June 27, 2017 Impact Statement

¥ The Community Based Organization

Ndola Nutrition Organization and Hosanna Mapalo, Zambia

¥ The Community Project

Development of 4 community based outreach shelters in rural settings to service pregnant women.

¥ The Problem

Since 2012, Ndola Nutrition Organization and Hosanna Mapalo have been implementing a community driven prevention of mother to child transmission of HIV (PMTCT) program aimed at increasing the follow up on the up take of PMTCT services and promote early infant diagnosis for effective HIV prevention in Ndola and Luanshya districts of Zambia by 2016. One of the main lessons learnt of the project was that though mobile outreach centers were very important but they were not sustainable especially in rural settings hence the need to construct and operationalize permanent outreach centers in four communities as a pilot to other rural based communities by December 2015.

Only 47 percent of births in Zambia are attended by skilled health workers and home delivery is as high, as 53 percent. 591 maternal deaths occur per 100,000 live births while the infant, neonatal and under-five mortality rates are at 70, 34, and 119 per 1,000 live births, respectively (UNICEF, 2013). These mortality rates are unacceptably high. It is currently, estimated that in urban areas approximately 99 percent of households are within 5 kilometres of a health facility, compared to 50 percent in rural areas. This situation has adversely affected Luanshya Districts whose population is 163,111

¥ The Proposed Solution

The organisation aims at achieving optimal nutrition status of under-five year’s children, HIV / AIDS / TB patients, and pregnant women and fosters sustainable livelihood development and provision for vulnerable households in Zambia. The project activities includes conducting community sensitizations aimed at promoting PMTCT, strengthening referrals systems, and conducting mobile outreach centers in rural areas. The project will seek to build and operationalize rural based outreach centers and enhance the capacities of community based volunteers; equipping them with basic skills to handle obstetric emergencies as well as to identify and monitor pregnant women in the last trimester.

¥ The Investment

• $10000 NWN grant contribution

• $7900 Ndola Nutrition Organization /Hosanna contribution related to grant

• 2,160 Additional In kind hours by Ndola : 2,160 x $ 2 =$4,320

• $1,120 Additional costs associated with project

TOTAL Investment Cost: $ 23,340

Total # recipients in first year following project completion: 17,418

Cost per recipient (total costs divided by total recipients): $1.33

¥ The Impact

The project impact is measured by:

• Target contacts – project expected to reach up to 15,890 pregnant mothers and 14,200 infants undergoing early diagnosis. – (30,000 individuals)

o actual numbers for one year (contributes to estimate of lives saved and disease burden/ disability prevented) 17,418 individuals

o % of pregnant mothers reached by the project and accessing healthcare services against the target – verified through Ministry of Health information systems at health centers, antenatal clinic cards, 51.8%

• Productivity increase through more efficient service delivery at centralized health posts compared to previous satellite clinic delivery results in $28,188 per year of valued services. Data compiled from community based antenatal Registers and Monthly field reports.

Sites:

• New Health Posts | 52 visits/day | $6 per visit | $312 total value of visits per clinics per day

• Satellites Clinics before Health Posts | 34 visits/day | $6 per visit | $204 total value of visits per clinics per day

• Net difference per day | 18 visits or $108 increased productivity

• Net difference per year | 4698 visits or $28,188 increased productivity

• # of actual physical outreach centers constructed against the target. 4 centers constructed (100%)

• # of actual community volunteers trained with healthcare services as % of planned target – verified through training registers and reports. 96% of 80 volunteers targeted =76 volunteers.

• Lives saved through better clinical access. Given the challenges inherent in proving a non-event such as mortality, the process used to calculate this statistic is based on projected numbers using a combination of UNICEF infant and mother mortality statistics for Zambia and actual clinic post records:

o Total # of expecting mothers lives saved via better healthcare access: Based on the UNICEF ratio (0.6% pregnant women would be expected to die). The project targeted to reach 15890 pregnant women; of these according to the UNICEF ratio about 95 pregnant women were at high risk of maternal death. However the project saved 62 pregnant women indicating 65% achievement.

o Total # of newborns lives saved via better healthcare access: Based on the UNICEF ratio (12% infants were expected to die). The project targeted to reach 14200 infants; of these according to the UNICEF ratio about 1700 infants were at high risk of infant death. However the project saved 1210 infants indicating 71.1% achievement.

o While an economic value for a human life is very difficult to establish, nevertheless reputable organizations have completed modeling for this purpose.[1] The valuation of lives saved for this project based on a conservative internationally accepted standard formulation:

• 52 women plus 1210 infants = 1272 individuals x $50,000 per person = $63,600,000

• Using a more conservative estimate, 5 women and 100 infants = 105 individuals x $50,000 per person = $5,250,000

• Estimated Return on Investment (ROI) – the estimated savings or increased production value, less total investment costs, divided by total investment costs (does not include other daily operational costs). Using different outcome measures, the ROI calculation ranges from 1.2:1 to 2,699:1

o Productivity gain view - $28,188 less $23,340 development costs = 1.20:1 ROI or 20% of original investment

o Lives saved view - $63,000,000 less $23,340 development costs = 2,699:1 ROI or 2,699% of original investment

o Lives saved more conservative view - $5,250,000 less $23,340 development costs = 224:1 ROI or 224% of original investment

• Project sustainability –

o How much will it cost to continue the program on an annual basis? $23,340

o How are the funds generated? Through donations and contributions

• Project replicability:

o Has this project business model been replicated based on the demonstrated success of the prototype?

• Yes No X

• If yes, to what scale:_NA

• If no, are there any plans to replicate in the future: Yes

o Will the project be replicated in another community location based on the demonstrated impact (through additional raised funds / payment for services)?

Yes, pending funding, the project will be replicated through the business model and provision of services.

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[1] The following estimates have been applied to the value of life. The estimates are either for one year of additional life or for the statistical value of a single life. Recognizing the challenges inherent in establishing an appropriate numerical value for one year of a human life, NWN has selected the most conservative valuation from a set of internationally available options. https://en.wikipedia.org/wiki/Value_of_life#cite_note-time-5

• · $50,000 per year of quality life (international standard most private and government-run health insurance plans worldwide use to determine whether to cover a new medical procedure) http://content.time.com/time/health/article/0,8599,1808049,00.html ^[5]

• · $129,000 per year of quality life (based on analysis of kidney dialysis procedures by Stefanos Zenios and colleagues at Stanford Graduate School of Business)^[5]

• · $9.1 million (Environmental Protection Agency, 2010)^[6]

• · $7.9 million (Food and Drug Administration, 2010)^[6]

• · $9.4 million (Transportation Department, 2015)^[7]

• · $9.1 million (Prof. W. Kip Viscusi, Vanderbilt University, 2013)^[8]