肯尼亚为女性性工作者提供全面性生殖健康服务的成本及成本驱动因素。

Costs and cost drivers of comprehensive sexual reproductive health services to female sex workers in Kenya.

作者信息

Manguro Griffins O, Kioko Urbanus Mutuku, Githinji Gerald, Owira Patricia, Langat Lillian, Okoro Dan, Temmerman Marleen, Luchters Stanley

机构信息

Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

University of Nairobi School of Economics, Nairobi, Kenya.

出版信息

BMC Health Serv Res. 2024 Jul 17;24(1):822. doi: 10.1186/s12913-024-11293-5.

DOI:10.1186/s12913-024-11293-5

PMID:39014381

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11253356/

Abstract

BACKGROUND

Comprehensive sexual reproductive health (SRH) programs for female sex workers (FSW) offering clinical, behavioural, and structural interventions have contributed to declining rates of HIV in this population. However, data on costs and cost drivers is needed to support programs and their donors to better allocate resources, make an investment case for continued funding, and to identify areas of improvement in program design and implementation. We aimed to estimate the annual per-FSW costs of comprehensive services for a standalone FSW program in Kenya.

METHODS

We implemented a top-bottom and activity-based costing study of comprehensive FSW services at two drop-in centres (DICs), Mtwapa and Kilifi town, in Kilifi County, Kenya. Service costs were obtained from routinely collected patient data during FSW scheduled and unscheduled visits using Kenyan Ministry of Health records. Costing data were from the program and organization's expenditure reports, cross checked against bank documents and supported by information from in-depth interviews. Data were collected retrospectively for the fiscal year 2019. We obtained approval from the AMREF Research Ethics Committee (AMREF-ESRC P862/2020).

RESULTS

In 2019, the unit cost of comprehensive services was 105.93 USD per FSW per year, roughly equivalent to 10,593 Kenya shillings. Costs were higher at Mtwapa DICs compared to Kilifi town DIC; 121.90 USD and 89.90 USD respectively. HIV counselling and testing cost 63.90 USD per person, PrEP was 34.20 USD and family planning was 9.93 USD. Of the total costs, staff salaries accounted for about 60%. Adjusted for inflation, costs in 2024 would be approximately 146.60.

CONCLUSION

Programs should strive to maximize the number of FSW served to benefit from economies of scale. Given that personnel costs contribute most to the unit costs, programs should consider alternative designs which reduce personnel and other costs.

摘要

背景

为女性性工作者提供临床、行为和结构性干预措施的综合性性与生殖健康（SRH）项目，促使该人群中的艾滋病毒感染率下降。然而，需要有关成本和成本驱动因素的数据，以支持项目及其捐助者更好地分配资源、为持续供资提供投资依据，并确定项目设计和实施中的改进领域。我们旨在估算肯尼亚一个独立的女性性工作者项目提供综合服务的人均年度成本。

方法

我们在肯尼亚基利菲县的姆特瓦帕和基利菲镇的两个一站式服务中心，对综合性女性性工作者服务进行了自上而下和基于活动的成本核算研究。服务成本来自女性性工作者按计划和非计划就诊期间使用肯尼亚卫生部记录常规收集的患者数据。成本核算数据来自项目和组织的支出报告，与银行文件进行交叉核对，并得到深入访谈信息的支持。数据是对2019财年进行回顾性收集的。我们获得了非洲医学和研究基金会研究伦理委员会（AMREF-ESRC P862/2020）的批准。

结果

2019年，综合服务的单位成本为每位女性性工作者每年105.93美元，大致相当于10,593肯尼亚先令。姆特瓦帕一站式服务中心的成本高于基利菲镇一站式服务中心；分别为121.90美元和89.90美元。艾滋病毒咨询和检测人均成本为63.90美元，暴露前预防为34.20美元，计划生育为9.93美元。在总成本中，员工工资约占60%。经通胀调整后，2024年的成本约为146.60美元。