Cost Comparison Activity
How might we support families to access health services that they previously thought were unaffordable?
Alheri Jatau/Breakthrough ACTION-NigeriaCountries: 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.
“[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
Continue exploring breakthroughs
Alheri Jatau/Breakthrough ACTION-Nigeria
Maheder Haileselassie Tadese/Getty Images/Images of Empowerment
Lyder Group
USAID