MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies

analysis be conducted. Moreover, given the uncertainty about
the need for, approach to, and costs of border screening, the
costs associated with this intervention are presented separately
in the final analysis to enable the reader to view the full possible
range of costs (from no border screening to the comprehensive
approach outlined above).
FIGURE 28: COST OF SURVEILLANCE FOR 3 DIFFERENT SCENARIOS:
SCENARIO 1 (LLINS REMAIN > 75%;), SCENARIO 2 (PROGRESSIVE SCALE
DOWN OF LLINS; BORDER SCREENING;) AND SCENARIO 2 WITHOUT
BORDER SCREENING
As illustrated in Figure 25, surveillance will be considerably more
expensive when pursuing elimination (2012 onwards). The
initial high cost (2012-2020) is mainly explained by the high
number of cases that will require an investigation and thus a
relatively high number of investigation teams needed per district.
As cases decrease, the MOHSW will be able to correspondingly
reduce the number of teams and therefore surveillance cost.
However, under the second scenario, this modest decline in active
surveillance costs will be offset by the assumed introduction of
border screening.
HUMAN RESOURCES
Human resources make up a significant fraction of the
additional cost of elimination, as surveillance and M&E
activities are manpower-intensive and are crucial to the success
of an elimination campaign. The additional human resources
needed for an elimination program (e.g., surveillance officers
at the central level, entomologists, M&E specialists, etc.) have
been outlined in Chapter 2 and their salaries, administrative
support, and transportation expenses (e.g. gas, insurance, etc.)
are all included in this costing. The human resource costs of the
case investigation teams are not included here, but rather under
surveillance. Additional human resource expenses crucial to
elimination are related to training, notably of the new outbreak
response teams, lab technicians (on PCR), and private sector
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health professionals. It is assumed that the approach to training–
and therefore the costs–will be the same as is currently used
by the ZMCP. We also include in this category the cost of the
elimination technical advisory meetings and steering committee
meetings that have been recommended. These expenses are not
expected to decline over time because the training is costed as
annual or bi-annual refresher sessions and the annual meetings
are expected to continue in perpetuity. We therefore estimate that
the additional human resource cost of elimination is just below
$300,000 annually (roughly 50% for salaries, 35% for training
and 15% for meetings). This additional cost for elimination was
kept constant over time. However, the baseline human resource
and training cost was assumed to represent similar proportions
over time as for sustained control as per the Global Fund budget
proposal (i.e., 1.5% on salaries and 2.9% on training). The total
of cost of human resources therefore increases gradually in line
with growth of other program costs.
EQUIPMENT
The additional equipment requirements for an elimination
program are mainly those that will be needed by the new
personnel, including cars and computers for the ZMCP (for
district ACD teams these cost have been included in surveillance).
We also include GPS machines for surveillance and M&E, the
cost of setting up a data server for the ZMEP, and a lab with PCR
capacity. Equipment costs are amortized over the expected useful
life of the equipment (8 years for cars and 4 years for GPS) with
an assumption of zero resale value at the end of the amortization
period. Equipment expenses are not expected to decline and
are assumed to continue to represent 1% of the total budget
for sustained control plus the additional elimination specific
equipment.
BEHAVIOR CHANGE COMMUNICATION (BCC)
It is difficult to know exactly how much more BCC will cost
under an elimination program than under sustained control, but
two requirements are certain. First, BCC campaigns will need to
be adapted and expanded to cover the private sector to promote
compliance with policies on diagnosis and treatment. Second,
activities will need to become more intensive due to the limited
margin of error under an elimination program; even a small minority
of people continuing to seek treatment from informal sources or
denying spraymen entry to homes can jeopardize the effort.
It is not possible at this stage to concretely identify the specific
changes in BCC activities and therefore costs. For the purposes
of this exercise, we took the estimated annual cost of BCC
under sustained control and multiplied the amount by five.
While clearly a rough estimate, the ZMCP will need to reach
at least double the number of facilities it currently targets if the
private sector is included, and a more elaborate effort will need
to be made at the community level. Moreover, as BCC is not
a significant driver of overall program costs, it is unlikely that
changes in this area will have more than a modest impact on the
overall comparison between sustained control and elimination
so a precise analysis is less essential.