Cost-effectiveness analysis of a hybrid mobile and static clinic model delivering integrated sexual and reproductive health services in conflict-affected Cabo Delgado, Mozambique

Populations affected by conflict in Cabo Delgado, Mozambique, encounter significant barriers to accessing essential sexual and reproductive health (SRH) services. While integrated service delivery is crucial in such settings, evidence on its economic efficiency remains scarce. This study aimed to determine the cost per client reached of a hybrid mobile and static clinic model delivering integrated SRH services, including contraception, antenatal care, and HIV testing, in conflict-affected districts of Cabo Delgado. A cost-effectiveness analysis was conducted from a provider perspective. Financial and economic costs were collected retrospectively for a defined implementation period. The primary outcome was the cost per client receiving at least one SRH service. Data were analysed to calculate average costs and to explore key cost drivers. The overall economic cost per client reached was US$42.50. The mobile clinic component was more costly per client (US$58.20) than the static clinic component (US$32.10), primarily due to transportation and security expenditures. The model reached a high proportion of clients in hard-to-reach areas. The hybrid model represents a financially viable strategy for delivering integrated SRH services in insecure and inaccessible regions, despite a higher cost than static services alone. The increased cost for mobile outreach reflects the necessary investment to achieve coverage in conflict settings. Programme planners should consider hybrid models to ensure SRH service continuity in conflict zones. Further research should explore the cost-effectiveness of specific service packages and the long-term sustainability of such models. cost-effectiveness, sexual and reproductive health, conflict, mobile clinics, Mozambique, service integration This study provides evidence on the costs of delivering integrated SRH services via a hybrid model in a complex humanitarian setting.