Cost of providing Peer Education programme in the National Adolescent Health programme and its variations across two states of India.

Background Health system cost entails the cost incurred by the health care provider to deliver services and these costing studies are critical for budgeting and price setting of essential health interventions. Moreover, cost information is used for evaluating cost effectiveness of various interventions, which guide resource allocation decisions. In India, though these studies bear significance because of low public spending on health care, there are scant evidence on health system costs of various interventions. The present study was undertaken to estimate the resource use and implementation cost of the Peer Educator (PE) programme, a community-based intervention, under the Rashtriya Kishor Swasthya Karyakram (RKSK) within the National Adolescent Health Programme in India. Methods This study was undertaken using a provider perspective to estimate the unit cost of service provided through the PE programme in the two states of India namely Madhya Pradesh and Maharashtra. We used the micro-costing approach (bottom-up costing), where all relevant resources used for the programme were identified and subsequently, costs were estimated. We estimated the total programme cost, the per capita cost of creating a peer educator and an adolescent enrolled and trained under PE. The per capita cost was estimated separately for the Peer educators and adolescents enrolled under the PE. The programme is run by a Non-Government Organization (NGO) in Madhya Pradesh, while, it is implemented by the government, known as government-led model in Maharashtra. The cost data was collected retrospectively for the two financial years: 2019-20 and 2020-21 respectively from 16 blocks covering 4 districts across the two states. Results The total programme cost was found to be Indian National Rupee (INR) 1092968 (95% CI: 608344–1577592) in the NGO-led model in Madhya Pradesh and INR 412990 (95% CI: 246728–579252) in the government-led model in Maharashtra in 2020-21. The share of human resource cost was 45% of total cost and was the major driver of the overall cost in Maharashtra while monitoring cost formed the highest share (59%) in the total programme cost in Madhya Pradesh. The per capita cost of creating a Peer Educator in Madhya Pradesh was INR 2935 (95% CI: 2509–3362) compared to INR 1818 (95% CI: 1122–2515) in Maharashtra in 2020-21. Similarly, the per capita cost of proving the Peer Education intervention to the adolescents enrolled under the PE known as adolescents enrolled under PE (AEP) in the year 2020-21 is INR 262 in Madhya Pradesh and INR 168 in Maharashtra. Conclusion This study generates evidence on the total programme cost, the per capita cost of providing the peer educator programme and its variations across two states of India. The findings suggest that the per capita cost of adolescents trained on various aspects adolescent health and the resource use pattern varies between the two states. The findings of the study could help the policy makers for future planning and budgeting of adolescent health programmes.