Elimination of visceral leishmaniasis in Ethiopia - cross-sector collaboration and costsharing to promote sustainability.

Highlights

• Visceral leishmaniasis is targeted for elimination as a public health in 64 countries by 2030

• Sustainable elimination of visceral leishmaniasis will require collaboration of different stakeholders led by the governments

• The government contribution is critical and essential in ensuring sustainability and ownership

• In Ethiopia, the government through the hospital, was found to contribute up to an average of 76% of the cost of diagnosis, treatment and management of visceral leishmaniasis.

Abstract

Background Sustainable elimination of Visceral leishmaniasis as a public health problem requires the contribution of various stakeholders led by governments efforts. An estimation of the contribution of different stakeholders was conducted focusing on the cost of diagnosis, treatment and management of visceral leishmaniasis in a hospital setting.

Objectives The study aimed to estimate the cost of diagnosis, treatment and management of visceral leishmaniasis in a public hospital in Ethiopia, when including the contributions of the government and other stakeholders.

Method A cross-sectional survey using discharged patients’ data and interviews of health workers responsible for managing visceral leishmaniasis patients was used to estimate the cost of diagnosis and management of visceral leishmaniasis and the proportion of government contribution.

Results Data was collected from 189 patientrecords and 32 hospital staff. The patients’ mean age was 16.3yrs (95% CI: 14.7, 17.9). The total cost of diagnosis and treatment of a patient on first line regimen was $104.7 and on second line regimen was $331.9. The WHO contribution through the provision of diagnostic kits and medicines was $26.9 and $241.1 per patient on first and second line treatments, respectively. The hospital contribution was $77.8 and $90.8 per patient on first and second line treatments respectively. The pro-rated monthly medical staff payments ranged from $93.5 to $163. The monthly Government contribution for diagnosis, treatment and management was 76% and 29% for patients on first and second line treatments, respectively.

Conclusion The contribution by the Ethiopia government of 76% of the cost of diagnosis, treatment and management of visceral leishmaniasis cases on first line treatment is significant for the sustainable elimination of visceral leishmaniasis. Further research should be done to investigate the cost effectiveness of integrating visceral leishmaniasis services into the existing health services.