Policy-makers have long argued about the potential
efficiency gains and cost savings from integrating HIV and sexual reproductive
health (SRH) services, particularly in resource-constrained settings with
generalised HIV epidemics. However, until now, little empirical evidence exists
on whether the hypothesised efficiency gains associated with such integration
can be achieved in practice.
We estimated a quadratic cost function using data obtained
from 40 health facilities, over a 2-year-period, in Kenya and Swaziland. The
quadratic specification enables us to determine the existence of economies of
scale and scope.
The empirical results reveal that at the current output
levels, only HIV counselling and testing services are characterised by
service-specific economies of scale. However, no overall economies of scale
exist as all outputs are increased. The results also indicate cost
complementarities between cervical cancer screening and HIV care; post-natal
care and HIV care and family planning and sexually transmitted infection
treatment combinations only.
The results from this analysis reveal that contrary to
expectation, efficiency gains from the integration of HIV and SRH services, if
any, are likely to be modest. Efficiency gains are likely to be most achievable
in settings that are currently delivering HIV and SRH services at a low scale
with high levels of fixed costs. The presence of cost complementarities for
only three service combinations implies that careful consideration of
setting-specific clinical practices and the extent to which they can be
combined should be made when deciding which services to integrate.
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By:
- 1Faculty of Public Health and Policy, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
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