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Salas-Ortiz A. Socioeconomic Inequalities and Ethnic Discrimination in COVID-19 Outcomes: the Case of Mexico. J Racial Ethn Health Disparities 2024; 11:900-912. [PMID: 37041406 PMCID: PMC10089566 DOI: 10.1007/s40615-023-01571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
In Mexico, Indigenous people were hospitalised and killed by COVID-19 at a disproportionate rate compared to the non-Indigenous population. The main factors contributing to this were poor health conditions and impoverished social and economic circumstances within the country. The objective of this study is to examine the extent to which ethnic disparities are attributable to processes of structural discrimination and further explore the factors that exacerbate or mitigate them. Using administrative public data on COVID-19 and Census information, this study uses the Oaxaca-Blinder decomposition method to examine the extent to which disparities are illegitimate and signal discrimination against Indigenous people. The results show that although ethnic disparities were mainly attributable to observable differences in individual and contextual characteristics, 22.8% (p < 0.001) of the ethnic gap in hospitalisations, 17.5% in early deaths and 16.4% in overall deaths remained unexplained and could potentially indicate systemic discrimination. These findings highlight that pre-existing and longstanding illegitimate disparities against Indigenous people jeopardise the capacity of multi-ethnic countries to achieve social justice in health.
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Affiliation(s)
- Andrea Salas-Ortiz
- Centre for Health Economics, University of York, Alcuin Block A, York, YO105DD, North Yorkshire, England, UK.
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Salas-Ortiz A, Opuni M, Rodríguez-Atristain A, Figeroa JL, Sánchez-Morales JE, Bula AK, Nyambura B, Bautista-Arredondo S. Management practices in facilities providing HIV services to key populations in Kenya and Malawi: A descriptive analysis of management in community-based organizations. PLOS Glob Public Health 2024; 4:e0002813. [PMID: 38507416 PMCID: PMC10954182 DOI: 10.1371/journal.pgph.0002813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
HIV services for key populations (KP) at higher risk of HIV infection are often delivered by community-based organizations. To achieve HIV epidemic control, countries need to scale up HIV services for KP. Little is known about the management practices of community-based organizations delivering health services. We explored the management practices and facility characteristics of community-based health facilities providing HIV services to key populations as part of the LINKAGES program in Kenya and Malawi. We collected information on management practices from 45 facilities called drop-in centers (DICs) during US Government FY 2019, adapting the World Management Survey to the HIV community-based health service delivery context. We constructed management domain scores for each facility. We then analyzed the statistical correlations between management domains (performance monitoring, people management, financial management, and community engagement) and facility characteristics (e.g., number of staff, organization maturity, service scale) using ordinary least square models. The lowest mean management domain scores were found for people management in Kenya (38.3) and financial management in Malawi (25.7). The highest mean scores in both countries were for performance monitoring (80.9 in Kenya and 82.2 in Malawi). Within each management domain, there was significant variation across DICs, with the widest ranges in scores (0 to 100) observed for financial management and community involvement. The DIC characteristics we considered explained only a small proportion of the variation in management domain scores across DICs. Community-based health facilities providing HIV services to KP can achieve high levels of management in a context where they receive adequate levels of above-facility support and oversight-even if they deliver complex services, rely heavily on temporary workers and community volunteers, and face significant financial constraints. The variation in scores suggests that some facilities may require more above-facility support and oversight than others.
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Affiliation(s)
| | - Marjorie Opuni
- Independent Public Health Researcher, Lausanne, Switzerland
| | - Alejandra Rodríguez-Atristain
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - José Luis Figeroa
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Jorge Eduardo Sánchez-Morales
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Agatha Kapatuka Bula
- UNC Project-Malawi, Lilongwe, Malawi
- UNC School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
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Salas-Ortiz A, Moreno-Serra R, Kreif N, Suhrcke M, Casas G. The effect of conflict-related violence intensity and alcohol use on mental health: The case of Colombia. SSM Popul Health 2024; 25:101626. [PMID: 38405166 PMCID: PMC10884503 DOI: 10.1016/j.ssmph.2024.101626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
We investigated the causal impact of conflict-related violence on individual mental health and its potential pathways in Colombia. Using data from before and after the 2016 peace accord between the Colombian government and the Revolutionary Armed Forces of Colombia (FARC), we adopted a difference-in-differences empirical design combined with instrumental variables estimation. We also used formal mediation analysis to investigate a possible mediating role of alcohol consumption in the relationship between conflict exposure and mental health. Our results did not support the hypothesis that changes in exposure to conflict violence after the peace accord causally led to any changes in individual mental health. We were unable to identify a statistically significant mediating effect of alcohol consumption in the relationship between exposure to conflict violence and mental health.
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Affiliation(s)
| | | | - Noemi Kreif
- Centre for Health Economics, University of York. United Kingdom
| | - Marc Suhrcke
- Luxembourg Institute of Socioeconomic Research. Luxembourg
| | - German Casas
- Universidad de Los Andes, School of Medicine and Santa Fe University Hospital. Bogotá, Colombia
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Opuni M, Figueroa JL, Sanchez-Morales JE, Salas-Ortiz A, Ochoa-Sanchez LE, Morales-Vazquez M, Banda LM, Olawo A, Munthali S, Korir J, DiCarlo M, Persaud N, Bautista-Arredondo S. The Cost of Providing Comprehensive HIV Services to Key Populations: An Analysis of the LINKAGES Program in Kenya and Malawi. Glob Health Sci Pract 2023; 11:e2200538. [PMID: 37348941 DOI: 10.9745/ghsp-d-22-00538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/03/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Timely data on HIV service costs are critical for estimating resource needs and allocating funding, but few data exist on the cost of HIV services for key populations (KPs) at higher risk of HIV infection in low- and middle-income countries. We aimed to estimate the total and per contact annual cost of providing comprehensive HIV services to KPs to inform planning and budgeting decisions. METHODS We collected cost data from the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) program in Kenya and Malawi serving female and male sex workers, men who have sex with men, and transgender women. Data were collected prospectively for fiscal year (FY) 2019 and retrospectively for start-up activities conducted in FY2015 and FY2016. Data to estimate economic costs from the provider's perspective were collected from LINKAGES headquarters, country offices, implementing partners (IPs), and drop-in centers (DICs). We used top-down and bottom-up cost estimation approaches. RESULTS Total economic costs for FY2019 were US$6,175,960 in Kenya and US$4,261,207 in Malawi. The proportion of costs incurred in IPs and DICs was 66% in Kenya and 42% in Malawi. The costliest program areas were clinical services, management, peer outreach, and monitoring and data use. Mean cost per contact was US$127 in Kenya and US$279 in Malawi, with a mean cost per contact in DICs and IPs of US$63 in Kenya and US$104 in Malawi. CONCLUSION Actions undertaken above the service level in headquarters and country offices along with those conducted below the service level in communities, comprised important proportions of KP HIV service costs. The costs of pre-service population mapping and size estimation activities were not negligible. Costing studies that focus on the service level alone are likely to underestimate the costs of delivering HIV services to KPs.
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Affiliation(s)
| | - Jose Luis Figueroa
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico
| | - Jorge Eduardo Sanchez-Morales
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Luz Edith Ochoa-Sanchez
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico
| | - Mariana Morales-Vazquez
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | | | | | | | | | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico.
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Opuni M, Sanchez-Morales JE, Figueroa JL, Salas-Ortiz A, Banda LM, Olawo A, Munthali S, Korir J, DiCarlo M, Bautista-Arredondo S. Estimating the cost of HIV services for key populations provided by the LINKAGES program in Kenya and Malawi. BMC Health Serv Res 2023; 23:337. [PMID: 37016402 PMCID: PMC10071702 DOI: 10.1186/s12913-023-09279-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/13/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Data remain scarce on the costs of HIV services for key populations (KPs). The objective of this study was to bridge this gap in the literature by estimating the unit costs of HIV services delivered to KPs in the LINKAGES program in Kenya and Malawi. We estimated the mean total unit costs of seven clinical services: post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), HIV testing services (HTS), antiretroviral therapy (ART), sexually transmitted infection (STI) services, sexual and reproductive health (SRH) services, and management of sexual violence (MSV). These costs take into account the costs of non-clinical services delivered alongside clinical services and the pre-service and above-service program management integral to the LINKAGES program. METHODS Data were collected at all implementation levels of the LINKAGES program including 30 drop-in-centers (DICs) in Kenya and 15 in Malawi. This study was conducted from the provider's perspective. We estimated economic costs for FY 2019 and cost estimates include start-up costs. Start-up and capital costs were annualized using a discount rate of 3%. We used a combination of top-down and bottom-up costing approaches. Top-down methods were used to estimate the costs of headquarters, country offices, and implementing partners. Bottom-up micro-costing methods were used to measure the quantities and prices of inputs used to produce services in DICs. Volume-weighted mean unit costs were calculated for each clinical service. Costs are presented in 2019 United States dollars (US$). RESULTS The mean total unit costs per service ranged from US$18 (95% CI: 16, 21) for STI services to US$635 (95% CI: 484, 785) for PrEP in Kenya and from US$41 (95% CI: 37, 44) for STI services to US$1,240 (95% CI 1156, 1324) for MSV in Malawi. Clinical costs accounted for between 21 and 59% of total mean unit costs in Kenya, and between 25 and 38% in Malawi. Indirect costs-including start-up activities, the costs of KP interventions implemented alongside clinical services, and program management and data monitoring-made up the remaining costs incurred. CONCLUSIONS A better understanding of the cost of HIV services is highly relevant for budgeting and planning purposes and for optimizing HIV services. When considering all service delivery costs of a comprehensive HIV service package for KPs, costs of services can be significantly higher than when considering direct clinical service costs alone. These estimates can inform investment cases, strategic plans and other budgeting exercises.
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Affiliation(s)
| | - Jorge Eduardo Sanchez-Morales
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Jose Luis Figueroa
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Andrea Salas-Ortiz
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | | | | | | | | | | | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico.
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Nance N, Salas-Ortiz A, Ogungbemi K, Akeju D, Oluwayinka AG, Ezirim I, Anenih J, Amanze O, Omoregie G, Aliyu SH, Bautista-Arredondo S. Costs of HIV prevention services provided by community-based organizations to female sex workers in Nigeria. PLoS One 2023; 18:e0282826. [PMID: 36913371 PMCID: PMC10010541 DOI: 10.1371/journal.pone.0282826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 02/17/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Nigeria has been consistently targeted in sub-Saharan Africa as an HIV-priority country. Its main mode of transmission is heterosexual, and consequently, a key population of interest is female sex workers (FSWs). While HIV prevention services are increasingly implemented by community-based organizations (CBOs) in Nigeria, there is a paucity of evidence on the implementation costs of these organizations. This study seeks to fill this gap by providing new evidence about service delivery unit cost for HIV education (HIVE), HIV counseling and testing (HCT), and sexually transmitted infection (STI) referral services. METHODS In a sample of 31 CBOs across Nigeria, we calculated the costs of HIV prevention services for FSWs taking a provider-based perspective. We collected 2016 fiscal year data on tablet computers during a central data training in Abuja, Nigeria, in August 2017. Data collection was part of a cluster-randomized trial examining the effects of management practices in CBOs on HIV prevention service delivery. Staff costs, recurrent inputs, utilities, and training costs were aggregated and allocated to each intervention to produce total cost calculations, and then divided by the number of FSWs served to produce unit costs. Where costs were shared across interventions, a weight proportional to intervention outputs was applied. All cost data were converted to US dollars using the mid-year 2016 exchange rate. We also explored the cost variation across the CBOs, particularly the roles of service scale, geographic location, and time. RESULTS The average annual number of services provided per CBO was 11,294 for HIVE, 3,326 for HCT, and 473 for STI referrals. The unit cost per FSW tested for HIV was 22 USD, the unit cost per FSW reached with HIV education services was 19 USD, and the unit cost per FSW reached by STI referrals was 3 USD. We found heterogeneity in total and unit costs across CBOs and geographic location. Results from the regression models show that total cost and service scale were positively correlated, while unit costs and scale were consistently negatively correlated; this indicates the presence of economies of scale. By increasing the annual number of services by 100 percent, the unit cost decreases by 50 percent for HIVE, 40 percent for HCT, and 10 percent for STI. There was also evidence that indicates that the level of service provision was not constant over time across the fiscal year. We also found unit costs and management to be negatively correlated, though results were not statistically significant. CONCLUSIONS Estimates for HCT services are relatively similar to previous studies. There is substantial variation in unit costs across facilities, and evidence of a negative relationship between unit costs and scale for all services. This is one of the few studies to measure HIV prevention service delivery costs to female sex workers through CBOs. Furthermore, this study also looked at the relationship between costs and management practices-the first of its kind to do so in Nigeria. Results can be leveraged to strategically plan for future service delivery across similar settings.
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Affiliation(s)
- Nerissa Nance
- National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
- University of California, Berkeley, Berkeley, CA, United States of America
| | - Andrea Salas-Ortiz
- National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
- Centre for Health Economics, University of York, York, United Kingdom
- * E-mail:
| | | | - David Akeju
- University of Lagos (UNILAG), Lagos, Nigeria
| | | | - Idoteyin Ezirim
- National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - James Anenih
- National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - Ogbonna Amanze
- National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | | | - Sani H. Aliyu
- National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - Sergio Bautista-Arredondo
- National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
- University of California, Berkeley, Berkeley, CA, United States of America
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Salas-Ortiz A, Ochoa-Sánchez LE, Bautista-Arredondo S. Coordinación y cooperación de las redes formadas detrás del continuo de atención a personas que viven con VIH en México. Salud Publica Mex 2022; 64:488-497. [PMID: 36130369 DOI: 10.21149/13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/01/2022] [Indexed: 11/06/2022] Open
Abstract
OBJETIVO Describir y caracterizar las redes formadas detrás del continuo de atención a personas que viven con VIH en México. Material y métodos. Bajo un enfoque de análisis de redes sociales se analizó información sobre las relaciones que establecen los actores que participan en el continuo de atención del VIH. RESULTADOS Existe una formación de re-des de atención con distintos actores y, conforme se avanza en el continuo de atención, las redes tienden a fragmentarse y se observa una baja conectividad. CONCLUSIONES La provisión de servicios para VIH en México es un proceso de gober-nanza múltiple; sin embargo, la configuración de las redes no implica que la provisión de servicios sea óptima. No obstante, la formación de redes es una potencial herramienta que los Centros Ambulatorios para la Prevención y Atención de Sida e Infecciones de Transmisión Sexual y Servicios de Atención Integral Hospitalaria han establecido para lograr su objetivo de ofrecer atención oportuna y continua, ante un contexto de recursos limitados y de gestión pública por resultados.
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Affiliation(s)
- Andrea Salas-Ortiz
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México/Department of Economics and Related Studies, University of York. York, Reino Unido.
| | - Luz Edith Ochoa-Sánchez
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México.
| | - Sergio Bautista-Arredondo
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México.
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Akeju D, Nance N, Salas-Ortiz A, Fakunmoju A, Ezirim I, Oluwayinka AG, Godpower O, Bautista-Arredondo S. Management practices in community-based HIV prevention organizations in Nigeria. BMC Health Serv Res 2021; 21:489. [PMID: 34022857 PMCID: PMC8141130 DOI: 10.1186/s12913-021-06494-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 05/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Nigeria has one of the largest Human Immunodeficiency Virus (HIV) epidemics in the world. Addressing the epidemic of HIV in such a high-burden country has necessitated responses of a multidimensional nature. Historically, community-based organizations (CBOs) have played an essential role in targeting key populations (eg. men who have sex with men, sex workers) that are particularly burdened by HIV. CBOs are an essential part of the provision of health services in sub-Saharan Africa, but very little is known about the management practices of CBOs that provide HIV prevention interventions. Methods We interviewed 31 CBO staff members and other key stakeholders in January 2017 about management practices in CBOs. Management was conceptualized under the classical management process perspective; these four management phases—planning, organizing, leading, and evaluating—guided the interview process and code development. Data analysis was conducted thematically using Atlas.ti software. The protocol was approved by the ethics committees of the National Institute of Public Health of Mexico (INSP), the National Agency for the Control of AIDS in Nigeria (NACA), and the Nigerian Institute for Medical Research (NIMR). Results We found that CBOs implement variable management practices that can either hinder or facilitate the efficient provision of HIV prevention services. Long-standing CBOs had relatively strong organizational infrastructure and capacity that positively influenced service planning. In contrast, fledgling CBOs were deficient of organizational infrastructure and lacked program planning capacity. The delivery of HIV services can become more efficient if management practices are taken into account. Conclusions The delivery of HIV services by CBOs in Nigeria was largely influenced by inherent issues related to skills, organizational structure, talent retention, and sanction application. These, in turn, affected management practices such as planning, organizing, leading, and evaluating. This study shows that KP-led CBOs are evolving and have strong potentials and capacity for growth, and can become more efficient and effective if attention is paid to issues such as hierarchy, staff recruitment, and talent retention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06494-1.
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Affiliation(s)
- David Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | | | - Andrea Salas-Ortiz
- National Institute of Public Health, Mexico and University of York, York, UK
| | | | - Idoteyin Ezirim
- National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | | | | | - Sergio Bautista-Arredondo
- Center for Health Systems Research, National Institute of Public Health, Universidad 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P, 62100, Cuernavaca, Morelos, Mexico.
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Salas-Ortiz A, La Hera-Fuentes G, Nance N, Sosa-Rubí SG, Bautista-Arredondo S. The relationship between management practices and the efficiency and quality of voluntary medical male circumcision services in four African countries. PLoS One 2019; 14:e0222180. [PMID: 31581192 PMCID: PMC6776351 DOI: 10.1371/journal.pone.0222180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/23/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Given constrained funding for Human Immunodeficiency Virus (HIV) programs across Sub-Saharan Africa, delivering services efficiently is paramount. Voluntary medical male circumcision (VMMC) is a key intervention that can substantially reduce heterosexual transmission—the primary mode of transmission across the continent. There is limited research, however, on what factors may contribute to the efficient and high-quality execution of such programs. Methods We analyzed a multi-country, multi-stage random sample of 108 health facilities providing VMMC services in sub-Saharan Africa in 2012 and 2013. The survey collected information on inputs, outputs, process quality and management practices from facilities providing VMMC services. We analyzed the relationship between management practices, quality (measured through provider vignettes) and efficiency (estimated through data envelopment analysis) using Generalized Linear Models and Mixed-effects Models. Applying multivariate regression models, we assessed the relationship between management indices and efficiency and quality of VMMC services. Results Across countries, both efficiency and quality varied widely. After adjusting for type of facility, country and scale, performance-base funding was negatively correlated with efficiency -0.156 (p < 0.05). In our analysis, we did not find any significant relationships between quality and management practices. Conclusions No significant relationship was found between process quality and management practices across 108 VMMC facilities. This study is the first to analyze the potential relationships between management and service quality and efficiency among a sample of VMMC health facilities in sub-Saharan Africa and can potentially inform policy-relevant hypotheses to later test through prospective experimental studies.
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Affiliation(s)
- Andrea Salas-Ortiz
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
- University of York, York, United Kingdom
| | - Gina La Hera-Fuentes
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
- University of Newcastle, Newcastle, Australia
| | - Nerissa Nance
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Sandra G. Sosa-Rubí
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
- School of Public Health, University of California, Berkeley, California, United States of America
- * E-mail:
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Bautista-Arredondo S, Nance N, Salas-Ortiz A, Akeju D, Oluwayinka AG, Ezirim I, Anenih J, Chima C, Amanze O, Omoregie G, Ogungbemi K, Aliyu SH. The role of management on costs and efficiency in HIV prevention interventions for female sex workers in Nigeria: a cluster-randomized control trial. Cost Eff Resour Alloc 2018; 16:37. [PMID: 30386184 PMCID: PMC6199740 DOI: 10.1186/s12962-018-0107-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/05/2018] [Indexed: 01/20/2023] Open
Abstract
Background While the world has made much global progress toward the reduction of new HIV infections, HIV continues to be an important public health problem. In the face of constantly constrained resources, donors and grantees alike must seek to optimize resources and deliver HIV services as efficiently as possible. While there is evidence that management practices can affect efficiency, this has yet to be rigorously tested in the context of HIV service delivery. Methods The present protocol describes the design of a cluster-randomized control trial to estimate the effect of management practices on efficiency. Specifically, we will evaluate the impact of an intervention focused on improving management practices among community-based organizations (CBOs), on the costs of HIV prevention services for female sex workers (FSW) in Nigeria. To design the intervention, we used a qualitative, design thinking-informed methodology that allowed us to understand management in its organizational context better and to develop a user-centered solution. After designing the suite of management tools, we randomly assigned 16 CBOs to the intervention group, and 15 CBOs to the control group. The intervention consisted of a comprehensive management training and a management “toolkit” to support better planning and organization of their work and better communication between CBOs and community volunteers. Both treatment and control groups received training to record data on efficiency—inputs used, and outputs produced. Both groups will be prospectively followed through to the end of the study, at which point we will compare the average unit cost per FSW served between the two groups using a quasi-experimental “difference-in-differences” (DiD) strategy. This approach identifies the effect of the intervention by examining differences between treatment and control groups, before and after the intervention thus accounting for time-constant differences between groups. Despite the rigorous randomization procedure, the small sample size and diversity in the country may still cause unobservable characteristics linked to efficiency to unbalanced between treatment and control groups at baseline. In anticipation of this possibility, using the quasi-experimental DiD approach allows any baseline differences to be “differenced out” when measuring the effect. Discussion This study design will uniquely add to the literature around management practices by building rigorous evidence on the relationship between management skills and practices and service delivery efficiency. We expect that management will positively affect efficiency. This study will produce valuable evidence that we will disseminate to key stakeholders, including those integral to the Nigerian HIV response. Trial registration This trial has been registered in Clinical Trials (NCT03371914). Registered 13 December 2018 Electronic supplementary material The online version of this article (10.1186/s12962-018-0107-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Bautista-Arredondo
- 1National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico.,2University of California, Berkeley, School of Public Health (UCB), Berkeley, USA
| | - N Nance
- 1National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
| | - A Salas-Ortiz
- 1National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
| | - D Akeju
- 3University of Lagos (UNILAG), Lagos, Nigeria
| | | | - I Ezirim
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - J Anenih
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - C Chima
- 4Society for Family Health (SFH), Abuja, Nigeria
| | - O Amanze
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - G Omoregie
- 4Society for Family Health (SFH), Abuja, Nigeria
| | - K Ogungbemi
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - S H Aliyu
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
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