以储蓄为基础的经济赋权干预对乌干达艾滋病青少年的成本效益：对资源匮乏社区扩大规模的影响。
Cost-Effectiveness of a Savings-Led Economic Empowerment Intervention for AIDS-Affected Adolescents in Uganda: Implications for Scale-up in Low-Resource Communities.
机构信息
George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri.
Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong.
出版信息
J Adolesc Health. 2018 Jan;62(1S):S29-S36. doi: 10.1016/j.jadohealth.2017.09.026.
PURPOSE
Nearly 12 million children and adolescents in sub-Saharan Africa have lost one or both parents to AIDS. Within sub-Saharan Africa, Uganda has been greatly impacted, with an estimated 1.2 million orphaned children, nearly half of which have experienced parental loss due to the epidemic. Cost-effective and scalable interventions are needed to improve developmental outcomes for these children, most of whom are growing up in poverty. This article examines the direct impacts and cost-effectiveness of a savings-led family economic empowerment intervention, Bridges to the Future, that employed varying matched savings incentives to encourage investment in Ugandan children orphaned by AIDS.
METHODS
Using data from 48 primary schools in southwestern Uganda, we calculate per-person costs in each of the two treatment arms-Bridges (1:1 match savings) versus Bridges PLUS (1:2 match savings); estimate program effectiveness across outcomes of interest; and provide the ratios of per-person costs to their corresponding effectiveness.
RESULTS
At the 24-month postintervention initiation, children in the two treatment arms showed better results in health, mental health, and education when compared to the usual care condition; however, no statistically significant differences were found between treatment arms with the exception of school attendance rates which were higher for those in Bridges PLUS. Owing to the minimal cost difference between the Bridges and Bridges PLUS arms, we did not find substantial cost-effectiveness differences across the two treatment arms.
CONCLUSION
After 24 months, an economic intervention that incorporated matched savings yielded positive results on critical development outcomes for adolescents orphaned by AIDS in Uganda. The 1:1 and 1:2 match rates did not demonstrate variable levels of cost-effectiveness at 24-month follow-up, suggesting that governments intending to incorporate savings-led interventions within their social protection frameworks may not need to select a higher match rate to see positive developmental outcomes in the short term. Further research is required to understand intervention impacts and cost-effectiveness after a longer follow-up period.
目的
撒哈拉以南非洲地区有近 1200 万儿童和青少年失去了父母中的一方或双方，他们的父母死于艾滋病。在撒哈拉以南非洲地区，乌干达受到了巨大影响，估计有 120 万孤儿，其中近一半的儿童因艾滋病失去了父母。需要采取具有成本效益和可扩展的干预措施来改善这些儿童的发展成果，因为他们中的大多数人都生活在贫困之中。本文研究了一种以储蓄为导向的家庭经济赋权干预措施（Bridges to the Future）的直接影响和成本效益，该措施采用不同的匹配储蓄激励措施，鼓励投资因艾滋病而成为孤儿的乌干达儿童。
方法
利用乌干达西南部 48 所小学的数据，我们计算了每个治疗组（Bridges 组：1:1 匹配储蓄和 Bridges PLUS 组：1:2 匹配储蓄）中每人的成本；根据各相关结果估计了方案的有效性；并提供了每人成本与其相应有效性的比值。
结果
在干预启动后 24 个月，与常规护理条件相比，两个治疗组的儿童在健康、心理健康和教育方面的结果都更好；但是，除了 Bridges PLUS 组的儿童入学率更高之外，两个治疗组之间没有发现统计学上的显著差异。由于 Bridges 组和 Bridges PLUS 组之间的成本差异很小，因此我们没有发现两个治疗组之间存在实质性的成本效益差异。
结论
在 24 个月后，在乌干达，一项纳入匹配储蓄的经济干预措施对艾滋病孤儿的青少年关键发展成果产生了积极影响。在 24 个月的随访中，1:1 和 1:2 的匹配率并没有表现出不同的成本效益水平，这表明打算在其社会保护框架内纳入储蓄导向型干预措施的政府可能不需要选择更高的匹配率，就能在短期内看到积极的发展成果。需要进一步研究来了解干预措施的影响和成本效益在更长的随访期之后的情况。
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