Assefa Geteneh Moges, Muluneh Muluken Dessalegn, Abebe Sintayehu, Addisu Genetu, Yeshanehe Wendemagegn
Amref Health Africa, P.O. Box 20855, Addis Ababa 1000, Ethiopia.
Selam Global Health Consultancy, 6701 BH Wageningen, The Netherlands.
Int J Environ Res Public Health. 2025 Jul 25;22(8):1179. doi: 10.3390/ijerph22081179.
Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia.
Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated.
Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls.
The ICER was USD 25.50 per DALY averted, well below Ethiopia's GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia.
埃塞俄比亚的青少年，尤其是农村地区的青少年，在获得全面的性与生殖健康（SRH）服务方面面临重大障碍，导致健康状况不佳。青年友好型卫生服务（YFHS）倡议通过培训卫生推广工作者（HEW）在初级保健层面提供量身定制、适合年龄的护理来应对这些挑战。本研究评估了在埃塞俄比亚吉马地区农村卫生站实施YFHS的成本效益。
采用基于成分的成本核算方法，对六个卫生站的成本进行了分析，其中三个实施YFHS，三个提供常规服务。使用避免的伤残调整生命年（DALY）对健康结果进行建模，并计算增量成本效益比（ICER）。
结果显示，与2012年相比，YFHS每年为9854名青少年提供服务，成本为29,680美元，而对照站点为2012.5名青少年提供服务，成本为7519美元。该研究显示，每避免一个DALY的ICER为25.50美元。该干预措施改善了健康结果，包括产前护理利用率提高27%，避孕药具使用增加34%，与堕胎相关的死亡率降低0.065%，避免了52.11个DALY，而对照组为26.42个。
每避免一个DALY的ICER为25.50美元，远低于埃塞俄比亚的人均国内生产总值，按照世界卫生组织的标准，这使其具有很高的成本效益。通过卫生推广工作者扩大YFHS提供了一种变革性的、具有成本效益的战略，以促进埃塞俄比亚青少年性与生殖健康公平并实现全民健康覆盖。
