INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
Cost Analysis of Delivering Sexual and Reproductive Health Services  
Among Adolescents and Young People in Zambia: Results from the  
Yathu Yathu Trial  
Lawrence Mwenge, Chileshe Lesa, Leticia Chisanga, Mweete Chiluba, Helen Ayles, Peter Hangoma  
University of Zambia, School of Public Health  
DOI: https://dx.doi.org/10.51244/IJRSI.2025.12110021  
Received: 18 November 2025; Accepted: 27 November 2025; Published: 03 December 2025  
ABSTRACT  
Background: Adolescents and young people (AYP) in low- and middle-income countries (LMICs), including  
Zambia, face significant structural and social barriers to accessing essential Sexual and Reproductive Health  
(SRH) services. This challenge contributes to high rates of negative health outcomes, including early  
pregnancies, sexually transmitted infections (STIs), and HIV incidence. Evidence on the affordability and value-  
for-money of youth-tailored SRH interventions in Zambia is urgently needed to inform resource allocation. This  
study contributes to the literature on the cost of the SRH service delivery in Zambia.  
Methods: Following a provider perspective, we prospectively conducted an economic evaluation. An  
ingredient-based costing approach was used to calculate the total and unit costs of the SRH intervention  
compared to routine care. Effectiveness was measured as changes in the knowledge of HIV status among AYP.  
The primary outcomes were the unit costs by services for the trial arms and the standard of care (Youth-friendly  
corner model). Deterministic sensitivity analysis was conducted to assess changes in the Youth-friendly platform  
when key cost inputs were varied.  
Results: The YFC platform had a total cost of US$31,185.33 and a cost per person reached of US$4.66, while  
the iYFC platform cost US$27,084.90 with a cost per person of US$14.82, and the iCYFH platform cost  
US$217,411.91 with a cost per person of US$19.41. Integrated SRH service delivery ($371,235.98) in the  
iCYFH model was significantly more cost-efficient than parallel provision ($1,131,410.18), resulting in a  
potential saving of $760,174.20. Sensitivity analysis indicated that discount rate and project life years are key  
cost drivers, with personnel costs also significantly influencing unit costs. The incentivized community model,  
despite higher platform costs, offers substantial efficiency gains through integrated service delivery.  
Conclusion: The findings provide critical economic evidence necessary for decision-making regarding the  
scale-up of targeted SRH interventions for AYP in Zambia. This analysis supports policy efforts to prioritize  
and efficiently allocate resources toward effective SRH delivery models, ultimately improving health equity and  
outcomes for this population.  
BACKGROUND  
Adolescents and young people (AYP) in low- and middle-income countries face significant barriers to accessing  
sexual and reproductive health (SRH) services [1-8]. This vulnerability places them at a high risk of experiencing  
poor health outcomes that can lead to increased morbidity and mortality rates [9, 10]. In sub-Saharan Africa,  
AYP continue to face challenges such as early and unwanted pregnancies, unsafe abortions, and sexually  
transmitted infections (STIs), including HIV [1, 11-19]. In Zambia, the median age at first sex is 16.6 years for  
women and 18.5 years for men, with high fertility rates and low contraceptive prevalence rates among young  
people [20]. The country is also faced with high fertility rates among young women, with 88 and 144 births per  
1000 women aged 15-19 and 20-24 years, respectively [20]. Despite high knowledge of family planning, the  
contraceptive prevalence rate (CPR) remains low, at 12% and 35% for 15-19 and 20-24-year-olds, respectively  
[20]. Furthermore, the unmet need for contraceptives is substantial, with 13% of 15-19-year-old and 16% of 20-  
24-year-old women lacking access, despite a total demand of 25% and 52%, respectively [20]. Additionally,  
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INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
HIV prevalence among young people aged 15-24 years in Zambia is disproportionately estimated at 1.90% and  
3.8% for men and women, respectively [21, 22].  
Investing in the health of AYP is critical for future global health and development [23]. The World Health  
Organisation (WHO) recommends incentivised SRH programming as an effective strategy for improving SRH  
service uptake among AYP [24], which has shown promise in increasing SRH service utilisation among AYP in  
similar contexts [25-27]. However, information on the cost of SRH service delivery for young people in Southern  
Africa is limited. This study aims to address this research gap by calculating the cost and exploring the economies  
of scope (EOS) of incentivised SRH service delivery for adolescents and young people in Zambia. The findings  
of this study provide valuable insights for policymakers, program implementers, and stakeholders to inform  
resource allocation and decision making.  
METHODOLOGY  
Study setting  
This study was nested within a cluster-randomized trial called the Yathu Yathu (“For us by us”) trial, which aims  
to assess the impact of comprehensive community-based and peer-led SRH service delivery on knowledge of  
HIV status and coverage of SRH among adolescents and young people in Zambia. The trial was undertaken in  
two highly populated urban communities in Lusaka. The trial design has been described elsewhere[28]. Each  
community was divided into ten (10) geographical areas, consisting of five intervention and five control clusters.  
Each cluster consisted of approximately 2,350 young people aged 15–24 years, including approximately 500  
adolescent boys (15–19 years), 500 young men (20–24 years), 600 adolescent girls (15–19 years), and 700 young  
women (20–24 years). These estimates were based on unpublished data from a preceding study conducted in the  
two communities[29].  
Description of the trial implementation activities  
The Yathu Yathu trial was a cluster-randomized study designed to evaluate a comprehensive, community-based,  
and peer-led approach to improving SRH outcomes among AYP in Zambia. The main objective was to assess  
the impact of the trial intervention on knowledge of HIV status and the overall coverage of SRH services. The  
core of the intervention was the fixed community hubs staffed by Peer Support Workers (PSWs), lay counsellors,  
and rotating nurses, and situated away from, but linked to, government health facilities through a referral system.  
The hubs offered a range of comprehensive SRH services such as HIV services, sexually transmitted infections  
(STIs) treatment, and contraceptives. Additionally, they provided other health services, as well as non-health  
services (e.g. substance abuse screening)[28]. The second component was the Prevention Point Card (PPC)  
program, which worked like a retail loyalty card. The PPC allows AYP to accrue points every time they access  
pre-determined SRH services at the hubs or local clinics. The number of points awarded varied based on the  
service's importance (e.g., an HIV test earned more points than collecting condoms), and additional incentives  
("nudges") such as ‘bring a friend’ encourage peer mobilisation and referrals. Once sufficient points were  
accumulated, AYP could redeem them for rewards of their choice, which range from health/hygiene products  
(like sanitary pads and soap) to non-health services (like hair salon visits). The PPC program was implemented  
in both the intervention and control arms of the trial to collect service utilisation data and other trial data[28].  
The trial control arm formed a combination of the Standard of Care System and the PPC program, designed to  
provide the current standard of care for AYP at the local government health facility[28]. The standard of care  
structures for SHR service delivery are designed around the Youth-Friendly Corner model, which acts as the  
initial, low-barrier entry point for AYP [30, 31]. In this study, the Yathu Yathu hub and facility Youth-Friendly  
corner will both be synonymously referred to as youth-friendly platforms. The hub will be referred to as  
incentivised Community-based Youth-Friendly (iCYFH) platform, while the facility-based Youth-Friendly  
model and Yathu Yathu control arm shall be referred to as the ‘Facility-based Youth-Friendly corner (YFC)  
platform, and incentivised YFC (iCYFC) platforms  
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ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
Data collection  
Cost data collection  
Costing information was collected using a mixed research method by combining top-down (through expenditure  
reviews) and bottom-up (by reviewing field records and observations) approaches. Trial cost data were collected  
through the expenditure review to establish financial costs, coupled with field observations to account for  
opportunity costs and identify shared/overhead allocation factors[32-34]. During field observation, we first  
developed client pathways (process maps) to identify services accessed by AYPs and activities conducted for  
each service delivery. On the other hand, the cost data for routine SRH services at local government health  
facilities were collated through a facility costing survey[35], which involved process mapping and cost-tracking  
activities using informal discussions with key facility staff, observations, and record reviews. Following the  
development of process maps, we identified and quantified all resources associated with service delivery for  
each activity within the client or patient pathways. The SRH services for AYP were categorized into two main  
components: the "Youth-friendly platform," which included community engagement, rewards, training, and safe  
space coordination, and SRH-specific services, which comprised HIV testing, antenatal care, contraceptive  
services (both short-term and long-term), voluntary medical male circumcision, sanitary towel distribution,  
substance abuse screening, TB screening, active referrals, condom distribution, STI and syphilis screening, lab  
testing, and treatment.  
Study Sample Selection  
The study included all the ten Yathu Yathu hubs for the trial intervention activities, and two local public health  
facilities (one in each trial community) for the control arm and routine service delivery activities. Staff time is a  
crucial component in calculating personnel costs and should be measured accurately, particularly for personnel  
who are involved in multiple activities. In this study, a purposive sample of 1-3 key SRH service providers from  
relevant departments in each health facility was selected and observed while delivering services over two  
consecutive days. All project field staff members were included in both the trial and control arms. The sample  
size and sampling strategy for the trial service utilisation and outcome data are beyond the scope of this study,  
as the data were compiled from the PPC system (secondary outcomes) and the cross-sectional survey (primary  
outcome) [36-38].  
Data analysis  
Costing  
Cost data were analysed using Microsoft Excel (MS Excel 2013). The costing framework is presented in  
Supplementary Material S1. We calculated the total and unit costs for each SRH activity by service delivery  
modality. Our base case analysis included all costs associated with the Yathu Yathu trial setup and  
implementation, excluding the costs of research activities. Set-up costs for routine service delivery were not  
calculated due to feasibility constraints. The Set-up costs included all resources used to establish the trial,  
identified through activities conducted before the commencement of implementation. Implementation/service  
delivery costs accounted for all resources used for trial execution and routine service delivery. Total costs were  
calculated as the summation of the costs of all the youth-friendly activities and SRH services. As depicted in  
Equation i, both direct and indirect costs were accounted for.  
∑
(
) ∑  
+
(
=0  
)
=
(i); Where TC=total, DC=direct cost and IC =indirect cost, taking values of  
i=0-n  
=0  
Costs were categorised into capital (start-up, training, building, and equipment resources) and recurrent costs  
(personnel, non-medical, operations, and drugs). Capital costs were annualised over their economic life years  
using a 3% discount rate [39, 40]. Overhead and shared costs were allocated to service delivery activities based  
on predetermined allocation factors [35], verified with the service providers and project team as outlined in  
sections H and I of Supplementary Material S1, for the trial activities and routine services, respectively . Costs  
were further allocated to services based on the average time required to provide each service. Unit costs were  
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ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
calculated by dividing the total costs by the intermediate outcomes for trial costing and service utilisation data  
for routine service costing (equation ii).  
∑
(
)
/
= (  
(ii);  
=0  
Where AC=direct cost and TC=total, taking values of i=0-n, and N=number of recipients for each service  
All costs were adjusted for inflation and converted to 2020 United States dollars (US$) using the Consumer Price  
Index deflator for Zambia and the US$/Zambia Kwacha exchange rate [41]. The year 2020 was chosen as the  
base year for costing because most trial expenditures occurred in that year. The costing framework is presented  
in Supplementary S2.  
Cost analysis  
The total unit cost of SRH services was calculated by adding the unit cost of the youth-friendly platform to the  
SRH service-specific unit costs. The unit cost of the incentivised youth-friendly platform in the control arm was  
calculated by summing the unit costs of the routine youth-friendly corner and those of the trial activities.  
Finally, we descriptively explored the economies of scope (ES) to understand the cost efficiency, in terms of  
cost saving, of delivering SRH through the Yathu Yathu hub. ES arises when cost savings can be achieved by  
providing two or more services together compared to when they are provided separately [42]. The cost efficiency  
was measured in terms of the degree of economies of scope (DES), calculated as the quotient of the total cost of  
the Yathu Yathu intervention and the summation of the cost of parallel SRH service delivery using the same  
youth-friendly platform. The following formulas were used to calculate the ES and DES:  
= (  
(
) < (  
(
) +  
(
− 19) (iii); Where EOS is economies of scope and  
TC is total cost.  
(
)
(
)
“
+
−19  
=
”
(iv); where TC=Total Economic Costs, DSC=  
(
)
”
,
−19  
Degree of economies of scope; technical efficiency= DSC>1  
Sensitivity analysis  
Deterministic sensitivity analysis (DSA) was performed to investigate the responsiveness of the cost per person  
for the youth-friendly platform to changes in the key cost inputs, exchange rate, and discount rate [46]. We varied  
the unit cost of different cost inputs by minus or plus 20 percent (-/+20%) [47]. The discount rate was varied  
between 0% and 9.75%. Economic life years of the capital costs were varied as follows: buildings (25 and 50  
years), office equipment (2 and 4 years), fabricated office facilities (15 and 25 years), vehicles (5 and 10 years),  
and other capital assets (4 and 7 years). The project lifespan was considered at 1 year and 5 years as lower value  
and higher value, respectively. The results are presented on a ‘tornado diagram, ordering varied inputs according  
to the extent of variation of the resulting ‘cost per person’, with the widest variation at the top [32, 35].  
RESULTS  
Healthcare utilisation data  
Table 1 presents the detailed annual outcome data related to SRH service provision. Outcome data for the  
Routine service delivery model were not AYP-specific. The number of AYP enrolled in the trial was 20,092 for  
the control arm and 20,772 for the intervention arm. 10966 accessed services in the intervention arm, whereas  
the control arm only reached 1,614. The facility-based Youth Friendly model reached 4,950. Reward redemption  
points were significantly higher in the community hub at 8,803 than in the control arm, 494. The total number  
of individuals testing for HIV in the routine model was estimated at 32,352. but the community hub identified  
133 HIV-positive cases, which was proportionally similar to the other models. The community hub also had  
higher numbers of women receiving short-term hormonal contraceptives (859), antenatal care visits (84), and  
men undergoing circumcision (32). For sexually transmitted infections, the community hub screened 7,310  
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individuals, tested 678 for STIs, and identified 57 positive cases, with similar trends observed in syphilis testing  
and treatment.  
Table 1: Health Care Utilisation data  
Outcome&  
Routine  
Service  
delivery*  
Incentivised  
Routine Service fixed  
delivery&  
community  
hub&  
Incentivised  
Youth-friendly platform  
Number of AYP enrolled  
Number of AYP consented  
Number of AYP reached  
Number of AYP redeeming reward points  
SRH service  
-
20092  
20772  
-
4,950  
-
14498  
1614  
494  
14872  
10966  
8803  
IV testing services  
Number of persons tested for HIV*  
32352  
3012  
568  
4
8841  
133  
Number of persons who tested positive for  
HIV*  
Number of women who received short-term  
hormonal contraceptives  
15180  
50  
859  
Antenatal care visits  
24691  
5190  
36  
14  
84  
32  
Number of AYP who got circumcised using  
Voluntary Medical male circumcision  
Syphilis screening, testing & treatment  
Number of persons screened for STIs  
Number of persons tested for STIs  
2342  
2342  
231  
393  
129  
32  
7310  
678  
57  
Number of persons who tested positive for  
syphilis  
Number of persons treated for syphilis  
231  
32  
57  
*Throughputs for the Routine service delivery model were not AYP-specific; &Outcome data for  
incentivised routine and community hub are reported as annual average by dividing data collated  
for a period of 2 years by project life years  
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Costing results  
Standard Facility-Based Youth-Friendly Model  
Table 2 represents the cost of delivering services through a Facility-based Youth-friendly platform (Youth-  
friendly Corner), a standard of care for delivering youth-friendly SRH services to young people. The total cost  
of the youth-friendly platform was calculated at US$31,185.33, with capital costs accounting for (6.13%) and  
recurrent costs forming the larger proportion at 93.87%. Capital costs constitute buildings and facilities and  
equipment at US$1,289.82 and US$621.49, respectively. There were no start-up costs reported in this model, as  
the model had been in existence for many years before the study. Recurrent costs (US$29,274.02) were  
dominated by personnel at 95%. The costs of non-medical supplies and operations were calculated at US$935.46,  
US$295.04, and US$953.76, respectively, whereas the cost of medical supplies was US$124. The cost per person  
reached was calculated at US$4.66; US$0.54 for community engagement, and US$4.12 for Youth-friendly  
Corner coordination.  
The total cost of HIV testing was US$97,791.32 at a cost per person tested of US$2.91 and a cost per person  
tested positive of US$31.23. The total costs of ANC, short-term contraceptives, long-term contraceptives, and  
VMMC were US$123,290.94, US$94,063.01, US$4,228.69, and US$133,327.65, resulting in the cost per person  
of US$19.97, US$6.20, US$13.47 and US$250.69, respectively. The total cost of syphilis management was  
US$9,73013, comprising of STI screening (US$663.63), Rapid Plasma Reagin (RPR) testing (US$5,731.51) and  
treatment (US$3,331.99) costs, with a cost per person treated of US$39.52; US$0.28 for STI screening, US$2.45  
for RPR testing, US$24.81 syphilis case identified, and 14.42 for case treated.  
Incentivised Facility-Based Youth-Friendly Model  
This model introduces incentives (rewards) to facility-based youth-friendly services to encourage service uptake  
(Table 3). The total cost of youth-friendly platform was US$27,084.90, with capital costs of US$1,1340.38 and  
recurrent costs of US$25,950.52. The capital costs comprised building and facilities (63%), equipment (31%),  
and modest safe space start-up activities (6%). Similar to the facility-based youth-friendly model, recurrent costs  
were driven by personnel at US$22,9270.28. The total cost of non-medical supplies was US$2,412.36, and  
medical supplies were US$600.7. The operational costs were US$100.18. The cost per person was calculated as  
US14.82: US$0.54, US$6.02, and US$8.26 for community engagement, rewards, and safe space coordination,  
respectively.  
The total costs of SRH-specific services were US$626.95, US$688.14, US$1,066.61, US$825.77, and  
US$1,162.95, at cost per person of US$29.98, US$6.04, US$2.80, US$2.13 and US$2.96 for active referral to  
different service points within a local government health facility, alcohol and drug screening, TB screening,  
condom distribution, and STI Screening, respectively.  
Incentivised fixed Community-Based Youth-Friendly Model  
Table 4 presents the detailed costs of the incentivised fixed community youth-friendly platform. The total cost  
of youth-friendliness services was calculated at US$217,411.91, with capital and recurrent costs 13.94% and  
86.06%, respectively. Capital investments were driven by start-up costs (US$29,78195). The equipment costs  
were calculated at US$518.06. Like for the other two models, personnel cost formed (US$85,788.93), followed  
by non-medical supplies (US$85,261.33). Operations were the third driver at US$14,727.72, with medical  
supplies (US$1,332.91) being the lowest. The cost per person was calculated at US$19.41, comprising  
community engagement (US$2.40), reward programme (US$8.73) and safe space coordination (US$8.28).  
The total costs, with cost per person presented in parentheses, of SRH-specific services were US$106,633.22  
(US$129.57) for active referral, US$81,314.49 for HIV testing (US$9.20 per person tested and US$611.39 per  
person tested positive), US$27,393.88 (US$326.12) for ANC services, US$61,306.56 (US$US$71.37) for short-  
term contraceptives, US$7,204.44 (US$1.15) for sanitary pad distribution, US$6,087.53 (US$0.57 for alcohol  
and drug screening, US$10,957.56 (US$1.39) for TB screening, US$10,348.80 (US$2.07) for condom  
distribution, and US$15,117.37 (US$2.07) for STI screening.  
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Sensitivity analysis of Unit Cost for Youth-friendly platform  
The sensitivity analysis results showed that the unit cost estimates for the three youth-friendly platforms were  
influenced to varying degrees by different costing inputs (Figure 1). The discount rate was one of the most  
influential inputs, with unit costs increasing substantially from US$4.66 to US$7.61, US$14.81 to US$17.83,  
and US$19.41 to US$23.33, when the discount rate was set at Zambia’s economic policy rate of 9.25%, for the  
facility-based youth-friendly platform, incentivised facility-based youth-friendly platform, and incentivised  
fixed community-based youth-friendly platform, respectively. Project life year assumptions were another key  
cost driver, especially for the community model, where shorter project life years resulted in higher unit costs as  
capital costs are spread over fewer years than longer project life years. Unit costs were also responsive to the  
changes in the personnel costs; a -/+20% change in personnel costs leads to a substantial change in the unit cost.  
In contrast, changes in the economic life of buildings, vehicles, equipment, and other assets, as well as changes  
in building and facility costs, have a minimal effect on unit cost outcomes. Similarly, -/+20% variations in  
medical supplies and operational costs had only a small impact.  
Economies of scope for service delivery at a fixed incentivised community hub  
Table 5 presents the economics of the scope of providing SRH services at a fixed incentivised community Youth-  
friendly platform, comparing parallel and integrated service delivery models. The table presents the costs of HIV  
testing, antenatal care, short-term contraceptives, sanitary towels, alcohol and drug screening, TB screening,  
condom distribution, and STI Screening services. We estimated a total cost of $371,235.98 for service integration  
and $1,131,410.18 for parallel service delivery, with a degree of economies of scope (DSC) of 3.05, indicating  
that integrated service delivery is three times more cost-efficient, resulting in a potential cost saving of  
$760,174.20, underscoring the approach’s financial gains.  
Table 2: Costs of delivering SRH services through a standard Facility-based Youth-friendly platform  
(Youth-friendly Corner)  
Youth-friendly  
SRH-specific costs  
platform  
Syphilis  
Com  
mun  
ity  
enga  
gem  
ent  
Short Long  
Tr  
La eat  
HI  
V
al test  
ing  
Cost line  
Capital  
ST  
I
Scr  
een  
ing  
Safe  
spac  
e
-term -term  
contr contr  
acept acept  
Tot  
AN  
C
VM  
MC  
b
me Tot  
test nt  
ing cos  
ts  
al  
ives  
ives  
1,2 1,1  
89. 61.  
Buildings &  
facilities  
437. 852.  
48 34  
2,14 1,193  
0.42 .92  
847. 9.7 68. 1.9 6,73  
88 11 2.47  
19.53  
2
5
82  
13  
216. 404. 621 691 1,57 1,246 794.2 4,83 11. 74. 53. 9,90  
Equipment  
Start-up  
96  
52  
.49 .11 6.67  
.38  
6
5.18 42  
22  
82 4.54  
-
-
-
-
-
-
-
-
-
-
-
-
1,9 1,8  
11. 52.  
16,6  
37.0  
2
654. 1,25  
44 6.86  
3,71 2,440 813.7 5,68 21. 142 55.  
7.09 .31 3.06 13 .33 76  
Total capital  
9
31  
24  
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ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
Recurrent  
-
18,2 27, 35, 39,3  
61.2 900 362 24.0  
65,6  
06.7  
3
1,9  
89.  
25  
198,  
736.  
41  
9,63  
9.65  
27,83 518.9  
169  
.87  
26.  
8
Personnel  
7.15  
7
5
.90 .68  
6
2,3  
51.  
17  
102. 192. 295  
1,43 822.0  
8.52  
2,28 141 113 1.2 7,46  
General supplies  
Operations  
15.76  
13  
91  
.04  
6
6.42 .68 .49  
9
5.43  
7,5  
58.  
86  
19 17,9  
2.2 22.4  
12.0 18.  
29  
3,42 3,455  
1.55 .97  
2,70 286 201  
0.01 .11 .92  
6.25  
87.48  
4
2
1
50,  
666  
.37  
48,5  
82.5  
7
3,2 12 107,  
84. 6.5 594.  
Medical  
supplies  
334. 600. 935  
54 93 .46  
2,52 1,176 253.0  
47.  
83  
1.63  
.39  
7
52  
1
36  
72,8  
68.0  
9
2,9 145,  
29. 261.  
44.0 80.2 124  
.33  
58,33 2,539 8,46  
Drugs  
-
-
-
5
8
1.14  
.61  
8.86  
41  
44  
29, 95, 119,  
274 939 573.  
127,  
644.  
59  
5,5 3,2 476,  
89. 76. 980.  
10,1 19,1  
26.6 47.4  
91,62 3,414  
2.71 .90  
645  
.49  
Total recurrent  
Total  
.03 .08  
85  
18  
23  
05  
2
1
10,7 20,4 31, 97, 123,  
81.0 04.2 185 791 290.  
133,  
327.  
65  
5,7 3,3 493,  
31. 31. 617.  
94,06 4,228  
666  
.63  
3.01  
.69  
6
7
.33 .32  
94  
51  
99  
07  
323  
234  
2
(23  
1)  
Denominator  
(positive results)  
2009 495  
52 617 1518  
(30  
12)  
519 234  
23  
1
-
314  
-
2
0
3
0
0
2
2.9  
1
(31  
.23  
)
2.4  
5
(24. 42  
81)  
Cost per person  
(person tested  
positive)  
4.6  
6
19.9  
7
25.6 0.2  
14. 39.5  
0.54 4.12  
6.20 13.47  
9
8
2
Table 3: Costs of delivering SRH services through an Incentivised standard Facility-based Youth-  
friendly platform  
Cost input  
Youth-friendly platform  
SRH - specific costs  
Safe  
Total  
Active Alcohol  
referra & drug  
screenin ning  
TB  
STI  
Comm Rewar space  
scree Cond Scree  
unity  
engage  
ment  
ds  
l
om  
ning  
g
distri  
butio  
n
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Capital  
Buildings &  
facilities  
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
437.48  
216.96  
-
277.91  
131.90  
70.13  
715.39  
348.86  
70.13  
Equipment  
Start-up  
-
-
Total capital  
0
0
654.44  
479.94 1,134.38  
-
-
-
-
Recurrent  
Personnel  
9,639.6 1,008. 12,279. 22,927.2 5,770.7 658.88  
09 55  
1,021. 790.66 1,113  
27 .51  
5
8
1
General  
supplies  
102.13 1,966. 343.76  
46  
2,412.36 256.23 29.26  
45.35 35.11 49.44  
Operations  
6.25  
-
-
3.93  
10.18  
-
-
-
-
-
-
-
-
-
-
Medical  
supplies  
378.59  
222.12  
600.70  
Total recurrent  
10,126. 2,974. 12,849. 25,950.5 6,026.9  
62 56 35  
688.14  
1,066. 825.77 1,162  
61 .95  
2
5
Total  
10,781. 2,974. 13,329. 27,084.9 6,026.9  
688.14  
1,066. 825.77 1,162  
06  
56  
29  
0
5
61  
.95  
393  
2.96  
Denominator  
20092  
0.54  
494  
6.02  
1614  
8.26  
201  
29.98  
114  
381  
2.80  
387  
Cost per  
person  
14.82  
6.04  
2.13  
Table 4: Costs of delivering SRH services through an Incentivised fixed Community-Based Youth-  
Friendly Model (Community Hub)  
Youth-friendly  
platform  
Cost line  
SRH - specific costs  
Co  
H
Al  
Short  
-term  
contr  
acept  
ives  
Con  
dom  
dist  
ribu  
tion  
Saf  
e
Act HI  
Tot ive  
spa al refe testi  
ce rral ng  
TB  
scr  
een  
ing  
STI  
Scr  
een  
ing  
mm  
unit  
y
eng  
age  
yg co  
ie hol  
ne  
se dr  
rvi ug  
Re  
wa  
rds  
V
AN  
C
&
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men  
t
ce scr  
s
ee  
nin  
g
Capital  
28  
8.8  
2
13  
181. 47.  
73 51  
518 543 182.  
24. 31. 55. 52.7 77.  
84 06 12  
Equipment  
Start-up  
9.7 74.53  
5
.06 .99  
97  
9
9
29,  
29,  
782  
.95  
20  
3.3  
9
531. 69. 18  
36 15 2.4  
4
791 266.  
108.4 36. 45. 81. 76.8 112  
.73  
3
8
16  
2
36  
4
.24  
29,  
11  
6.6  
6
30, 1,3  
301 35.  
34  
3.1  
4
713.  
09  
47  
1.2  
6
449.  
27  
183.0  
1
76. 137 129. 189  
Total capital  
Recurrent  
Personnel  
61  
25 .26  
63  
.37  
.02  
72  
42,  
02  
9.2  
2
20,  
36,8 6,9  
45.2 14.  
85, 79, 26,6  
788 162 26.0  
3,6 4,5 8,1  
15. 19. 34.  
42 27 69  
11,  
222  
.86  
33 53,56  
6.7 4.72  
2
7,68  
2.76  
3
48  
.93 .56  
4
68, 10,  
6,51 39 35  
8.01 3.0 0.2  
85, 9,3  
261 58.  
.33 11  
2,4  
2,7 53  
1,3  
26.  
70  
General  
supplies  
4,02  
9.22  
1,282  
04.  
961 908.  
61. 4.2  
81  
.18  
.63  
21  
08  
4
5
7
1,3 8,1 14, 15,  
36. 21. 727 297  
14 64 .72 .21  
3,9  
69 87 1,5  
8.6 3.2 71.  
2,1  
68.  
68  
5,26  
9.94  
5,14  
5.16  
2,095  
29.  
1,48  
4.60  
Operations  
.91  
83  
4
9
93  
12 78 1,3 1,4 45,0 38  
9.2 5.5 32. 79. 64.8 0.1 235.3  
Medical  
supplies  
418.  
11  
67. 84. 152 143. 209  
58 47 .04  
6
.77  
4
6
91 62  
0
1
3,945  
.44  
Drugs  
-
-
-
-
-
-
-
-
-
-
-
-
76, 61, 187 105  
77 28 ,11 ,29  
2.9 6.6 0.8 7.5  
27,  
49,0  
51.2  
9
80,8  
65.2  
2
7,1 6,0 10, 10,2 14,  
43. 11. 820 19.1 928  
Total  
recurrent  
05 61,12  
0.7 3.55  
4
44 28 .30  
7
.00  
1
9
9
0
76, 90, 217 106  
88 75 ,41 ,63  
9.5 7.9 1.9 3.2  
27,  
49,7  
64.3  
8
81,3  
14.4  
9
7,2 6,0 10, 10,3 15,  
04. 87. 957 48.8 117  
39 61,30  
3.8 6.56  
8
Total  
44 53 .56  
0
.37  
7
5
1
2
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884  
1
(13  
3)  
Denominator  
(positive  
results)  
10  
96  
6
10  
76  
9
207 88  
62  
49  
787 498 731  
823  
84  
859  
72  
03  
7
9
0
Cost per  
person  
(person  
tested  
9.20  
32  
8.7 8.2 19. 129 (61  
1.1 0.5 1.3  
2.0  
7
2.40  
6.1 71.37  
2
2.07  
3
8
41  
.57 1.39  
)
5
7
9
positive)  
Figure 1: Sensitivity analysis of Unit Cost for Youth-friendly platform  
Table 6: Economies of Scope Analysis Results  
Activity  
Parallel service delivery  
Integr  
ated  
service  
deliver  
y
HIV Anten Short- Hygi Alco  
TB Cond STI Total  
scre om Scre  
enin distri enin  
testin  
g
atal  
term  
ene  
hol  
&
care contra servi  
ceptiv ces drug  
es  
g
butio  
n
g
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scree  
ning  
Youth-  
friendly  
platform  
171,5 1,630. 16,670 121, 208,9 152, 96,81 141, 911,6  
212,81  
1.91  
73.06  
15  
.20 271. 88.82 865.  
35 16  
9.13 861. 79.55  
67  
SRH  
service-  
specific  
81,31 27,39 61,306 7,20 6,087 10,9 10,34 15,1 219,7  
158,42  
4.07  
4.49  
3.88  
.56 4.44  
.53 57.5  
6
8.80 17.3 30.63  
7
Total cost  
(TC)  
252,8 29,02 77,976 128, 215,0 163, 107,1 156, 1,131,  
87.55 4.03 .76 475. 76.35 822. 67.93 979. 410.1  
79 72 04  
371,23  
5.98  
8
Degree of Economies of Scope (DSC)  
Cost saved  
3.05  
760,17  
4.20  
DISCUSSION  
To the best of our knowledge, this study is the first to explore the costs of SRH for young people in Zambia,  
filling a critical evidence gap in the country's health policy and planning landscape. The report presents a  
comprehensive analysis of the costs of three different alternatives for delivering sexual and reproductive health  
(SRH) services to young people in Zambia: the standard facility-based, youth-friendly, incentivized facility-  
based youth-friendly, and incentivised fixed Community-Based Youth-Friendly Models. The results show that  
the cost per person of the youth-friendly platform varies significantly across the three models, with the  
incentivised fixed Community-Based Model being the most expensive, followed by the incentivised Standard  
Facility-Based Modality. Recurrent costs, primarily driven by personnel expenses, constituted the largest  
proportion of costs in all three models. The study also provides detailed costs for specific SRH services, such as  
HIV testing, ANC, and contraceptives, highlighting the variations in costs across the models.  
Furthermore, the sensitivity analysis revealed that the key cost drivers were the discount rate, personnel costs,  
and project life years. For example, increasing the discount rate to Zambia's economic policy rate significantly  
raised unit costs across all models. This demonstrates the importance of considering economic conditions when  
projecting the costs. A 20% change in personnel costs led to substantial fluctuations in the cost per person across  
all three models. This indicates that careful management of human resource costs is critical for maintaining the  
cost efficiency of these models. In contrast, capital costs and assumptions about the economic life of assets had  
minimal effects on unit costs, suggesting that recurrent costs, such as personnel and operational inputs, are the  
primary concern in these service delivery models.  
The analysis of economies of scope in delivering sexual and reproductive health services for AYP at a fixed  
incentivised community hub revealed the significant advantages of adopting an integrated service delivery model  
over a parallel approach. By combining various services, such as HIV testing, antenatal care, contraceptive  
provision, and screenings for tuberculosis and sexually transmitted infections, the integrated model demonstrates  
a higher level of cost-efficiency. This is evidenced by the substantial cost difference between the two models,  
with integration resulting in considerable savings. The findings suggest that integrating these services not only  
enhances accessibility and convenience for users but also optimises resource utilisation, leading to a more  
sustainable financial framework for community health initiatives in the future. Ultimately, this approach  
highlights the potential for improved health outcomes while simultaneously reducing operational costs, making  
it a strategic choice for public health planning.  
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These findings have important implications for policymakers and program managers seeking to scale up youth-  
friendly SRH services, providing valuable insights into the potential cost savings and cost-efficiency. Our results  
can inform resource allocation decisions, highlighting the need to balance costs with service quality and  
accessibility. Furthermore, the variations in costs across the Youth-friendly platforms and services suggest that  
a one-size-fits-all approach may not be suitable, and context-specific considerations are essential when designing  
and implementing youth-friendly SRH programs. These findings suggest that no single model is universally  
optimal; rather, a hybrid approach leveraging facility-based care for complex services and community models  
for preventive outreach may maximise cost-efficiency and health impact. Importantly, these data provide a  
foundation for a more detailed cost-effectiveness analysis, budgeting, and resource mobilisation efforts to  
support scale-up of integrated SRH and HIV services in resource-constrained settings.  
Our findings are consistent with prior studies that have highlighted the importance of integrated service delivery  
in optimising resource utilisation and improving health outcomes [48-51]. A study in Zambia found that  
integrated services were found to be more efficient and cost-effective than vertical service provision [52]. Like  
a study in Kenya and Swaziland [53], our study found that personnel costs form the largest proportion of the  
costs of most services, but HIV testing services of which it was second, following medical consumables. Another  
study in Kenya found that integrating SRH services with HIV services resulted in cost-efficiency.  
This study has several limitations that impact the generalizability and validity of the findings. Firstly, the study's  
focus on two densely populated urban communities limits the applicability of the results to rural settings or other  
urban areas with different socio-economic contexts. Secondly, the exclusion of costs associated with AYP’s time  
and productivity loss may also affect the overall cost estimates. Furthermore, the study's short time frame may  
not capture the long-term sustainability and cost-effectiveness of the interventions. The outcome data were  
derived from client loyalty cards, health information systems, and cross-sectional surveys, which may not fully  
capture the impact of the interventions on other important health outcomes. The study did not account for all  
potential confounding factors, and the cluster-randomised trial design may have been affected by spill-over  
effects. Moreover, the incentivised reward system may introduce biases in reporting and service utilisation.  
These limitations should be considered when interpreting the findings, and further research is needed to address  
these limitations and enhance the understanding of effective SRH service delivery strategies in diverse contexts.  
Notwithstanding these limitations, our study presents a comprehensive economic evaluation of sexual and  
reproductive health (SRH) service delivery models for AYP in Zambia, addressing a critical gap in the existing  
literature. By employing a robust methodology that includes micro-costing, sensitivity analyses, and the  
assessment of economies of scope, the research provides detailed insights into the costs of various SRH  
interventions. The inclusion of diverse service delivery models—standard facility-based, incentivised facility-  
based, and incentivised community-based—enables a nuanced comparison that is valuable for policymakers.  
Furthermore, the study's findings contribute to optimising resource allocation and enhancing the efficiency of  
SRH services in resource-constrained settings, thus supporting the development of evidence-based health  
policies tailored to the needs of AYP. The ethical rigour, with approval from relevant ethics committees and  
informed consent from participants, further strengthens the study's credibility and relevance.  
CONCLUSION  
This study provides the first comprehensive exploration of the costs of sexual and reproductive health (SRH)  
service delivery for AYP in Zambia, addressing a crucial evidence gap in the country’s health policy landscape.  
The analysis compares three models: the standard facility-based youth-friendly platform, an incentivised facility-  
based model, and an incentivised community-based hub. Results reveal significant variation in cost per person  
across these models, with the community-based hub being the most expensive, primarily driven by personnel  
costs, which form the largest portion of recurrent expenses. The study also demonstrates the potential advantages  
of integrated service delivery, showing that economies of scope can lead to substantial cost savings while  
enhancing access and efficiency. Further, the findings provide valuable insights for policymakers and program  
implementers. They underscore the importance of tailoring SRH delivery approaches to maximise cost efficiency  
and health in resource-constrained settings.  
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ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
REFERENCE  
1. Namukonda, E.S., et al., Sexual and reproductive health knowledge, attitudes and service uptake barriers  
among Zambian in-school adolescents: a mixed methods study. Sex Education, 2021. 21(4): p. 463-479.  
2. Mbizvo, M.T. and S. Zaidi, Addressing critical gaps in achieving universal access to sexual and  
reproductive health (SRH): the case for improving adolescent SRH, preventing unsafe abortion, and  
enhancing linkages between SRH and HIV interventions. International Journal of Gynecology &  
Obstetrics, 2010. 110: p. S3-S6.  
3. Dennis, M.L., et al., Pathways to increased coverage: an analysis of time trends in contraceptive need and  
use among adolescents and young women in Kenya, Rwanda, Tanzania, and Uganda. Reproductive  
health, 2017. 14(1): p. 1-13.  
4. Cortez, R., M. Quinlan-Davidson, and S. Saadat, Challenges for Adolescent's Sexual and Reproductive  
Health within the Context of Universal Health Coverage. 2014.  
5. Chandra-Mouli, V., C. Lane, and S. Wong, What does not work in adolescent sexual and reproductive  
health: a review of evidence on interventions commonly accepted as best practices. Global Health: Science  
and Practice, 2015. 3(3): p. 333-340.  
6. Brittain, A.W., et al., Youth-Friendly Family Planning Services for Young People: A Systematic Review  
Update. American Journal of Preventive Medicine, 2018. 55(5): p. 725-735.  
7. Birhan, Z., K. Tushune, and M.G. Jebena, Sexual and reproductive health services use, perceptions, and  
barriers among young people in southwest Oromia, Ethiopia. Ethiopian journal of health sciences, 2018.  
28(1): p. 37-48.  
8. Abdurahman, C., et al., Sexual and reproductive health services utilization and associated factors among  
adolescents attending secondary schools. Reproductive health, 2022. 19(1): p. 161.  
9. WHO, Adolescent and young adult health. 2024: https://www.who.int/news-room/fact-  
sheets/detail/adolescents-health-risks-and-solutions.  
10. Wong, W.C.W., Gaps in Sexual and Reproductive Health in Young People, in Gaps and Actions in Health  
Improvement from Hong Kong and Beyond: All for Health, B.Y.F. Fong and W.C.W. Wong, Editors.  
2023, Springer Nature Singapore: Singapore. p. 243-254.  
11. Peterson, J.M., et al., Turned Away and at Risk: Denial of Family Planning Services to Women in Malawi.  
Studies in family planning, 2022. 53(2): p. 281-299.  
12. Nkosi, B., et al., Exploring adolescents and young people’s candidacy for utilising health services in a  
rural district, South Africa. BMC health services research, 2019. 19(1): p. 1-12.  
13. HIV/AIDS, J.U.N.P.o., Male engagement in HIV testing, treatment and prevention in eastern and southern  
Africa: a framework for action. 2022.  
14. Denison, J.A., et al., Youth engagement in developing an implementation science research agenda on  
adolescent HIV testing and care linkages in sub-Saharan Africa. AIDS (London, England), 2017. 31(Suppl  
3): p. S195.  
15. Cooper, C.M., et al., Integrated Family Planning and Immunization Service Delivery at Health Facility  
and Community Sites in Dowa and Ntchisi Districts of Malawi: A Mixed Methods Process Evaluation.  
International Journal of Environmental Research and Public Health, 2020. 17(12): p. 4530.  
16. UNESCO, U., Young people today. Time to act now. Why adolescents and young people need  
comprehensive sexuality education and sexual and reproductive health services in Eastern and Southern  
Africa. 2013, Geneva: UNESCO.  
17. Wigle, J.M., et al., Participation of young women in sexual and reproductive health decision-making in  
Malawi: Local realities versus global rhetoric. PLOS Global Public Health, 2022. 2(11): p. e0001297.  
18. Wangamati, C.K., Comprehensive sexuality education in sub-Saharan Africa: adaptation and  
implementation challenges in universal access for children and adolescents. Sexual and Reproductive  
Health Matters, 2020. 28(2): p. 1851346.  
19. Ninsiima, L.R., I.K. Chiumia, and R. Ndejjo, Factors influencing access to and utilisation of youth-  
friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review. Reproductive  
health, 2021. 18(1): p. 1-17.  
20. Zambia Statistics Agency , Ministry of Health (MOH) Zambia , and ICF, Zambia Demographic and  
Health Survey 2018. 2019, Zambia Statistics Agency, Ministry of Health, ICF: Lusaka, Zambia.  
Page 242  
         
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
21. Ministry of Health, Zambia Population-based HIV Impact Assessment (ZAMPHIA) 2021: Final Report.  
2023, Ministry of Health: Lusaka, Zambia.  
22. Mulenga, L.B., et al., Comparison of HIV prevalence, incidence, and viral load suppression in Zambia  
population-based HIV impact assessments from 2016 and 2021. AIDS, 2024. 38(6): p. 895-905.  
23. Organization, W.H., Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to  
support country implementation. 2023: World Health Organization.  
24. WHO, Global accelerated action for the health of adolescents (AA-HA!): guidance to support country  
implementation: summary. 2017, World Health Organization.  
25. Arur, A., et al., Insights from innovations: lessons from designing and implementing family  
planning/reproductive health voucher programs in Kenya and Uganda. Bethesda: Private Sector  
Partnerships-One project, Abt Associates Inc, 2009: p. 23-38.  
26. Ashraf, N., E. Field, and J. Lee, Household bargaining and excess fertility: an experimental study in  
Zambia. American Economic Review, 2014. 104(7): p. 2210-37.  
27. Chhabra, E., Applying Behavioral Science to Family Planning and Reproductive Health Challenges in  
Sub-Saharan Africa. 2015: Woodrow Wilson School of Public & International Affairs, Princeton  
University.  
28. Hensen, B., et al., Yathu Yathu (“For us, by us”): Design of a cluster-randomised trial of the impact of  
community-based, peer-led comprehensive sexual and reproductive health services for adolescents and  
young people aged 15 to 24 in Lusaka, Zambia. Contemporary Clinical Trials, 2021. 110: p. 106568.  
29. Shanaube, K., et al., Impact of a community-wide combination HIV prevention intervention on knowledge  
of HIV status among adolescents. AIDS (London, England), 2021. 35(2): p. 275.  
30. Fikree, F.F. and H. Zerihun, Scaling up a strengthened youth-friendly service delivery model to include  
long-acting reversible contraceptives in Ethiopia: a mixed methods retrospective assessment. International  
Journal of Health Policy and Management, 2020. 9(2): p. 53.  
31. Ipas, The youth-friendly corner: Where all young people find safe, respectful health care. 2015.  
32. Mangenah, C., et al., Economic cost analysis of door‐to‐door community‐based distribution of HIV self‐  
test kits in Malawi, Zambia and Zimbabwe. J Int AIDS Soc, 2019. 22: p. e25255.  
33. Hrifach, A., et al., Mixed method versus full top-down microcosting for organ recovery cost assessment  
in a French hospital group. Health economics review, 2016. 6(1): p. 53.  
34. Raftery, J., Costing in economic evaluation. BMJ (Clinical research ed.), 2000. 320(7249): p. 1597-1597.  
35. Mwenge, L., et al., Costs of facility-based HIV testing in Malawi, Zambia and Zimbabwe. PloS one, 2017.  
12(10): p. e0185740.  
36. Hensen, B., et al., The impact of community-based, peer-led sexual and reproductive health services on  
knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The  
Yathu Yathu cluster-randomised trial. PLoS Medicine, 2023. 20(4): p. e1004203.  
37. Hensen, B., et al., Uptake of HIV Testing Services Through Novel Community-Based Sexual and  
Reproductive Health Services: An Analysis of the Pilot Implementation Phase of the Yathu Yathu  
Intervention for Adolescents and Young People Aged 15–24 in Lusaka, Zambia. AIDS and Behavior,  
2022. 26(1): p. 172-182.  
38. Phiri, M.M., et al., The impact of an innovative community-based peer-led intervention on uptake and  
coverage of sexual and reproductive health services among adolescents and young people 15–24 years  
old: results from the Yathu Yathu cluster randomised trial. BMC public health, 2024. 24(1): p. 1424.  
39. Haacker, M., T.B. Hallett, and R. Atun, On discount rates for economic evaluations in global health.  
Health Policy and Planning, 2019. 35(1): p. 107-114.  
40. Smith, D. and H. Gravelle, The practice of discounting economic evaluation of health care interventions.  
2000: University of York, Centre for Health Economics York.  
41. Zambia  
Statistics  
Agency,  
The  
Monthly  
Bulletin.  
2020,  
https://www.zamstats.gov.zm/index.php/publications/category/39-2020?download=401:vol-213-2020-  
the-monthly-december.  
42. Ferreira, D.C., R.C. Marques, and A.M. Nunes, Economies of scope in the health sector: The case of  
Portuguese hospitals. European Journal of Operational Research, 2018. 266(2): p. 716-735.  
43. SAENGOW, U., Decision Rules in Cost-Utility Analysis of Health Technologies. Walailak Journal of  
Science and Technology (WJST), 2021. 18(3): p. 7357 (9 pages)-7357 (9 pages).  
Page 243  
                               
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
44. WHO Commission on Macroeconomics and Health, Macroeconomics and health : investing in health for  
economic development / report of the Commission on Macroeconomics and Health. 2001, World Health  
Organization: Geneva.  
45. Hutubessy, R.C., et al., Stochastic league tables: communicating cost‐effectiveness results to decision‐  
makers. Health Economics, 2001. 10(5): p. 473-477.  
46. York; York Health Economics Consortium, Deterministic Sensitivity Analysis [online]. 2016.  
47. Golovaty, I., et al., Cost of Integrating Noncommunicable Disease Screening Into Home-Based HIV  
Testing and Counseling in South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes,  
2018. 78(5): p. 522-526.  
48. Buthelezi, U.E., et al., Optimizing the role and functions of CHWs in service of a people-centred  
community health system in sub-Saharan Africa. A realist synthesis. SSM - Health Systems, 2025. 5: p.  
100089.  
49. Okoroafor, S.C. and C.D. Christmals, Optimizing the roles of health workers to improve access to health  
services in Africa: an implementation framework for task shifting and sharing for policy and practice.  
BMC Health Services Research, 2023. 23(1): p. 843.  
50. Gwaza, G., et al., Integrated Diagnosis in Africa's Low- and Middle-Income Countries: What Is It, What  
Works, and for Whom? A Realist Synthesis. Int J Integr Care, 2024. 24(3): p. 20.  
51. Han, L. and Y. Tian, Enhancing Healthcare Delivery through IntegratedManagement Strategies: A Multi-  
Sector Approach. International Journal of Social Sciences and Public Administration, 2024. 4(1): p. 219-  
226.  
52. Hewett, P.C., et al., Randomized evaluation and cost-effectiveness of HIV and sexual and reproductive  
health service referral and linkage models in Zambia. BMC Public Health, 2016. 16(1): p. 785.  
53. Obure, C.D., et al., The costs of delivering integrated HIV and sexual reproductive health services in  
limited resource settings. PloS one, 2015. 10(5): p. e0124476.  
Page 244