Scaling Up Affordable SRH Services: Cost-Effectiveness of Health Bazaar Interventions in Underserved Ethiopian Communities

Background Access to Sexual and Reproductive Health (SRH) services remains limited in rural and underserved areas of Ethiopia. Health bazaars, a community-based mobile healthcare intervention piloted by Amref Health Africa, aims to improve accessibility. This study evaluated the cost-effectiveness of health bazaars compared to routine facility-based SRH services. Methods A full economic evaluation was performed using historical data from July 2023 to June 2024. Cost data were collected from the healthcare provider and implementer (Amref) perspectives, covering 20 health facilities across intervention and non-intervention areas. Health outcomes analyzed included uptake of family planning (FP), antenatal care (ANC), skilled birth attendance (SBA), postnatal care (PNC), and HIV testing. Average Cost Effectiveness Ratios (ACER) were calculated, with sensitivity analyses conducted to assess robustness. Results The combined annual cost of implementing health bazaars alongside routine services was $93,353.84, compared to $76,394.78 for routine facility-based services alone. Health bazaars significantly improved SRH service uptake by 17.52 percentage points overall (65.12% vs. 47.6%), with notable increases in FP use (11.5%), ANC (10.11%), SBA (8.8%), and HIV testing (10.55%). The ACER for health bazaars was $1,433.57 per percentage point increase in overall SRH uptake, compared to $1,604.93 for routine services, indicating that health bazaars were more cost-effective. Conclusions Health bazaars effectively enhance access to SRH services at a slightly higher total cost but lower incremental cost per unit of service uptake compared to routine care, suggesting their potential for scalable integration into Ethiopia’s primary healthcare system.