title: Assessing the costs of mobile voluntary counseling and testing at the work place versus facility based voluntary counseling and testing in Namibia.
abstract: BACKGROUND
  Bophelo! is a mobile voluntary counseling and testing (VCT) and wellness screening program operated by PharmAccess at workplaces in Namibia, funded from both public and private resources. Publicly funded fixed site New Start centers provide similar services in Namibia. At this time of this study, no comparative information on the cost effectiveness of mobile versus fixed site service provision was available in Namibia to inform future programming for scale-up of VCT. The objectives of the study were to assess the costs of mobile VCT and wellness service delivery in Namibia and to compare the costs and effectiveness with fixed site VCT testing in Namibia.
  
  
  METHODS
  The full direct costs of all resources used by the mobile and fixed site testing programs and data on people tested and outcomes were obtained from PharmAccess and New Start centers in Namibia. Data were also collected on the source of funding, both public donor funding and private funding through contributions from employers. The data were analyzed using Microsoft Excel to determine the average cost per person tested for HIV.
  
  
  RESULTS
  In 2009, the average cost per person tested for HIV at the Bophelo! mobile clinic was an estimated US$60.59 (US$310,451 for the 5124 people tested). Private employer contributions to the testing costs reduced the public cost per person tested to US$37.76. The incremental cost per person associated with testing for conditions other than HIV infection was US$11.35, an increase of 18.7%, consisting of the costs of additional tests (US$8.62) and staff time (US$2.73). The cost of testing one person for HIV in 2009 at the New Start centers was estimated at US$58.21 (US$4,082,936 for the 70 143 people tested).
  
  
  CONCLUSIONS
  Mobile clinics can provide cost-effective wellness testing services at the workplace and have the potential to mobilize local private funding sources. Providing wellness testing in addition to VCT can help address the growing issue of non-communicable diseases.
authors.affiliation: PharmAccess Foundation Namibia, 1 Fouche Street, Windhoek West, Windhoek, Namibia. ingriddb@namibia.pharmaccess.org.
authors.forename: Ingrid
authors.initials: I
authors.lastname: de Beer
authors.affiliation: Intrahealth International Namibia, &#8232;Yang Tze Village, &#8232;Klein Windhoek, Namibia. kchani@caa.org.na.
authors.forename: Kudakwashe
authors.initials: K
authors.lastname: Chani
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, USA. ffeeley@bu.edu.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Feeley
authors.affiliation: Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands. t.rinkedewit@pharmaccess.org.
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Rinke de Wit
authors.affiliation: PharmAccess Foundation Namibia, Windhoek, Namibia. elsbindels@gmail.com.
authors.forename: Els
authors.initials: E
authors.lastname: Sweeney-Bindels
authors.affiliation: PharmAccess Foundation Namibia, Windhoek, Namibia. writinghealth@gmail.com.
authors.forename: Pancho
authors.initials: P
authors.lastname: Mulongeni
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics*; D003906:Developing Countries; D003955:Diagnostic Tests, Routine / Q000191:economics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics; D006293:Health Promotion / Q000191:economics*; D006295:Health Resources; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units / Q000191:economics*; D009276:Namibia; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D014838:Volunteers; D017132:Workplace / Q000191:economics*; D055815:Young Adult
keywords: Africa; HIV/AIDS; Health Service reform; Medical; Public Health