The cost of delivering and sustaining a control programme for schistosomiasis and soil-transmitted helminthiasis.

Large-scale chemotherapy programmes for helminth control continue to rely heavily on donor support. This is despite more than a 10-fold reduction in delivery costs from integrating drug distribution through the school system rather than using mobile teams and a marked decline in the price of albendazole and praziquantel. Even at these low prices (<US dollars 0.25 per child treated with albendazole), it seems that school-based programmes may not be affordable to governments or communities. It is estimated, for instance, that mass albendazole treatment of school-aged children in Kenya could cost over US dollars 3 million each year, which is 4% of current national expenditure on all health care. It has been suggested that a cost retrieval system could help ensure sustainability of these programmes. Some studies have shown that parents may be willing-to-pay for the treatment of their children but the actual amount that could be recovered and the ability of households to pay these amounts is uncertain. Furthermore, the costs incurred in implementing school-based delivery are likely to be much higher than the frequently quoted US dollars 0.03 per child by the Partnership for Child Development (PCD) programmes, as this estimate does not include the 'external costs' for the scientific co-ordinating centre which was responsible for supporting these approaches. Whether these school health programmes could run independently of this system at such a low cost remains to be seen.