142nd APHA Annual Meeting and Exposition

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306873
Determinants of Technical Efficiency of HIV Prevention Interventions in four African Countries

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Sergio Bautista Arredondo, MSc , Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
Sandra Sosa-Rubi, PhD , Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
Jeanine Condo, PhD , School of Public Health, National University of Rwanda, Kigali, Rwanda
Neil Martinson, MD , Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
Felix Masiye, PhD , Division of Economics, University of Zambia, Lusaka, Zambia
Sabin Nsanzimana, MD , Rwanda Biomedical Center, Kigali, Rwanda
Joseph Wang'ombe, PhD , School of Public Health, University of Nairobi, Nairobi, Kenya
Kumbutso Dzekedzeke, PhD , Dzekedzeke Research & Consultancy, Lusaka, Zambia
Omar Galarraga, PhD , Brown University, Providence
Richard Wamai, PhD , Department of African American Studies, Northeastern University, Boston, MA
Jenny Coetzee , Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
Raluca Buzdugan, PhD , School of Public Health, University of California, Berkeley, Berkeley
Claire Chaumont, MSc , Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
Ada Kwan, MHS , Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
Ivan Ochoa Moreno, MSc , Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
INTRODUCTION

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, 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
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

Presenting author's disclosure statement:

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.