Email updates

Keep up to date with the latest news and content from CERA and BioMed Central.

Open Access Research

Cost-effectiveness of community vegetable gardens for people living with HIV in Zimbabwe

Chloe Puett1*, Cécile Salpéteur2, Elisabeth Lacroix3, Simbarashe Dennis Zimunya4, Anne-Dominique Israël2 and Myriam Aït-Aïssa2

Author Affiliations

1 Action Against Hunger, 247 West 37th Street, New York, NY 10018, USA

2 Action contre la Faim - France, 4 rue Niepce, 75 662 Paris Cedex 14, France

3 Action contre la Faim - France, 78-D Thanlwin Road, Bahan Township, Yangon, Myanmar

4 Action contre la Faim - France, 4356 Cnr Chibuku/Unity Road, Masvingo, Zimbabwe

For all author emails, please log on.

Cost Effectiveness and Resource Allocation 2014, 12:11  doi:10.1186/1478-7547-12-11

Published: 30 April 2014

Abstract

Background

There is little evidence to date of the potential impact of vegetable gardens on people living with HIV (PLHIV), who often suffer from social and economic losses due to the disease. From 2008 through 2011, Action Contre la Faim France (ACF) implemented a project in Chipinge District, eastern Zimbabwe, providing low-input vegetable gardens (LIGs) to households of PLHIV. Program partners included Médecins du Monde, which provided medical support, and Zimbabwe's Agricultural Extension Service, which supported vegetable cultivation. A survey conducted at the end of the program found LIG participants to have higher Food Consumption Scores (FCS) and Household Dietary Diversity Scores (HDDS) relative to comparator households of PLHIV receiving other support programs. This study assessed the incremental cost-effectiveness of LIGs to improve FCS and HDDS of PLHIV compared to other support programs.

Methods

This analysis used an activity-based cost model, and combined ACF accounting data with estimates of partner and beneficiary costs derived using an ingredients approach to build an estimate of total program resource use. A societal perspective was adopted to encompass costs to beneficiary households, including their opportunity costs and an estimate of their income earned from vegetable sales. Qualitative methods were used to assess program benefits to beneficiary households. Effectiveness data was taken from a previously-conducted survey.

Results

Providing LIGs to PLHIV cost an additional 8,299 EUR per household with adequate FCS and 12,456 EUR per household with HDDS in the upper tertile, relative to comparator households of PLHIV receiving other support programs. Beneficiaries cited multiple tangible and intangible benefits from LIGs, and over 80% of gardens observed were still functioning more than one year after the program had finished.

Conclusions

Cost outcomes were 20–30 times Zimbabwe's per capita GDP, and unlikely to be affordable within government services. This analysis concludes that LIGs are not cost-effective or affordable relative to other interventions for improving health and nutrition status of PLHIV. Nonetheless, given the myriad benefits acquired by participant households, such programs hold important potential to improve quality of life and reduce stigma against PLHIV.

Keywords:
Vegetable gardens; Livelihoods; People living with HIV; Food consumption score; Household dietary diversity score; Cost-effectiveness; Societal costs; Mixed methods; Activity-based cost analysis; Zimbabwe