Objectives
Compare preschool-VAS coverage and distribution costs associated with facility-plus-outreach vs door-to-door distribution in four health zones of Kasai Oriental province, Democratic Republic of the Congo (DRC)
Methods
2 representative cross-sectional VAS coverage surveys including ~1800 households conducted immediately after the distribution round in four health zones, stratified by urban vs. rural, and randomly assigned to distribute VAS to children 6-59 m either by a door-to-door or facility-plus-outreach strategy. The cost of each distribution approach was measured using an ingredient approach that captured costs associated with preparation, implementation, and supervision and monitoring of the approaches
Results
VAS coverage was high and similar between the distribution approaches (89.1% for door-to-door vs. 89.5% for facility-plus-outreach). The cost of VAS distribution by facility-plus-outreach was significant lower than the door-to-door approach in both urban and rural settings ($0.31 vs $0.41 in rural, and $0.40 vs. $0.48 in urban areas). The main cost components of door-to-door distribution were related to transport of health staff to reach all households, whereas the main costs of facility-plus-outreach were associated with outreach and social mobilization
Conclusions
Facility-plus-outreach VAS distribution costs less and achieved high and comparable coverage of preschool-age children compared to door-to-door distribution. In the context of polio eradication in most Sub-Saharan African countries, transition from the current door to door model to a fixed and outreach one could offer significant advantages
