In sub-Saharan Africa, an estimated 15 million children under age 18 have lost one or both parents to AIDS. Losing adults in their prime years of production is a huge shock to a family’s economic and psychological wellbeing. The high prevalence of poverty, coupled with a lack of governmental safety nets in the sub-Saharan African region exacerbate AIDS-affected children’s prospect to succeed in life. Effective interventions are urgently needed to improve the life chances of these children. Given scarce economic resources, the region needs interventions that are cost-effective with multidimensional benefits.

Emerging evidence from a series of randomized controlled trials (RCTs) in Uganda shows that an innovative economic empowering intervention that promotes asset accumulation in the form of children’s savings accounts for education and family small business development may be a viable approach to improving multidimensional wellbeing among AIDS-affected children. Research on cost-effectiveness of program may help guide the assessment of feasibility to scale up these interventions. Against that backdrop, this study uses data from an RCT, called Bridges to the Future, and examines the cost-effectiveness of this economic empowering intervention on AIDS-affected children’s multidimensional wellbeing in Uganda. Particularly, we investigate how varying incentives and costs embedded in the intervention translate into benefits.

METHODS

The Bridges to the Future is a NICHD sponsored study that recruits children in grade 5 or 6 from 48 randomly selected primary schools in southwest districts of Uganda. In total, 1,410 students met the inclusion criteria (having lost one or both parents) and were recruited in 2012. The 48 schools were randomly assigned to three study arms: Usual Care (n=496), Bridges (n=402), and Bridges PLUS (n=512). Children in all study arms receive usual care for AIDS-orphaned children in the study area, consisting of counseling, school lunches and scholastic materials. Each child in each Bridges and Bridges PLUS arm receives the usual care intervention plus a Child Development Account; a 12-session of workshop on asset-building and future planning; regular mentorship meetings with undergraduate students; and income-generating activity training. Bridges and Bridges PLUS have varying financial incentives for participants to save. Bridges PLUS participants receive a 1:2 match-rate while Bridges participants receive a 1:1 match-rate. The intervention will be provided for 24 months. This paper examines cost-effectiveness during the first intervention year (using data from baseline and 12-month post-intervention initiation).

In this paper, we conduct a cost-effectiveness analysis that examines how much Bridges or Bridges PLUS costs to achieve a benefit (e.g., an additional year of schooling). We measure program costs on a per person basis. We draw costs data from the management information system for savings and project administrative records. We assess program effectiveness on a wide range of outcomes (e.g., educational performances, health and mental health, sexual risk intentions, and actual savings). We draw data from interviews and schools and banks administrative records. The per-person costs of Bridges and Bridges PLUS is then divided by the relevant effect sizes to produce estimates of cost-effectiveness. We calculate confidence intervals using Monte Carlo and bootstrap methods.