Does the Integrated Management of Childhood Illness cost more than routine care? Results from the United Republic of Tanzania

• Published in: Bulletin of the World Health Organization 2005-05, Vol.83 (5), p.369-377
• Main Authors: ADAM, Taghreed, MANZI, Fatuma, SCHELLENBERG, Joanna Armstrong, MGALULA, Leslie, DE SAVIGNY, Don, EVANS, David B
• Format: Article
• Language: English
• Subjects: Bacterial pneumonia; Biological and medical sciences; Care and treatment; Child care; Child development; Child health; Child Health Services - economics; Child, Preschool; Children; Children & youth; Childrens health; Clinical trials; Clinics; Cost analysis; costos de la atención en salud; costos y análisis de costo; Costs; Costs and Cost Analysis; cuidados del niño; Developing countries; Diseases; Domestic relations; Drug therapy; Economics; entrega integrada de atención de salud; estudio comparativo; estudios de evaluación; Family medicine; General aspects; Health Care Costs - statistics & numerical data; Health care expenditures; Health facilities; Health Policy & Services; Humans; Illnesses; Infant; Integrated management; Intervention; Malaria; Medical care; Medical care, Cost of; Medical sciences; Medical sector; Medical service, Rural; Miscellaneous; Pediatrics; Pneumonia; preescolar; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression Analysis; república unida de tanzanía; servicios de salud infantil; Sickness; Social aspects; Tanzania; Utilization; Vaccination; Vaccines
• ISSN: 0042-9686; 1564-0604
• DOI: 10.1590/S0042-96862005000500013

The Integrated Management of Childhood Illness (IMCI) strategy is designed to address the five leading causes of childhood mortality, which together account for 70% of the 10 million deaths occurring among children worldwide annually. Although IMCI is associated with improved quality of care, which is a key determinant of better health outcomes, it has not yet been widely adopted, partly because it is assumed to be more expensive than routine care. Here we report the cost of IMCI compared with routine care in four districts in the United Republic of Tanzania. Total district costs of child care were estimated from the societal perspective as the sum of child health-care costs incurred in a district at the household level, primary health-facility level and hospital level. We also included administrative and support costs incurred by national and district administrations. The incremental cost of IMCI is the difference in costs of child health-care between districts with and without IMCI, after standardization for population size. The annual cost per child of caring for children less than five years old in districts with IMCI was USD 11.19, 44% lower than the cost in the districts without IMCI (USD 16.09). Much of the difference was due to higher rates of hospitalization of children less than 5 years old in the districts without IMCI. Not all of this difference can be attributed to IMCI but even when differences in hospitalization rates are excluded, the cost per child was still 6% lower in IMCI districts. IMCI was not associated with higher costs than routine child health-care in the four study districts in the United Republic of Tanzania. Given the evidence of improved quality of care in the IMCI districts, the results suggest that cost should not be a barrier to the adoption and scaling up of IMCI.