BackgroundThere is growing interest in integration of HIV and sexual and reproductive health (SRH) services as a way to improve the efficiency of human resources (HR) for health in low- and middle-income countries. Although this is supported by a wealth of evidence on the acceptability and clinical effectiveness of service integration, there is little evidence on whether staff in general health services can easily absorb HIV services.MethodsWe conducted a descriptive analysis of HR integration through task shifting/sharing and staff workload in the context of the Integra Initiative - a large-scale five-year evaluation of HIV/SRH integration. We describe the level, characteristics and changes in HR integration in the context of wider efforts to integrate HIV/SRH, and explore the impact of HR integration on staff workload.ResultsImprovements in the range of services provided by staff (HR integration) were more likely to be achieved in facilities which also improved other elements of integration. While there was no overall relationship between integration and workload at the facility level, HIV/SRH integration may be most influential on staff workload for provider-initiated HIV testing and counselling (PITC) and postnatal care (PNC) services, particularly where HIV care and treatment services are being supported with extra SRH/HIV staffing. Our findings therefore suggest that there may be potential for further efficiency gains through integration, but overall the pace of improvement is slow.ConclusionsThis descriptive analysis explores the effect of HIV/SRH integration on staff workload through economies of scale and scope in high- and medium-HIV prevalence settings. We find some evidence to suggest that there is potential to improve productivity through integration, but, at the same time, significant challenges are being faced, with the pace of productivity gain slow. We recommend that efforts to implement integration are assessed in the broader context of HR planning to ensure that neither staff nor patients are negatively impacted by integration policy.

ObjectiveTo present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services.DesignA retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland.MethodsEconomic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider’s perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars.ResultsThe mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity.ConclusionFor all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements.

ObjectivesTo estimate the own-price, cross-price and income elasticities for carbonated soft drinks (CSDs), malt drinks, chocolate powder, sachet water and sugar in Nigeria. These elasticities can be used to estimate the potential demand response to the recently-introduced sugar tax in Nigeria.SettingThe study uses household data from the 2018/2019 Nigeria Living Standards Survey (NLSS).ParticipantsThe NLSS is a national household survey. 21 114 households were included in the final sample for this analysis.Primary and secondary outcomesWe used Deaton’s almost ideal demand system, which controls for the goods’ quality, to estimate the effect of price and income changes on the demand for CSDs, chocolate powder, malt drinks, sachet water and sugar.ResultsWe found that the own-price elasticity (ordered from most to least price-responsive) was −0.99 (p<0.01) for sachet water, −0.76 (p<0.01) for CSDs, –0.72 (p<0.01) for chocolate powder, −0.62 (p<0.01) for sugar and –0.19 (p<0.01) for malt drinks. The cross-price elasticities indicate that malt drinks and chocolate powders are substitutes of CSDs. The income elasticities indicate that all the commodities are normal goods. Sachet water had the highest income elasticity at 0.62 (p<0.01), followed by chocolate powder at 0.54 (p<0.01), CSDs at 0.47 (p<0.01), malt drinks at 0.43 (p<0.01) and sugar at 0.13 (p<0.01).ConclusionEven though the price elasticities for CSDs, malt drinks and chocolate powder are less than one, in absolute terms, they are significantly different from zero. Increases in the sugar-sweetened beverage tax could curb the demand for these beverages, and, in turn, reduce the incidence and prevalence of sugar-attributable diseases.