Cost-Effectiveness of an Economic Empowering Intervention for AIDS-Affected Orphans in Uganda

The caring of millions of AIDS-affected orphans in sub-Saharan Africa is a pressing social problem many countries face. Having lost one or both parents to AIDS bring economic and psychological challenges to surviving children and their family members. Given the lack of support from governmental social programs, effective and efficient interventions are urgently needed to ensure opportunities for AIDS-affected orphans to survive and thrive. Evidence from a series of randomized controlled trials (RCTs) in Uganda shows that an economic empowering intervention that promotes asset accumulation in the form of children’s savings accounts for education and family small business development may be a viable approach to improving multidimensional well-being among AIDS-affected children. However, we know limited about the cost-effectiveness of this economic empowering intervention. In this study, we aim to bridge this knowledge gap. Research on cost-effectiveness of program may help guide the assessment of feasibility to scale up this intervention, and findings from this study have implications for interventions and policies in low-income countries aiming to address child poverty issues.

The Bridges to the Future is a NICHD sponsored study that recruits children in grade 5 or 6 from 48 randomly selected primary schools in southwest districts of Uganda. In total, 1,410 students met the inclusion criteria (having lost one or both parents) and were recruited in 2012. The 48 schools were randomly assigned to three study arms: Usual Care (n=496), Bridges (n=402), and Bridges PLUS (n=512). Children in all study arms receive usual care for AIDS-orphaned children in the study area, consisting of counseling, school lunches and scholastic materials. Each child in each Bridges and Bridges PLUS arm receives the usual care intervention plus a Child Development Account; a 12-session of workshop on asset-building and future planning; regular mentorship meetings with undergraduate students; and income-generating activity training. Bridges and Bridges PLUS have varying financial incentives for participants to save. Bridges PLUS participants receive a 1:2 match-rate while Bridges participants receive a 1:1 match-rate. The intervention was provided for 24 months. This study examines cost-effectiveness during the two intervention years.

In this paper, we conduct a cost-effectiveness analysis that examines how much Bridges or Bridges PLUS costs to achieve an impact. We measure program costs on a per person basis. We draw costs data from the management information system for savings and project administrative records. We assess program effectiveness on a wide range of outcomes (e.g., health and mental health and sexual risk intentions). Data are drawn from interviews and schools and banks administrative records. The per-person costs of Bridges and Bridges PLUS is then divided by the relevant effect sizes to produce estimates of cost-effectiveness. Preliminary findings show that the intervention exhibits positive impacts on psychological functioning and savings behaviors. The Bridges PLUS intervention, being slightly more costly than Bridges due to its higher savings match rate, is more cost-effective in some outcomes but not in others. The next step is to compare of the cost-effectiveness of this intervention to other economic empowering interventions in this region.