The costs of changing national policy: lessons from malaria treatment policy guidelines in Tanzania

Summary Objective To document the cost incurred by the Tanzanian government by changing the policy on first‐line treatment of malaria, from chloroquine to sulfadoxine–pyrimethamine. Methods Costs were analysed from the perspective of the Ministry of Health and included all sources of funding. Costs external to the public health sector (e.g. private and community costs) were not included. The base case analysis adopted an incremental rather than a full cost approach, assuming that an organizational infrastructure was already in place. However, specific attention was paid to the burden placed on National Malaria Control Program staff. We also costed activities planned but not implemented to estimate the total expense for an ‘ideal’ process. Results Total costs were Tsh 795 million (USD 813 743), with the largest proportion accounted for by training. Costs of the policy change process were equivalent to about 4% of annual government and donor expenditure on malaria and to about 1% of overall public expenditure on health. A number of planned activities were not implemented; including these would bring the total cost to Ts 880 million (USD 896 130). Conclusion On top of extra costs for the drugs themselves, a change in treatment policy requires time, resources and substantial management capacity at national and local level. A better understanding of these issues and the costs involved benefits countries planning and implementing policy change. Objectifs Documenter le coût revenu au gouvernement tanzanien dans le changement de la politique sur le traitement de la malaria de première ligne, en passant de la chloroquine à la sulfadoxine‐pyrimethamine. Méthode Les coûts ont été analysés à partir des perspectives du Ministère de la Santé et ont inclus toute source de financement. Les coûts externes au secteur de la santé publique (e.g. coûts communautaires ou prives) on été exclus. L'analyse de base a adopté une approche en terme d'accroissement plutôt qu'en terme de dépense globale, vue que des infrastructures organisationnelles étaient déjà en place. Cependant, une attention spécifique a été accordée aux charges encourues par le personnel du programme national de contrôle de la malaria. Pour l'estimation des dépenses totales par une approche qui se voudrait ‘‘idéale’’, nous avons également tenu compte des activités planifiées mais non implémentées. Résultats Les coûts totaux étaient de 795 millions Tsh (813743 dollars US), la plus grande proportion dépensée