Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe.
A retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service deli...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2024-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0291082&type=printable |
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| author | Collin Mangenah Euphemia L Sibanda Galven Maringwa Justice Sithole Stephano Gudukeya Owen Mugurungi Karin Hatzold Fern Terris-Prestholt Hendramoorthy Maheswaran Harsha Thirumurthy Frances M Cowan |
| author_facet | Collin Mangenah Euphemia L Sibanda Galven Maringwa Justice Sithole Stephano Gudukeya Owen Mugurungi Karin Hatzold Fern Terris-Prestholt Hendramoorthy Maheswaran Harsha Thirumurthy Frances M Cowan |
| author_sort | Collin Mangenah |
| collection | DOAJ |
| description | A retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service delivery models: Non-governmental-organisation (NGO) directly managed model (Chitungwiza and New Africa House sites), NGO partner managed site (Mutare site), private-public-partnership (PPP) model (Chitungwiza Profam Clinic), and NGO directly managed outreach (operating from New Africa House site. In addition client cost exit interviews (client perspective) were conducted among 856 female clients exiting integrated services at three of the sites. Our costing approach involved first a facility bottom-up costing exercise (February to April 2015), conducted to quantify and value each resource input required to provide individual SRH and HIV services. 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 prior 12 months. Costs were assessed in 2015 United States dollars (USD). Costs were assessed for HIV testing and counselling, screening and treatment of sexually transmitted infections, tuberculosis screening with smear microscopy, family planning, and cervical cancer screening and treatment employing visual inspection with acetic acid and cervicography and cryotherapy. Variability in costs per visit was evident across the models being highest for cervical cancer screening and cryotherapy (range: US$6.98-US$49.66). HIV testing and counselling showed least variability (range; US$10.96-US$16.28). In general the PPP model offered integrated services at the lowest unit costs whereas the partner managed site was highest. Significant client costs remain despite availability of integrated sexual and reproductive health and HIV services free of charge in our Zimbabwe study setting. Situating services closer to communities, incentives, transport reimbursements, reducing waiting times and co-location of sexual and reproductive health and HIV services may help minimise impact of client costs. |
| first_indexed | 2024-03-08T00:15:38Z |
| format | Article |
| id | doaj.art-ef26fb91d5264566a8ad0b727d5a2c5b |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-08T00:15:38Z |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-ef26fb91d5264566a8ad0b727d5a2c5b2024-02-17T05:32:43ZengPublic Library of Science (PLoS)PLoS ONE1932-62032024-01-01192e029108210.1371/journal.pone.0291082Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe.Collin MangenahEuphemia L SibandaGalven MaringwaJustice SitholeStephano GudukeyaOwen MugurungiKarin HatzoldFern Terris-PrestholtHendramoorthy MaheswaranHarsha ThirumurthyFrances M CowanA retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service delivery models: Non-governmental-organisation (NGO) directly managed model (Chitungwiza and New Africa House sites), NGO partner managed site (Mutare site), private-public-partnership (PPP) model (Chitungwiza Profam Clinic), and NGO directly managed outreach (operating from New Africa House site. In addition client cost exit interviews (client perspective) were conducted among 856 female clients exiting integrated services at three of the sites. Our costing approach involved first a facility bottom-up costing exercise (February to April 2015), conducted to quantify and value each resource input required to provide individual SRH and HIV services. 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 prior 12 months. Costs were assessed in 2015 United States dollars (USD). Costs were assessed for HIV testing and counselling, screening and treatment of sexually transmitted infections, tuberculosis screening with smear microscopy, family planning, and cervical cancer screening and treatment employing visual inspection with acetic acid and cervicography and cryotherapy. Variability in costs per visit was evident across the models being highest for cervical cancer screening and cryotherapy (range: US$6.98-US$49.66). HIV testing and counselling showed least variability (range; US$10.96-US$16.28). In general the PPP model offered integrated services at the lowest unit costs whereas the partner managed site was highest. Significant client costs remain despite availability of integrated sexual and reproductive health and HIV services free of charge in our Zimbabwe study setting. Situating services closer to communities, incentives, transport reimbursements, reducing waiting times and co-location of sexual and reproductive health and HIV services may help minimise impact of client costs.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0291082&type=printable |
| spellingShingle | Collin Mangenah Euphemia L Sibanda Galven Maringwa Justice Sithole Stephano Gudukeya Owen Mugurungi Karin Hatzold Fern Terris-Prestholt Hendramoorthy Maheswaran Harsha Thirumurthy Frances M Cowan Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe. PLoS ONE |
| title | Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe. |
| title_full | Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe. |
| title_fullStr | Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe. |
| title_full_unstemmed | Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe. |
| title_short | Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe. |
| title_sort | provider and female client economic costs of integrated sexual and reproductive health and hiv services in zimbabwe |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0291082&type=printable |
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