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Does integrated services delivery lead to improved efficiencies?

Summary: The costing study of integration across 42 facilities found that the wide variation in the costs of HIV-SRH at different sites suggests potential for integration to improve efficiency. However, to date no clear and widespread impact of integration on aggregate costs and resource utilisation has been found due to the huge heterogeneity of integration and cost determinants between study sites.

Detail: The costing study across 42 facilities described and analysed the level of efficiency of different models of SRH-HIV integration. Economic and financial costs were collected over two years, 2008/09 (year 1) and 2010/11 (year 2), from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using micro-costing and step down costing methods was conducted from the health provider’s perspective. The main unit of analysis is the unit cost per visit for each service.

The findings show the costs for each of the different models at a wide range of different facility types, and examines whether integration itself improves the utilization of both human and physical resources. Although the findings are not conclusive on the latter point, given that each facility study showed a different pattern of resource utilization, the findings outline and describe the ways and extent to which integration is able to improve efficiency.

Overall the findings help to describe for planners and policy makers the cost, level of integration and resource utilization of a package of SRH-HIV services across two countries. However, it is not possible to say whether integration itself is a substantial driver of the level of these costs at any aggregate level, given the complexity of integration, the limited extent to which it was achieved in this period and the numbers of other influences on costs. Further work on this dataset is required to draw firm policy conclusions out of this complex picture.

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