ALIMA

ALIMA is a humanitarian medical aid organization based in Dakar, Senegal. ALIMA is dedicated to continuous quality improvement in medical care in humanitarian contexts and carries out scientific research to improve access and outcomes in these settings. ALIMA is building a culture of innovation in health care delivery. Since its creation in 2009, ALIMA has treated over 2 million people, conducted 56 programs in 13 countries, and launched more than 10 research projects. ALIMA and its partners have embarked on several research studies to evaluate/determine the health impact of different interventions or packages of interventions, including research on the cost, effectiveness, and cost-effectiveness of innovative child health and nutrition service packages in Africa, aiming to build the evidence base to convince policy and decision makers in nutrition, health, and finance to begin scaling up these approaches.

OPTIMA

To improve standard malnutrition treatment protocols, ALIMA has developed Optimizing Treatment for Acute Malnutrition (OptiMA). OptiMA simplifies the treatment of acute malnutrition as a continuum condition under one protocol, rather than the current approach which designates two separate categories: severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). OptiMA uses family-based screening at home by mid-upper arm circumference (MUAC), instead of more complex algorithms for SAM and MAM case management. An operational pilot in Burkina Faso showed it is
feasible to implement the simpler OptiMA protocol in an entire health district with outcomes meeting or exceeding Burkina Faso’s reference standards. ALIMA hypothesizes that switching to OptiMA would result in non-inferior outcomes for children enrolled in a randomized control trial and be cost-saving due to its relative simplicity, but a comprehensive economic evaluation of the OptiMA approach has not yet been done.

THE PHAROS SOLUTION

Pharos is working with the Yale School of Public Health and the Harvard School of Public Health to test these hypotheses using data from two randomized control trials (RCTs) in Niger and the Democratic Republic of Congo (DRC) supplemented with data from operational pilot studies in Burkina Faso, Niger, and Mali. Pharos will estimate the comparative resource use from a health sector perspective, focusing on the cost of nutritional supplementation products, outpatient clinical care, hospitalizations, and supply chain management. The team will use decision-analytic modeling to estimate the expected health outcomes and costs of operating an acute malnutrition program at scale, comparing OptiMA to the standard national protocol.

The three phases of the project include:

Phase 1 (January 2020 – March 2021): Conduct a cost analysis of the OptiMA program using existing data from operational pilot projects in Burkina Faso. The article “Utilization patterns, outcomes and costs of a simplified acute malnutrition treatment programme in Burkina Faso” was published in Maternal & Child Nutrition in December of 2021.

Phase 2 (March 2021 – December 2021): Design and use a model to estimate cost-effectiveness of OptiMA compared to standard care in the DRC RCT.

Phase 3 (January 2021 – December 2022): Further develop model using data from operational pilots from Niger, Mali, and/or Burkina Faso, and use it to estimate cost-effectiveness of OptiMA compared to standard care in the Niger RCT.

LOOKING AHEAD

This analysis will assist in program and financial planning, fill a major gap in evidence by calculating the incremental cost-effectiveness of the OptiMA protocol compared to the existing standard, and quantify how many more cases of acute malnutrition can be successfully treated with OptiMA given resource constraints.

Status: Ongoing, January 2020 – December 2022

Team Members Involved: Robert Hecht, Stephen Resch, Ryoko Sato, Claire Young, Grace Chen, and Mila Dorji

For more information, contact Mila Dorji at [email protected].