306873
Determinants of Technical Efficiency of HIV Prevention Interventions in four African Countries
Limited evidence on the efficiency of HIV prevention-interventions is a barrier in creating effective policy. ORPHEA project aimed to estimate average costs and to analyze the determinants of efficiency using a micro-costing and stochastic-cost-frontier methods for three HIV-prevention interventions: prevention of mother-to-child transmission (PMTCT), voluntary medical male-circumcision (VMMC), and HIV testing and counseling (HTC) in Kenya, Zambia, Rwanda and South Africa.
METHODS
Sample comprises 60-80 clinics per country. Input costs and intervention output data were collected retrospectively by month for 2011/2012. Staff’s time allocation was measured using time-motion methods. Quality was captured by measuring the facility’s attrition rate at each stage of the service delivery, using clinical vignettes and client’s exit interviews. We estimated average cost per each HIV prevention intervention.
Cost-inefficiencies were estimated using stochastic-frontier methods and including determinants of efficiency: facility type, quality, scale and management (supervision, accountability, monitoring, incentives and governance).
RESULTS
Cost-functions show that scale has a significant negative effect on costs. Scale and quality explain approximately 30% of the variability in average costs, implying potential efficiency gains with expansion of output volume. Management characteristics as the frequency of supervision, local community-participation in the supply of services and accountability are related with efficient-supply.
CONCLUSIONS
There is a large potential to increase efficiency with the current financial and structural constraints of the health systems. Unit-cost variation implies that other constraints different from technology or competence explains inefficiency; economies of scale are gained with increasing volumes and higher levels of service’s quality are feasible without increasing the costs.
Learning Areas:
Biostatistics, economicsConduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related public policy
Social and behavioral sciences
Learning Objectives:
Evaluate the efficiency and heterogeneity of efficiency in producing HIV prevention services
Keyword(s): Economic Analysis, Health Care Costs
Qualified on the content I am responsible for because: I have been the co-principal of the project entitled: Determinants of Technical Efficiency of HIV Prevention Interventions in four Africna Countries. Among my scientific interests has been the analysis of the efficient use of health resources used for HIV prevention interventions in LA and Africa
Any relevant financial relationships? Yes
| Name of Organization | Clinical/Research Area | Type of relationship |
|---|---|---|
| Instituto Nacional de Salud Pública (Mexico) | Health Economics/Efficiency Analysis | academic staff |
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.