The Costs of Expanding an Intervention to Improve the Quality of Care in Ministry of Health Clinics in Egypt

Barbara S. Janowitz, Family Health International
Stirling Cummings, Family Health International
Ibrahim Kharboush, Population Council
Laila Nawar, Population Council
Sara Loza, Social Planning, Analysis and Administration Consultants (SPAAC)
Susan E. Adamchak, Family Health International

Some studies suggest that improvements in quality of care increase contraceptive continuation rates, but there are no data on the costs of achieving these changes. FRONTIERS, is testing the impact of an intervention to improve client-provider interaction (CPI) which is thought to improve quality of care and continuation of contraceptive use in Egypt and Peru. Quality was assessed through interviews with clients and observation of interactions. We designed spreadsheets to identify and record inputs used in planning the intervention, training providers and supervisors, and overseeing the initial months of service delivery. We carried out activity sampling to determine how providers spent their time and the length of CPIs. We present data to assess the ability to afford the intervention and its cost effectiveness. Specifically we calculate the costs per client reached by the intervention as well as the incremental cost effectiveness ratio (ICER) under various assumptions.