Table 2 Components of implementation

1. Policy change and Sensitization

Policy change activities include planning, policy related consultations. Sensitization activities include meetings with stakeholders. Both policy change and sensitization involves working with a broad group of stakeholders at national and international organizations, a more focused IPTi core group of key stakeholders and district level health managers. These costs were incurred at the start of implementation.

2. Development of Behaviour Change Communication (BCC) materials

This was incurred before the start of implementation, but also includes minor recurrent costs related to occasional replacement of materials. Activities include development of materials (eg training leaflet, job aid, and posters), pilot testing, production and distribution.

3. SP purchase and distribution

This is mainly a recurrent cost. Purchase activities include importation and overhead costs of arranging importation. Distribution activities involve the distribution from port to Medical Stores Department (MSD), then to regional level, district level and finally to health facilities.

4. Training

This is mainly incurred at the start of implementation but also includes refresher and new staff training. The training involves training trainers at regional and district levels in strategy change, BCC and IPTi administration. In turn, these trainers train the front-line health facility staff.

5. Administration of the intervention in health facilities

This is a recurrent cost. It involves SP provision: preparation, administration to children, recording dosage and dates in immunization cards and books of the Health Management Information System (HMIS) by health workers at facilities. It also includes education of mothers about IPTi. This was calculated as the proportion of an RCH nurse's gross salary spent on IPTi per year at implementing facilities in the 5 study districts.

6. Strategy management

This is incurred partly at the start of implementation, and partly as an ongoing activity. The start-up costs are converted to annual costs assuming a 10 year intervention period. In the case of the Southern Tanzania project, it involved the recruitment of a public health professional to support the implementation activities. It also included consultations with regard to adaptation of HMIS and immunization cards, as well as printing costs.