Digital transformation of campaign delivery: a mixed-methods costing and efficiency analysis from Mozambique's seasonal malaria chemoprevention programme

Summary Background Digital tools can improve the efficiency and effectiveness of large-scale health campaigns, yet evidence on their economic value remains limited. Mozambique introduced a digital platform (SALAMA) for 2023/2024 seasonal malaria chemoprevention (SMC) delivery in Nampula province, reaching 1. 5 million children. This study quantified the incremental costs and operational benefits of digitalisation compared to the 2022/2023 paper-based campaign. Methods We conducted a mixed-methods costing and operational efficiency analysis. Incremental financial and economic costs attributable to digitalisation were estimated from a programmatic perspective, excluding core SMC campaign costs. Operational benefits were measured through personnel time savings; health outcomes were not modelled. Data sources included financial records, documents, interviews, and focus group discussions. Scenario analyses projected future costs. Findings Digitalisation incurred an incremental cost of US1, 013, 330 (67% financial, 33% economic), or US0. 66 per child treated—an 8% increase from the paper-based campaign. Costs were attributed to training and supervision (28%), digital equipment (25%), operations (25%), digital human resources (17%), and planning and software development (6%). An estimated 37, 450 person-days were saved (US240, 000 potential saving), which could lower the unit cost to US0. 51 per child treated if realised through reduced staffing. Future scenarios projected reductions with digital and programme efficiencies. Stakeholders reported improved data availability, accuracy, and decision-making, while noting connectivity problems, device issues, and variable technology literacy. Interpretation While incurring upfront costs, digitalising SMC using locally adapted digital public infrastructure represents a strategic and potentially economical approach to improving large-scale health intervention efficiency and quality