The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings.
OBJECTIVE
To 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.


METHODS
A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland.


METHODS
Economic 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.


RESULTS
The 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.


CONCLUSIONS
For 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.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Carol Dayo
CD
Obure
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Sedona
S
Sweeney
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Vanessa
V
Darsamo
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Christine
C
Michaels-Igbokwe
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Lorna
L
Guinness
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Fern
F
Terris-Prestholt
Family Health Options Kenya, Nairobi, Kenya.
Esther
E
Muketo
Family Life Association of Swaziland, Manzini, Swaziland.
Zelda
Z
Nhlabatsi
Population Council, Nairobi, Kenya.
Charlotte E
CE
Warren
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Susannah
S
Mayhew
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Charlotte
C
Watts
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Anna
A
Vassall
D015658:HIV Infections / Q000191:economics*; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D010067:Ownership; D034121:Reproductive Health Services / Q000191:economics*