Micronutrient Initiative (MI) and Bihar government in September-2010 initiated a childhood diarrhea management program in 15 districts of Bihar to reduce diarrheal deaths by strengthening procurement and supply chain mechanism, capacity building of service providers, introducing a mechanism of supportive supervision and monitoring. The study analyzed the cost of different program components and unit cost of treatment to understand feasibility and sustainability of program scale-up.
MI program expenditure on different program components and government cost norms for various activities were collected. Costs were analysed to know fixed, variable and unit cost. Fixed costs include cost of strengthening procurement, training, monitoring etc and variable costs include costs of supplies’ procurement, trainings and printing etc. Different options worked out to suggest cost for scaling-up program components within the government health setup.
The cost of treating each diarrhea episode in the first year was found to be USD 2.9 (procurement USD 0.7, training 1.2, supportive supervision 0.1, demand generation 0.2 and sustainability 0.3). Over next two years, the unit cost of diarrhoea treatment projected to drop from USD 2.9 to 0.2. Third year onwards fixed cost will drop to zero and only variable cost will be incurred. Different scale-up options were worked out which were found to be less than 1% of the total state NRHM budget for 2012-13 thus making it financially viable .
The unit cost of diarrhea treatment under public sector over two years was found to be affordable and cost-wise the program is feasible to sustain and scale-up.