Leveraging existing program data for routine efficiency measurement in Zambia.

As donor contributions for HIV/AIDS stagnate globally, national governments must seek ways to improve use of existing resources through interventions to drive efficiency at the facility level.  But program managers lack routine information on unit expenditures at points of care, and higher-level planners are unable to assess resource use in the health system.  Thus, managers cannot measure current levels of technical efficiency, and are unable to evaluate effectiveness of interventions to increase technical efficiency.

Expanding Access to a New, More Affordable Levonorgestrel Intrauterine System in Kenya: Service Delivery Costs Compared With Other Contraceptive Methods and Perspectives of Key Opinion Leaders.

Background: The levonorgestrel intrauterine system (LNG IUS) is one of the most effective forms of contraception and offers important non-contraceptive health benefits. However, it is not widely available in developing countries, largely due to the high price of existing products. Medicines360 plans to introduce its new, more affordable LNG IUS in Kenya.

Integrating family planning promotion into the work of environmental volunteers: a population, health and environment initiative in Kenya.

Voluntary use of family planning is instrumental to the health and social well-being of women, families and communities.Although contraceptive use in Sub-Saharan Africa is increasing, unmet need for family planning remains high. Even within countries that have achieved increases in contraceptive prevalence, use remains low among some population subgroups.

Building on safety, feasibility, and acceptability: the impact and cost of community health worker provision of injectable contraception.

Background: A critical shortage of doctors, nurses, and midwives in many sub-Saharan African countries inhibits efforts to expand access to family planning services, especially in rural areas. One way to fill this gap is for community health workers (CHWs) to provide injectable contraceptives, an intervention for which there is growing evidence and international support. In 2009, with approval from the Government of Zambia (GoZ), FHI 360 collaborated with ChildFund Zambia to design and implement such an intervention as part of its existing CHW family planning program.

Comparing direct costs of facility-based Shang Ring provision versus a standard surgical technique for voluntary medical male circumcision in Zambia.

Background: Rapid scale-up of voluntary medical male circumcision (VMMC) is needed to realize potential reductions in HIV incidence in sub-Saharan Africa. New disposable VMMC devices such as the Shang Ring may offer several advantages over standard surgery, including lower costs.

Methods: We compared direct costs of the Shang Ring and dorsal slit techniques for delivery of VMMC in the context of a randomized-controlled trial carried out in Zambia in 2011.

The promise of affordable implants: is cost recovery possible in Kenya?

Background: Contraceptive implants are one of the most effective methods of family planning but remain underutilized due to their relatively high upfront cost. The increasing availability of a low-cost implant may reduce financial barriers and increase uptake of implants. The commodity cost of Sino-implant (II) is approximately 60% less than two other widely available implants, and a direct service delivery cost of approximately US$12 makes it one of the most cost-effective methods available.

Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities.

Objective: To present evidence on unit and total costs of outpatient HIV/AIDS services in ZPCT-supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV/AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in Zambia.

Methods: Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider.

Predicting impact of price increases on demand for reproductive health services: can it be done well?

Objective: To assess criterion validity of a survey that uses contingent valuation to elicit estimates of client willingness-to-pay (WTP) higher prices for family planning and reproductive health services in three developing countries.

Methods: Criterion validity was assessed at the individual client level and at the aggregate service level. Individual-level validity was assessed using a longitudinal approach in which we compared what women said they would do with their actual utilization behavior following a price increase.

The impact of price changes on demand for family planning and reproductive health services in Ecuador.

Donor funding for family planning and reproductive health (FP/RH) has declined in Latin America over the past decade, obliging providers to consider other financing mechanisms, including cost recovery through user fees. Pricing decisions are often difficult for providers, who fear that increased fees will cripple demand and create barriers to access for poor clients. Providers need information on how changes in price can affect utilization of services, and how to resolve trade-offs between generating income and serving poor clients.