Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe.
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
PLoS One. 2024 Feb 12;19(2):e0291082. doi: 10.1371/journal.pone.0291082. eCollection 2024.
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.
一项回顾性基于机构的成本研究旨在估计五个综合性性健康和生殖健康及艾滋病毒(人类免疫缺陷病毒)服务(提供者视角)的每次就诊的比较成本,这五个诊所来自四个服务提供模式:非政府组织(NGO)直接管理模式(奇通圭扎和新非洲之家站点)、NGO 合作伙伴管理站点(穆塔雷站点)、公私合作伙伴关系(PPP)模式(奇通圭扎专业诊所)和 NGO 直接管理外展(在新非洲之家站点运营)。此外,在三个站点中的 856 名接受综合服务的女性客户中进行了客户成本退出访谈(客户视角)。我们的成本核算方法首先是进行机构自下而上的成本核算(2015 年 2 月至 4 月),以量化和评估提供每个性健康和生殖健康及艾滋病毒服务所需的资源投入。其次,从中央办公室自上而下分配间接费用财务支出,然后根据前 12 个月从站点设施观察和方案数据中得出的预定义分配因素,将各自的综合服务分配到站点。成本以 2015 年美元(USD)评估。成本评估包括艾滋病毒检测和咨询、性传播感染的筛查和治疗、痰涂片显微镜检查的结核病筛查、计划生育以及采用醋酸和宫颈涂片中宫颈癌筛查和治疗以及冷冻疗法。模型之间的每次就诊成本差异明显,宫颈癌筛查和冷冻疗法的成本最高(范围:6.98 美元至 49.66 美元)。艾滋病毒检测和咨询的变异性最小(范围:10.96 美元至 16.28 美元)。一般来说,PPP 模式以最低的单位成本提供综合服务,而合作伙伴管理站点的成本最高。尽管在津巴布韦的研究环境中,免费提供了综合性性健康和生殖健康及艾滋病毒服务,但仍存在显著的客户成本。将服务更靠近社区、提供激励、报销交通费用、减少等待时间和将性健康和生殖健康及艾滋病毒服务置于同一地点,可能有助于最大限度地减少客户成本的影响。
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