Cost Drivers for Voluntary Medical Male Circumcision Using Primary Source Data from Sub-Saharan Africa
Cost Drivers for Voluntary Medical Male Circumcision Using Primary Source Data from Sub-Saharan Africa
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DOI：
10.1371/journal.pone.0084701
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发表时间：
2014-05-06
期刊：
影响因子：
3.7
通讯作者：
Njeuhmeli, Emmanuel
中科院分区：
文献类型：
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作者：
Bollinger, Lori;Adesina, Adebiyi;Njeuhmeli, Emmanuel
背景资料：随着自愿医疗男性包皮环切术（VMMC）计划的扩大，迫切需要有关重要成本驱动因素和潜在效率收益的信息。我们在这里研究这些成本驱动因素，并通过计量经济模型估计潜在的效率收益。方法和发现：我们研究了主要的成本驱动因素（即，人员和消耗品）与在撒哈拉以南非洲沿着提供VMMC相关，包括设施类型和服务提供商。在整个过程中，使用了肯尼亚、纳米比亚、南非、坦桑尼亚、乌干达和赞比亚的主要来源设施一级数据。为了计算规模和其他相关因素的影响，我们通过计量经济学估计成本函数来估计效率收益。人员和消耗品估计分别占各国总成本的36%和28%。规模经济（EOS）估计为8在VMMC进行的中位量，EOS福尔斯从23在VMMC进行的第25百分位数的体积到5.1在第75百分位数。结论：分析表明，有显着的空间，为效率的提高所示的下降EOS VMMC量的增加。随着VMMC数量的增加，EOS的下降规模表明我们仍处于VMMC规模扩大的Ascension阶段，继续增加新的站点也会导致额外的启动成本。提高效率的一个关键方面是任务共享VMMC程序，因为与人员成本相关的总成本的很大比例。此外，随着价格和分销成本的下降，消耗品的效率可能会随着时间的推移而提高。
Background: As voluntary medical male circumcision (VMMC) programs scale up, there is a pressing need for information about the important cost drivers, and potential efficiency gains. We examine those cost drivers here, and estimate the potential efficiency gains through an econometric model.Methods and Findings: We examined the main cost drivers (i.e., personnel and consumables) associated with providing VMMC in sub-Saharan Africa along a number of dimensions, including facility type and service provider. Primary source facility level data from Kenya, Namibia, South Africa, Tanzania, Uganda, and Zambia were utilized throughout. We estimated the efficiency gains by econometrically estimating a cost function in order to calculate the impact of scale and other relevant factors. Personnel and consumables were estimated at 36% and 28%, respectively, of total costs across countries. Economies of scale (EOS) is estimated to be eight at the median volume of VMMCs performed, and EOS falls from 23 at the 25th percentile volume of VMMCs performed to 5.1 at the 75th percentile.Conclusions: The analysis suggests that there is significant room for efficiency improvement as indicated by declining EOS as VMMC volume increases. The scale of the fall in EOS as VMMC volume increases suggests that we are still at the ascension phase of the scale-up of VMMC, where continuing to add new sites results in additional start-up costs as well. A key aspect of improving efficiency is task sharing VMMC procedures, due to the large percentage of overall costs associated with personnel costs. In addition, efficiency improvements in consumables are likely to occur over time as prices and distribution costs decrease.