The costs of changing national policy: lessons from changing malaria treatment policy in Tanzania
Many African countries are considering a change in their first line malaria treatment policy due to high levels of chloroquine resistance. In Tanzania, high levels of clinical failure led the government to change the recommended first line treatment from chloroquine to sulfadoxine/pyrimethamine.
Policy change incurs costs which are usually ignored in economic analyses of interventions. The Tanzanian national malaria control programme with its partners initiated a study to estimate the costs of the implementation of the change in policy. This paper reports the results of the study, and provides an account of the cost of policy change activities from a government perspective. Total costs were Tsh 795,027,390 (USD 813,743) with the largest proportion accounted for by training.
To put these results in perspective, the policy implementation process accounted for about 4% of annual government and donor expenditure on malaria and about 1% of overall public expenditure on health.
Changing treatment policy entails a broad range of activities and has substantial costs in addition to any extra costs of the drugs themselves. Moreover the process requires time, resources and substantial management capacity within both national control programmes and district health management teams to organise and undertake effectively a wide range of activities.
Better understanding of these issues and the costs involved will be of great benefit to other countries planning and implementing policy changes.
Tropical Medicine and International Health (2006) 11 (4) 452-461 [doi: 10.1111/j.1365-3156.2006.01590.x]