Title

Costing of voluntary medical male circumcision in South Africa's private sector

Presenter

Michel Tchuenche

Authors

M. Tchuenche¹, E. Njeuhmeli², C. Schütte³, L. Ngubeni⁴, I. Choge⁵, E. Martin⁶, D. Loykissoonlal⁷, V. Kiggundu², A. Yansaneh², S. Forsythe⁸

Institutions

¹Avenir Health, Project SOAR (Supporting Operational AIDS Research), Glastonbury, United States, ²USAID, Washington DC, United States, ³Strategic Development Consultants, Hammarsdale, South Africa, ⁴Avenir Health Consultant, Johannesburg, South Africa, ⁵USAID, Pretoria, South Africa, ⁶USAID, Pretoria, United States, ⁷National Department of Health, Pretoria, South Africa, ⁸Project SOAR (Supporting Operational AIDS Research), Avenir Health, Glastonbury, United States

Background: A previous study of the costs of providing a comprehensive set of services for surgical VMMC in South Africa at Government and PEPFAR-supported facilities noted that the lack of sufficient data from the private sector represented a gap in knowledge concerning the overall cost of scaling up VMMC services in South Africa.
Methods: VMMC Service delivery cost data were collected at 13 private for profit facilities in three provinces in South Africa: Gauteng, KwaZulu-Natal and Mpumalanga. Unit costs were calculated using a bottom-up approach by cost components and disaggregated by the type and level of urbanization of the facility. Supply chain, VMMC demand creation, and higher-level management and program support costs were not collected and therefore not included.
Results: The unit cost (including the cost of training and continuous quality improvement) to provide VMMC at private facilities was $137, which was comparable to public and PEPFAR-supported nonprofit facilities. The largest cost components were consumables (40%), and direct labor (35%). Eleven out of the 13 surveyed facilities were fixed sites ($142), while the remaining were a fixed site with outreach services ($156) and a fixed site with outreach and mobile services ($123). The unit cost was not substantially different based on the level of urbanization: respectively $141, $129 and $143 at urban, peri-urban and rural facilities.
Conclusions: Private sector VMMC unit cost ($137) did not differ substantially from the costs at government and nonprofit, PEPFAR-supported facilities ($132). Consumables and direct labor accounted for 75% of total cost at for-profit facilities compared to 67% at public and nonprofit facilities. Results from this study complement unit cost data necessary to make informed decisions regarding the funding and scale-up of VMMC services in South Africa in both the private and public sectors.

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