The cost of large-scale school health programmes which deliver anthelmintics to children in Ghana and Tanzania

It has been argued that the delivery of anthelmintics to school-children th rough existing education infrastructure can be one of the most cost-effecti ve approaches to controlling parasitic worm infection. This paper examines the actual costs of a combination of mass and selective treatment for schis tosomiasis using praziquantel and mass treatment for intestinal nematodes u sing albendazole, as an integral part of school health programmes reaching 80442 pupils in 577 schools in Volta Region, Ghana, and reaching 109099 pup ils in 350 schools in Tanga Region, Tanzania. The analysis shows that finan cial delivery costs per child treated using praziquantel, which involved a dose related to body mass and a prior screening at the school level, were U S$ 0.67 in Ghana and US$ 0.21 in Tanzania, while the delivery costs for alb endazole, which was given as a fixed dose to all children, were US$ 0.04 in Ghana and US$ 0.03 in Tanzania. The higher unit costs in Ghana reflect the epidemiology of infection; overall, fixed costs were similar in both count ries, but fewer children required treatment in Ghana. Analysis of economic costs-which includes the cost of unpaid days of labour-indicates that the f inancial costs are increased in Ghana by 78% and in Tanzania by 44%. It is these additional costs which are avoided by integration into an existing in frastructure. It is concluded that: the base cost of delivering a universal , standard, school-based health intervention can be as low as US$ 0.03 per child treated; that even a slight increase in the complexity of delivery ca n have a significant impact on the cost of intervention; and that the use o f the education infrastructure does indeed offer significant savings in del ivery costs. (C) 1999 Elsevier Science B.V. All rights reserved.