Évaluation économique de l’approche communautaire dans l’offre de soins à Madagascar

Community health workers play an important role in improving access to healthcare services, especially in areas where the population lives more than 5km from health facilities. One of their main activities is to raise awareness among the population of the need to use the healthcare services offered by health facilities. In Madagascar's Manjakandriana district, these agents are most functional and effective when supported by a community health program, and this was the case in 2017. In fact, eight (08) Centres de Santé de Base II in seven communes were supported by USAID's MIKOLO project. To better understand the importance of the community approach to healthcare provision, we have adopted a Cost-Effectiveness Analysis, using the Double Difference method and the Incremental Cost-Effectiveness Ratio (ICER). The indicators of effectiveness considered in this study were the number of children fully vaccinated and the number of prenatal consultations. We then compared the eight (08) Basic Health Centers II supported by the program in question against nine (09) Basic Health Centers II not supported. The result obtained is that there are 267 surpluses of increased use of care services between 2016 and 2017 in the Basic Health Center II supported. According to the ICER obtained, it was necessary to spend US$84 for an increase in the use of care services.