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Saving Lives in Sierra Leone (SLiSL) Phase II: Value for Money (VfM) / Cost-Efficiency Report: Ex-post analysis using logframe results and actual expenditures in January 2019–December 2021 (April 2022)

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Summary

This report presents the consolidated ex-post cost-efficiency analysis results of the Saving Lives in Sierra Leone (SLiSL) programme over the period of 2019–2021. The SLiSL programme supported the Government of Sierra Leone to protect women and children’s lives by improving the quality, availability and accessibility of reproductive, maternal, new-born, child and adolescent health (RMNCAH) services.

EmONC Mentorship

Overall efficiency (£11,289/mentee over 3 years, or £3,763/mentee/year) was higher than the 2018–2021 ex-ante benchmark (£20,392/mentee), because more mentees enrolled than was initially planned. 86% of all active mentees in 2021 improved their clinical competency by at least 20 percentage points from baseline. Lessons learned include prioritising engagement with MoHS district and national leadership, investing upfront in recruiting and training mentors, providing supervision to mentors to maintain high quality and high efficiency mentorship, and ensuring the use of high-quality data for decision making.

ETAT Mentorship

Overall efficiency (£499/mentee) was higher than the 2018–2021 ex-ante benchmark (£591/mentee), because more mentees enrolled than was initially planned. Shifting the emphasis from international mentors to national mentors can pave the way towards sustainability.

Family Planning Services Provided Through Outreach

Overall efficiency (£6.07/CYP) was higher than the 2018–2021 ex-ante benchmark (£7.76/CYP), because more CYPs were generated than was initially planned. Lessons learned include planning for programme continuity, planning outreach visits to remote locations by season, and conducting remote clinical audits.

Family Planning Services Provided Through Public Sector Strengthening (PSS)

Overall efficiency (£9.30/CYP) was higher than the 2018–2021 ex-ante benchmark (£17.11/CYP), because more CYPs were generated than was initially planned. Lessons learned include investing in training and supervision, providing non-monetary incentives for service providers, and collaborating with district FP Coordinators.

Drug Distribution

Overall efficiency (£0.01/unit of drug distributed) was higher than the 2018–2021 ex-ante benchmark (£0.02/unit of drug distributed). Lessons learned include outsourcing first mile delivery and insourcing last mile delivery.