Cost Comparison Activity

How might we support families to access health services that they previously thought were unaffordable?

Countries: The Democratic Republic of the Congo, adapted in Nigeria and Togo

Health Areas: Integrated Health, Nutrition, Family Planning/Reproductive Health

Context and Insights

According to the World Bank, the Democratic Republic of the Congo (DRC) is among the five poorest nations in the world; an estimated 74.6% of Congolese people lived on less than $2.15 a day. People perceive health services to be costly, and as a result, seek treatment from traditional healers or religious leaders even if they know that the religious leaders or traditional healers are not trained to offer health care. Many people do not perceive the risks, opportunity costs, and tragic consequences related to the delays in seeking health care at health facilities. People acknowledge they may end up going to the health center when other treatment schemes are not effective.

The Solution

Community members participate in a guided activity that allows them to compare the costs of commonly purchased items with the cost of health services at the local health center. The activity demonstrates how affordable health services are in comparison to other common purchases. It aims to increase participants’ self-efficacy to seek and pay for health services.

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“[Before the cost comparisons] people thought services were expensive, so they paid for medication from the pharmacy [without going to services].” — Woman, Haut Katanga Province

“I am aware that to have health and stay healthy depends on finances and quality [services]. So, in my family, we have set up a savings policy to meet the health needs of the family, and this makes it easier for us to access health care.” — Woman, South Kivu Province

The Innovation

By comparing health care costs to other daily expenses, the project helped to reframe the expenses for health care as affordable. The exercise was eye-opening for many: community members were surprised to see how the health care costs are comparable to the amounts spent for haircuts, beer, sugar, or phone credits. It reflects Cass Sunstein’s FEAST framework (fun, easy, attractive, social, and timely) since the activity is interactive, social, and fun!

The Evidence

The Cost Comparison activity has been integrated into community engagement activities where reminder tickets were distributed to refer people to health services. The analysis of the reminder tickets in three DRC provinces shows the link between participation in the community engagement activities and attendance at health facilities. Between six and 21% of reminder tickets were presented at health centers, depending on the province.

Scale-Up & Adapt

After implementation in eight health zones, programs are using the Cost Comparison activity in 52 health zones in nine USAID-supported provinces in DRC. Five local nongovernmental organizations in Haut Katanga are also using the approach.

In 2023, the Cost Comparison activity was adapted for use in select family planning community engagement activities in Togo. Participants of those select community engagement activities had a 10% greater uptake of costed family planning methods compared to those who participated in community dialogues without the Cost Comparison activity. The Cost Comparison activity was also adapted for nutrition counseling in Nigeria.

Who can I speak with about this solution?

The Democratic Republic of the Congo

Didier Kangudie, Chief of Party

Grace Nzolo, Innovations Officer

Florence Mpata, Deputy Chief of Party

Colin Elumba, Save the Children

Juanita Rodriguez, ThinkPlace

Nigeria

Shittu Abdu-Aguye, Chief of Party, Breakthrough ACTION-Nigeria

Togo

Hilaire Tokplo, Country Manager

Other resources

ENGLISH & FRANÇAIS

ENGLISH

SBC Flow Chart: Democratic Republic of the Congo Spotlight

FRANÇAIS

Breakthrough ACTION-DRC, VIVA! Community Interventions [Vidéo]
Coûts Comparatifs [PDF]

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This website is made possible by the support of the American people through the United States Agency for International Development (USAID). The Breakthrough awards are supported by USAID’s Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreements: #AID-OAA-A-17-00017 and #AID-OAA-A-17-00018. Breakthrough ACTION is based at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs. Breakthrough RESEARCH is based at Population Council. The contents of this website are the sole responsibility of Breakthrough ACTION and Breakthrough RESEARCH. The information provided on this website is not official U.S. Government information and does not necessarily represent the views or positions of USAID, the United States Government, Johns Hopkins University, or Population Council.