Is an integrated model of school eye health delivery more cost effective than a vertical model? An implementation research in Zanzibar

Abstract Objective To review and compare the cost effectiveness of the integrated model (IM) and vertical model (VM) of school eye health programme in Zanzibar. Methods and Analysis This 6-month implementation research was conducted in four districts in Zanzibar. Nine and ten schools were recruited into the IM and VM respectively. In the VM, teachers conducted eye health screening and education only while these eye health components were added to the existing School Feeding Programme (IM). The number of children screened and identified was collected monthly. A review of project accounts records was conducted with 19 key informants. The actual costs were calculated for each cost categories, and costs per child screened and cost per child identified were compared between the two models. Results Screening coverage was 96% and 90% in the IM and VM with 297 children (69.5%) from the IM and 130 children (30.5%) from VM failed eye health screening. The 6-month eye health screening cost for VM and IM was USD 6 728 and USD 7 355. The cost per child screened for IM and VM were USD 1.23 and USD 1.31, and the cost per child identified were USD 51.75 and USD 24.76 respectively. Conclusions Both models achieved high coverage of eye health screening with the IM being a more cost-effective school eye health delivery screening compared to VM with great opportunities for cost savings. Key messages There is a dearth of information on the actual cost of school eye health (SEH) delivery. This was the first implementation research to review and compare cost effectiveness of the integrated model (IM) versus the vertical model (VM) SEH delivery in Africa. VM used 1.2 times more resources per child screened compared to the IM and the cost per child identified in the VM is twice that of the IM, thus the IM is highly cost effective. Stakeholders in low- and middle-income settings will be better able to plan for a cost-effective SEH delivery model that suits their contexts and needs using these findings.