Effects of Alternative Spatial Distribution Schemes on Household Access Costs of Lipid-based Nutrient Supplements: Case Study in Rural Burkina Faso.

Objectives: Identifying cost-effective strategies for delivering efficacious nutrient supplements is a policy challenge, especially in rural areas. This paper examines the effects of alternative distribution outlet schemes on transportation costs of 3,146 households in the Dandé health clinic catchment area (1,600 sq. km), Burkina Faso, site of the International Lipid-Based Nutrient Supplements Zinc research project. Methods: Spatially referenced data on households, hospitals, clinics and markets, and on the road networks that link them, are combined with the motorized transportation fare structure to construct a distance-based transportation cost overlay. This overlay is then used to estimate the householdspecific, one-way transportation costs under alternative lipid-based nutrient supplement (LNS) distribution outlet schemes. Results: If the full-service Bobo Dioulasso Hospital is the only outlet, average transportation cost is US$ 1.96 and varies widely across households. Including the local Dandé Hospital in the distribution network reduces the average transportation cost to US$ 1.16; the spatial distribution of household access costs changes. Extending the network to include all health centers reduces average transportation cost to US$ 0.60. Adding markets as distribution outlets does not further reduce average transportation costs. Conclusions: Full-service hospital-based (only) distribution is the most costly LNS distribution scheme to households. Extending the network of outlets to include all hospitals, health centers and clinics reduces average households access costs by nearly 70%; doing so shifts the cost burden from households to other entities charged with managing this larger outlet network. At this site, involving retail outlets offers no household transportation costs savings.