A cost analysis to address issues of budget constraints on the implementation of the indoor residual spray programme in two districts of Maputo Province, Mozambique

BACKGROUND: It is frequently said that funding is essential to ensure optimal results from a malaria intervention control. However, in recent years, the capacity of the government of Mozambique to sustain the operational cost of indoor residual spraying (IRS) is facing numerous challenges due to restrictions of the Official Development Assistance. The purpose of the study was to estimate the cost of IRS operationalization in two districts of Maputo Province (Matutuíne and Namaacha) in Mozambique. The evidence produced in this study intends to provide decision-makers with insight into where they need to pay close attention in future planning in order to operationalize IRS with the existent budget in the actual context of budget restrictions. METHODS: Cost information was collected retrospectively from the provider perspective, and both economic and financial costs were calculated. A “one-way” deterministic sensitivity analysis was performed. RESULTS: The average economic costs totaled US$117,351.34, with an average economic cost per household sprayed of US$16.35, and an average economic cost per person protected of US$4.09. The average financial cost totaled US$69,174.83, with an average financial cost per household sprayed and per person protected of US$9.84 and US$2.46, respectively. Vehicle, salary, and insecticide costs were the greatest contributors to overall cost in the economic and financial analysis, corresponding to 52%, 17%, and 13% in the economic analysis and 21%, 27%, and 22% in the financial analysis, respectively. The sensitivity analysis was adapted to a range of ± (above and under) 25% change. There was an approximate change of 14% in the average economic cost when vehicle costs were decreased by 25%. In the financial analysis, the average financial cost was lowered by 7% when salary costs were decreased by 25%. CONCLUSIONS: Altogether, the current cost analysis provides an impetus for the consideration of targeted IRS operationalization within the available governmental budget, by using locally-available human resources as spray operators to decrease costs and having IRS rounds be correctly timed to coincide with the build-up of vector populations.