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Research
Cost and cost-effectiveness of a parenting programme to prevent violence against adolescents in South Africa
  1. Alice Redfern1,2,
  2. Lucie D Cluver1,3,
  3. Marisa Casale1,4,
  4. Janina I Steinert1,5
  1. 1Social Policy and Intervention, University of Oxford, Oxford, UK
  2. 2IDinsight, Nairobi, Kenya
  3. 3Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
  4. 4School of Public Health, University of Western Cape, Cape Town, South Africa
  5. 5Department of Economics, Georg-August-Universitat Gottingen, Gottingen, Germany
  1. Correspondence to Dr Alice Redfern; alice.redfern28{at}gmail.com

Abstract

Introduction This paper presents the costs and cost-effectiveness of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a non-commercialised parenting programme aimed at preventing violence against adolescents in low-income and middle-income countries.

Methods The effectiveness of Sinovuyo Teen was evaluated with a cluster randomised controlled trial in 40 villages and peri-urban townships in the Eastern Cape of South Africa from 2015 to 2016. The costs of implementation were calculated retrospectively and models of costs at scale estimated, from the perspective of the programme provider. Cost-effectiveness analysis considers both the cost per incident of abuse averted, and cost per disability-adjusted life year averted. Potential economic benefits from the societal perspective were estimated by developing a framework of possible savings.

Results The total implementation cost for Sinovuyo Teen over the duration of the trial was US$135 954, or US$504 per family enrolled. Among the 270 families in the treatment group, an estimated 73 incidents of physical and emotional abuse were averted (95% CI 29 to 118 incidents averted). During the trial, the total cost per incident of physical or emotional abuse averted was US$1837, which is likely to decrease to approximately US$972 if implemented at scale. By comparison, the economic benefits of averting abuse in South Africa are large with an estimated lifetime saving of US$2724 minimum per case.

Conclusion Parenting programmes are a cost-effective intervention to prevent the abuse of adolescents by their caregivers in South Africa, when compared with existing violence prevention programmes and cost-effectiveness thresholds based on GDP per capita.

  • public health
  • health economics
  • prevention strategies
  • child health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2018-001147

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors AR, LDC, MC and JIS contributed towards conceptualising and designing this study. AR conducted data acquisition, cleaning and analysis. All authors provided comments towards drafts of the article and approved the final version for publication.

    • Funding AR was funded to complete this study by the Oxford University Clinical Academic Graduate School Research Elective Bursary. The intervention and randomised controlled trial were supported by the European Research Council (ERC) under the European Union’s Seventh Framework Programme (FP7/2007–2013) with ERC grant agreement 313421, Unicef Innocenti Office of Research, Unicef South Africa, the John Fell Fund, the Leverhulme Trust (PLP-2014-095), the Cambridge Trust and the University of Oxford’s ESRC Impact Acceleration Account (1311-KEA-004 and 1602-KEA-189). The South African National Department of Social Development provided in-kind support through posting social workers to be trained as programme facilitators. Ongoing scale-up of the programme is being supported by USAID, PEPFAR, Unicef South Africa and World Childhood Foundation. LDC, MC and JIS had full access to all the data in the study. AR had final responsibility for the decision to submit for publication.

    • Disclaimer The funders of this study had no role in study design, data collection, data analysis or writing of the report.

    • Competing interests LDC and JIS were involved in developing the Sinovuyo Caring Families

      Programme for Parents and Teens, which is licensed under a Creative Commons 4.0 Noncommercial

      No Derivatives license.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval for the trial was obtained from the Institutional Review Boards

      of the University of Oxford (SSD/CUREC2/11-40) and University of Cape Town (PSY2013-46)

      and by the Provincial Government Departments of Social Development and Education.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No additional data are available