Geographic Resource Allocation Based on Cost Effectiveness: An Application to Malaria Policy

Abstract

Healthcare services are often provided to a country as a whole, though in many cases the available resources can be more effectively targeted to specific geographically defined populations. In the case of malaria, risk is highly geographically heterogeneous, and many interventions, such as insecticide-treated bed nets and malaria community health workers, can be targeted to populations in a way that maximises impact for the resources available. This paper describes a framework for geographically targeted budget allocation based on the principles of cost-effectiveness analysis and applied to priority setting in malaria control and elimination. The approach can be used with any underlying model able to estimate intervention costs and effects given relevant local data. Efficient geographic targeting of core malaria interventions could significantly increase the impact of the resources available, accelerating progress towards elimination. These methods may also be applicable to priority setting in other disease areas.

Fig. 1

Illustrative geographic allocation with cost-effectiveness plane (matching Table 1). Panel 1: A, B and C are illustrative geo-units corresponding to the example described in Sect. 2.1 and Table 1. The highlighted segments denote the intervention options selected to receive funding in the example. Abs. absolutely, Ex. extended, CHW community health worker, ITN insecticide-treated bed net

Fig. 2

Graphical representation of within and between geo-unit selection having initially selected ITN in geo-unit A. Panel 1: A, B and C are illustrative geo-units corresponding to the example within vs. between geo-unit selection described in Sect. 2.2. The darker highlighted ITN segment in geo-unit A denotes the intervention selected in the first step; the lighter highlighted segments denote the three options available for selection in the second step. Panel 2 represents the corresponding cost-effectiveness plane. CHW community health worker, ITN insecticide-treated bed net

Fig. 3

Geographic allocation of budget for universal insecticide bed net coverage compared with targeting of both bed nets and community health workers. a Universal bed net coverage (within the MARC region) compared with b geographic targeting of both bed nets and community health workers. CHW community health worker, DALY disability-adjusted life-year, ITN insecticide-treated bed net, MARC Myanmar Artemisinin Resistance Containment