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Costing Adult and Adolescent Male Circumcision in Kenya,
Zambia, Zimbabwe and Uganda
Urbanus Kioko (PHD)University of Nairobi
Arusha, Tanzania10 June 2010
Currently offering MMC services Meets existing policies for
comprehensive MMC services Represents geographic diversity Represents diversity of sites where
MMC services will be scaled-up
Country Number of Sites Costed
Kenya 30
Zambia 17
Zimbabwe 4
Uganda 27
Kenya Hospitals Fixed OutreachDirect Costs
Consumables $8.11 22% 8.68 21%Personnel $11.6
232%
24.04 57%Training $4.60 13% 0.83 2%Subtotal $24.3
267%
33.55 79%Indirect costs
Equipment $2.92 8% 2.24 5%Maintenance/Utility $4.55 13% 1.18 3%
Support personnel costs $2.44 7% 3.61 9%
Mgmt./supervision costs $1.33 4% 0.50 1%
Mobilisation $0.74 2% 1.24 3%Subtotal $11.9
933%
8.76 21%TOTAL $36.3
1100% 42.32 100
%
# of MC Clients/Yr/Facility
845 378
Kenya Health Center Fixed Outreach
Direct Costs (US$)
Consumables $8.15 $9.04Personnel $3.04 $22.61Training $4.36 $0.64Subtotal $15.55 $32.29
Indirect costs (US$)
Equipment $2.28 $1.67Maintenance/Utility $2.28 $2.00
Support personnel costs $3.82 $2.59
Mgmt. and supervision costs $0.95 $0.79
Mobilisation $1.40 $1.67Subtotal $10.74 $8.73TOTAL $26.30 $41.02
# of MC Clients/Yr/Facility 2044 445
Kenya Dispensaries
Fixed Outreach
Direct Costs (US$)
Consumables $12.57 $8.87
Personnel $25.99 $18.57
Training $2.98 $0.73
Subtotal $41.55 $28.17Indirect costs (US$)
Equipment $2.93 $1.92
Maintenance/Utility $2.33 $1.08
Support personnel costs $4.57 $3.24
Mgmt and supervision costs $1.13 $0.38
Mobilisation $1.06 $1.39
Subtotal $12.01 $8
TOTAL $53.56 $36.17
# of MC Clients/Yr/Facility
326 530
Zimbabwe Fixed % Outreach %
Direct Costs
Consumables $28.13 48% $28.13 40%Non-consumables $0.96 2% $1.01 1%Personnel costs $19.09 32% $19.12 27%Training costs $ 0.34 1% $0.26 0%Subtotal $48.43 82% $48.52 69%Indirect costs
Equipment/capital costs
$0.451% $3.56 5%
Maintenance/Utility $3.24 6% $12.29 17%Support personnel $4.42 8% $4.67 7%Indirect Labor/Mgmt. $2.28 4% $1.25 2%Subtotal $10.39 18% $21.77 31%TOTAL $58.82 100
%$70.29
100%# of MC Clients 9600 4800
Zambia Direct Costs %
Labor $8.95 16.40%Materials $8.54 15.65%Training N.A. Subtotal $17.49 32.05%
Indirect Costs
Equipment $21.27 38.98%Maintenance/Utility $13.80 25.29%Indirect Labor/Management $2.01 3.68%Subtotal $37.08 67.95%
TOTAL $54.57 100.00%# of MC Clients/Yr/Facility 328
# of MC Clients/Yr
Difficult to capture demand creation, training and management costs
Excludes traditional MC Does not address question about how
unit costs might change with different methods of service delivery
Limitation of the data used for estimating unit costs—may not be very accurate
Preliminary data-further analysis/validation of the unit costs
The unit cost of MC varies significantly particularly due to:› Scale (# of clients seen at each site)› Type of site (public, private)› Location of site (urban, peri-urban, rural)› Type of service delivery method
(integrated, outreach, mobile)› Surgical instrument method/kit(disposable
kits, non-disposable kits, etc.)› Persons responsible for delivery (e.g.,
nurse, surgeon, clinical officer)
Likely to generate more accurate data over time-2-3 yrs
Need to update the unit costs-2-3 years after the 1st costing exercise
Disseminate findings from countries where costing was performed
Repeat costing exercise to update and validate cost estimates every 2-3 years