Assessing Technical Efficiency of HIV Prevention Interventions in four African Countries
Evidence on the efficiency of HIV prevention interventions is limited. ORPHEA project aimed to estimate average costs and analyse their heterogeneity 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.
Sample comprises of 60-80 clinics per country. Micro-costing was performed and relevant costs (personnel, supplies, utilities, equipment and property) and intervention-output data were collected retrospectively for 2011/2012. Information on time-allocation, building-space-used and time-motion is also collected . Quality is captured by measuring the facility’s attrition rate at each stage along the service delivery, using provider-vignettes and patient-exit-interviews. We estimated average-cost per each HIV prevention intervention.
Estimated weighted-average costs were US$18.1 per HTC client, US$50.1 per women tested in PMTCT services, US$93.4 per MC client. Staff costs account for more than 80% of the average costs in each prevention intervention. Variation in average cost for HTC and PMTCT by facility type is limited, except for faith-based hospitals. VMMC costs show important variations among different type of facilities, resulting cheaper to perform VMMC intervention in health centres.
Results suggest that there is a large potential to increase efficiency within the current financial and structural constraints of the health system in some countries in Africa. Staff accounts for the larger proportion of average-costs and offer the highest potential to implement actions to increase efficiency and quality. There is also need to explore different types of service delivery-models and their impacts on efficiency.
Learning Areas:Biostatistics, economics
Conduct 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
Social and behavioral sciences
Analyze the determinants and constraints of technical efficiency in producing HIV prevention services in a context of limited resources
Keyword(s): Economic Analysis, Health Care Costs
Qualified on the content I am responsible for because: She is a health economist and researcher of the National Institute of Public Health in Mexico. She is the local PI of the project economic incentives to prevent HIV among male sex workers in Mexico, and is currently leading the development of a baseline survey of MSM in Mexico at the national level. Recently, she has 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.