Costs and economies of scale in the accelerated program for prevention of mother-to-child transmission of HIV in Zimbabwe

Abstract

BackgroundDespite a growing body of literature on HIV service costs in sub-Saharan Africa, only a few studies have estimated the facility-level cost of prevention of Mother-to-Child Transmission (PMTCT) services, and even fewer provide insights into the variation of PMTCT costs across facilities. In this study, we present the first empirical costs estimation of the accelerated program for the prevention of mother-to-child transmission of HIV in Zimbabwe and investigate the determinants of heterogeneity of the facility-level average cost per service. To understand such variation, we explored the association between average costs per service and supply-and demand-side characteristics, and quality of services. One aspect of the supply-side we explore carefully is the scale of production-which we define as the annual number of women tested or the yearly number of HIV-positive women on prophylaxis. MethodsWe collected rich data on the costs and PMTCT services provided by 157 health facilities out of 699 catchment areas in five provinces in Zimbabwe for 2013. In each health facility, we measured total costs and the number of women covered with PMTCT services and estimated the average cost per woman tested and the average cost per woman on either ARV prophylaxis or ART. We refer to these facility-level average costs per service as unitary costs. We also collected information on potential determinants of the variation of unitary costs. On the supply-side, we gathered data on the scale of production, staff composition and on the types of antenatal and family planning services provided. On the demand side, we measured the total population at the catchment area and surveyed eligible pairs of mothers and infants about previous use of HIV testing and prenatal care, and on the HIV status of

Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe

“…The costing involved first a facility bottomup costing exercise (February to April 2015) conducted to quantify and value each resource input consumed for provision of individual SRH and HIV services (S1 File). Secondly overhead financial expenditures were allocated top-down from central office to sites and then respective integrated service based on pre-defined allocation factors derived from both the site facility observations and programme data for the 12 month period January to December 2014 [28][29][30][31][32].…”

“…We conducted time and motion analysis to understand how health provider staff shared their time across departments and the specific duration of tasks in integrated service provision to individual clients. Time and motion analysis is the gold standard for measuring staff allocation of time through direct observation [31][32][33]. Health provider staff were randomly selected from a departmental staff roster or list of those providing integrated services (we aimed for all or every second participant if more than six) and asked to provide written informed consent to be observed during their work.…”

Relative efficiency of demand creation strategies to increase voluntary medical male circumcision uptake: a study conducted as part of a randomised controlled trial in Zimbabwe

“…[49][50][51] Costs of VMMC demand creation/service-delivery were analysed based on actual programme financial expenditures (topdown) including all start-up and initial training costs, incurred prior to launch of demand creation and facilitylevel data collection (bottom-up) at public health facilities to ensure the full value of all other resources used for VMMC service provision including clinic space and equipment; salaries and supplies were captured. [52][53][54][55] For this exercise, 15 facilities (n=5 per service-delivery model) offering VMMC services were purposively selected from the 5 RCT districts in order to estimate representative service-delivery costs retrospectively (12-month period). This exercise also accounted for any resources donated from other programmes and funders.…”