Technical efficiency and its relation to health providers' competence and scale of production of HTC services in Africa: A multi-country cost and quality of care study
Methods: A cost analysis was implemented at 92 facilities offering HTC in Kenya, Zambia, Rwanda and South Africa in 2011-2012. Staff costs were allocated to interventions using time-motion data. Standardized vignettes were administered to score technical proficiency. We estimated average staff cost by dividing total prorated staff costs by the number of HTC clients in each facility. We created quantiles of operation scale and quality, to analyze its tradeoff and explore costs efficiency of HTC delivery.
Results: Mean staff costs per client tested were 18.8 USD (IQR: 0.5;18.1), with heterogeneity by facility type. Independent of health providers' competence score, operation scale negatively correlated with average costs: Moving from the first quartile of scale towards the upper quartile yielded a 90% reduction in staff costs. Among the subset of facilities in the uppermost quartile of scale, we found a mean difference in staff costs between the lower and upper quartiles of providers’ competence of 1.2 USD.
Conclusions: These results demonstrate the need to understand the mechanisms that curb efficiency in the provision of HIV prevention interventions. We provide evidence of the possibility to achieve higher quality of care without escalating the budget, provided that service utilization is increased.
Learning Areas:Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Social and behavioral sciences
Analyze the heterogeneity of efficiency producing HIV prevention services. Discuss the role of technical efficiency as instrumental to increase value for money on HIV spending. Identify potential barriers that prevent health facilities providing HTC to increase service utilization.
Keyword(s): Health Care Costs, Quality of Care
Qualified on the content I am responsible for because: I am a health economist and researcher of the National Institute of Public Health in Mexico. I also am the local PI of the project economic incentives to prevent HIV among male sex workers in Mexico, and I currently lead the development of a baseline survey of MSM in Mexico at the national level. Recently, I have been involved in analyzing the efficiency of the delivery of HIV- prevention interventions in 5 countries in Africa.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.