with program staff, secondary data sources, and a bottom-up activity-based costing approach that includes both direct and shared inputs, as well as "off-budget" expenditures.

Key Findings

Cost Estimates

• Long-term, annual, recurrent cost per child under two participating in the program: US$6.82
• Long-term, annual, incremental budget requirements per child under two: US$4.00
• Long-term, annual recurrent cost per capita: US$0.44
• Cost of AIN-C monthly growth monitoring and counseling session per child as a percentage of the cost of a traditional MOH facility-based consultation: 11%

Program Structure

• The program is implemented by teams of 3 community volunteers per 25 children.
• It includes preventive care (78% of total annual recurrent costs) and curative care (focused on diarrhea, acute respiratory illness, and danger signs).
• The program has been implemented in 1,800 communities across 24 of Honduras’ 42 health areas.
• It is planned to expand to the poorest municipalities over the next several years.

Program Effectiveness

• A 2000 evaluation found the program achieved 92% coverage for children under two.
• It was effective in improving mothers' knowledge, attitudes, and practices regarding child care, feeding, and health.
• The program has been replicated or inspired similar initiatives in several countries, including El Salvador, Guatemala, Nicaragua, Senegal, Uganda, Ghana, Eritrea, and Zambia.

Cost Considerations

• The cost analysis includes both direct and indirect costs, such as volunteer time and shared resources.
• Some costs, like community leadership and mother participation, are not included in the analysis, as they are not directly borne by the MOH.
• The study includes six sensitivity analyses to explore the impact of program modifications on cost.

Main Objectives

The study serves two primary purposes:

1. To assist Honduran MOH officials and NGOs in planning and budgeting for AIN-C activities and understanding how changes in program structure may affect costs.
2. To provide health officials in other countries with a tool to estimate the feasibility and sustainability of implementing an AIN-C program in their own contexts.

Methodology

• Activity-based costing was used to estimate all inputs required for program activities.
• The analysis included 12 major activities and 11 sub-activities.
• A six-year phased-in implementation schedule was developed for a typical health area.
• Year-by-year cost accounts were prepared for a seven-year period.
• The study accounts for off-budget costs, which are essential for program sustainability.

Conclusion

The AIN-C Program is considered cost-effective and sustainable, with low costs and strong community participation. The volunteer model and the focus on preventive care contribute to its affordability and effectiveness. The cost estimates provided can be used as a planning and financial tool for both Honduras and other countries aiming to replicate the program. The study underscores the importance of understanding the full cost structure of community-based health and nutrition programs to ensure their long-term viability and impact.