Participation, resource mobilization and financial incentives in community-based health promotion: an economic evaluation perspective from Sweden.

Local community participation is an important objective for many health promotion interventions, but it hinges on the incentives for local organizations to participate. Both aspects might be explored with information obtained from economic evaluations, illustrated in this study with data from a cost-effectiveness analysis of an elderly safety promotion programme implemented in Sweden. Previously, resource mobilization has been used as a process indicator for successful community participation. We propose that resource mobilization can be measured as the proportion of total intervention costs paid by collaborators. In the case presented here, local collaborators contributed 50 per cent of the total intervention costs (SEK 6.45 million, in Swedish krona 2004; 1 USD = 7.35 SEK), while participants, i.e. the elderly in the intervention area, contributed 13 per cent and the remainder, 37 per cent, was paid by project funds. In a subsector financial analysis, the distribution of costs and financial benefits from interventions among different sectors in society is described. The estimated financial benefits in the case were divided between the health-care system (SEK 2.5 million), the local authority (SEK 3.7 million) and the elderly and their relatives (SEK 0.3 million). The only net beneficiary was the local authority. In the case presented here, the health promotion objective of local community participation was achieved as half of the total costs was mobilized from local collaborators. The local community participation objective was supported by financial incentives for at least one key collaborator.