PLOS Global Public Health · 11 authors, 8 centres
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This cost-effectiveness analysis of the Sugira Muryango home-visiting trial among rural Rwandan families found that the intervention cost US$456 per family in the trial setting, likely to fall below US$200 if scaled through government systems, and achieved cognitive development gains per session (0.009 SDs) comparable to longer-duration home-visiting programmes.
The study estimates the cost and cost-effectiveness of the Sugira Muryango (SM) trial, a home-visiting intervention aimed at improving early childhood development (ECD) through positive parent-child relationships among rural Rwandan families linked to the social protection system. Cost analysis across three scenarios showed US$456 per family in the trial setting (Scenario 1), with projected reductions in Scenarios 2 and 3 reflecting economies of scale and integration into government systems. The largest expenditure categories were salaries and transport. The cost-effectiveness analysis used cognitive development improvement per home-visit session as a single comparable outcome. SM achieved 0.009 standard deviations of improvement per session, matching the Jamaica home-visiting intervention and exceeding several programmes in Peru, Colombia, India, and Bangladesh, while trailing interventions in Jamaica, Pakistan, Kenya, and Brazil. Limitations include reliance on modelled assumptions for Scenarios 2 and 3, and the use of a single cognitive outcome that may understate the value of SM's reductions in harsh discipline and intimate partner violence.
