Cost Analysis of Delivering Sexual and Reproductive Health Services Among Adolescents and Young People in Zambia: Results from the Yathu Yathu Trial

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.