Costing Adult and Adolescent Male Circumcision in Kenya

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Costing Adult and Adolescent Male Circumcision in Kenya, Zambia, Zimbabwe and Uganda Urbanus Kioko

Costing Adult and Adolescent Male Circumcision in Kenya, Zambia, Zimbabwe and Uganda Urbanus Kioko (PHD) University of Nairobi Arusha, Tanzania 10 June 2010

Site Selection Criteria Currently offering MMC services Meets existing policies for comprehensive MMC services

Site Selection Criteria 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

Number of Sites Costed Country Kenya Zambia Zimbabwe Uganda Number of Sites Costed 30

Number of Sites Costed Country Kenya Zambia Zimbabwe Uganda Number of Sites Costed 30 17 4 27

Kenya Hospitals Fixed Outreach Direct Costs Consumables Personnel Training Subtotal $8. 11 $11. 62

Kenya Hospitals Fixed Outreach Direct Costs Consumables Personnel Training Subtotal $8. 11 $11. 62 22% 32% 8. 68 24. 04 21% 57% $4. 60 $24. 32 13% 67% 0. 83 33. 55 2% 79% 8% 13% 7% 4% 2% 33% 100% 2. 24 1. 18 3. 61 0. 50 1. 24 8. 76 42. 32 5% 3% 9% 1% 3% 21% 100% Indirect costs Equipment Maintenance/Utility Support personnel costs Mgmt. /supervision costs Mobilisation Subtotal TOTAL # of MC Clients/Yr/Facility $2. 92 $4. 55 $2. 44 $1. 33 $0. 74 $11. 99 $36. 31 845 378

Kenya Health Center Fixed Outreach Direct Costs (US$) Consumables Personnel $8. 15 $3. 04

Kenya Health Center Fixed Outreach Direct Costs (US$) Consumables Personnel $8. 15 $3. 04 $9. 04 $22. 61 Training Subtotal $4. 36 $15. 55 $0. 64 $32. 29 Support personnel costs Mgmt. and supervision costs Mobilisation Subtotal TOTAL $2. 28 $3. 82 $0. 95 $1. 40 $10. 74 $26. 30 $1. 67 $2. 00 $2. 59 $0. 79 $1. 67 $8. 73 $41. 02 # of MC Clients/Yr/Facility 2044 445 Indirect costs (US$) Equipment Maintenance/Utility

Kenya Dispensaries Fixed Outreach Direct Costs (US$) Consumables Personnel $12. 57 $25. 99 Training

Kenya Dispensaries Fixed Outreach Direct Costs (US$) Consumables Personnel $12. 57 $25. 99 Training Subtotal $2. 98 $41. 55 $8. 87 $18. 57 $0. 73 $28. 17 Indirect costs (US$) Equipment Maintenance/Utility Support personnel costs Mgmt and supervision costs Mobilisation Subtotal TOTAL # of MC Clients/Yr/Facility $2. 93 $2. 33 $4. 57 $1. 13 $1. 06 $12. 01 $53. 56 326 $1. 92 $1. 08 $3. 24 $0. 38 $1. 39 $8 $36. 17 530

Zimbabwe Fixed % Outreach % Consumables Non-consumables $28. 13 $0. 96 48% 2% $28.

Zimbabwe Fixed % Outreach % Consumables Non-consumables $28. 13 $0. 96 48% 2% $28. 13 $1. 01 40% 1% Personnel costs Training costs Subtotal Indirect costs Equipment/capital costs Maintenance/Utility Support personnel Indirect Labor/Mgmt. Subtotal TOTAL # of MC Clients $19. 09 $ 0. 34 $48. 43 32% 1% 82% $19. 12 $0. 26 $48. 52 27% 0% 69% $0. 45 $3. 24 $4. 42 $2. 28 $10. 39 $58. 82 9600 1% 6% 8% 4% 18% 100% $3. 56 $12. 29 $4. 67 $1. 25 $21. 77 $70. 29 4800 5% 17% 7% 2% 31% 100% Direct Costs

Zambia Direct Costs % Labor $8. 95 16. 40% Materials $8. 54 15. 65%

Zambia Direct Costs % Labor $8. 95 16. 40% Materials $8. 54 15. 65% Training N. A. Subtotal $17. 49 32. 05% 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% Indirect Costs # of MC Clients/Yr/Facility 328

Direct Cost per MC Client (Kenya)

Direct Cost per MC Client (Kenya)

Service Delivery Options (Kenya)

Service Delivery Options (Kenya)

Relationship Between Scale & Unit Costs # of MC Clients/Yr

Relationship Between Scale & Unit Costs # of MC Clients/Yr

Limitations of the Study Difficult to capture demand creation, training and management costs Excludes

Limitations of the Study 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

Conclusion The unit cost of MC varies significantly particularly due to: › › Scale

Conclusion 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)

Cont. . . Likely to generate more accurate data over time-2 -3 yrs Need

Cont. . . Likely to generate more accurate data over time-2 -3 yrs Need to update the unit costs-2 -3 years after the 1 st costing exercise

Recommendations Disseminate findings from countries where costing was performed Repeat costing exercise to update

Recommendations Disseminate findings from countries where costing was performed Repeat costing exercise to update and validate cost estimates every 2 -3 years