Cost effectiveness analysis of community health programs in Rwanda: a case study of Rusizi district

Abstract

This study aimed to determine the effectiveness of Classic and Light community health intervention programs focusing on costs and health promotion practices in regards to community mobilization strategy, hygiene behaviour change, and reduction of disease. The study employed a cross sectional design in which quantitative and qualitative data was collected. The sample size for this study included 144 households, which were derived from the 225 households targeted through Zuelueta and Clostales‟ (2003) sample size determination. Both purposive and systematic random sampling techniques were used to select respondents. Both primary and secondary sources of data where employed in this study and the major sources of data collection include questionnaires and documentation review. The reliability and validity of the research instrument was determined through Content Validity Index and test and re-test. The statistical tools used to analyze the data in this study included frequency counts and percentages, mean values, standard deviation and One-Way ANOVA. The costs incurred in the implementation of the two programs were effective, that health promotion practices among the beneficiaries of the two interventions are still at a moderate level, and that the costs incurred in the two programs varied significantly and results were significantly different between the two intervention programs in terms of health promotion interventions. In summary, classic intervention was found to be more cost effective and more important in enhancing health promotion practices among its beneficiaries than light intervention programs. The study supports the recommendation that the Ministry of Health and the two programs‟ administration should take the following actions: revise costs to include a baseline survey so that detailed and appropriate implementation approaches can be designed for better results in health promotion practices; community sensitization on health promotion practices should be intensive and prioritize such that they are aware on how to ensure wellness; local community members should establish rewards and penalties for people whose hygiene has met required standards and or not met such standards; the Ministry of Health and its partners should ensure that items or chemicals to purify drinking water are made affordable and more accessible to local community members so that they can be able to ensure that the water they drink is always clean and safe; and, finally, the administrators of the two programs should empower local community leaders at various sectors so that waste management practices can be imposed or enforced by the local community leader to ensure effectiveness.