Step by Step: The Cost and Efficiency of Integrating HIV & SRH

Cost Step 4

Efficiency gains through integrating SRH and HIV services are possible through better use of both human and capital resources. Whilst cost savings are likely to be small, integration has many benefits.

There is a wealth of evidence  to support the integration HIV prevention, treatment and care with sexual and reproductive health (SRH) services. In addition to improving health and social outcomes, it has been argued that integration of HIV and SRH services can increase the efficiency of service delivery and maximize the use of scarce health care resources.

Economic theory suggests there would be several potential efficiency advantages from the integration of HIV and SRH services, but there is limited evidence to support this. Now, the latest Steps to Integration Guide summarises a costing study of health facilities in Kenya and Swaziland, carried out as part of the Integra Initiative.

The retrospective facility based costing study was conducted in 40 health facilities in Kenya and Swaziland, to estimate the unit costs of six integrated HIV and SRH services. The services were family planning, postnatal care, cervical cancer screening, HIV counselling and testing, STI treatment, and HIV treatment and care. Determinants of costs of integrated HIV and SRH services were evaluated and the existence of economies of scale and scope associated with integrated delivery of HIV and SRH services explored.

Full findings from the study are available here, in the ‘Steps to Integration Guide to Cost and technical efficiency of integrated HIV and SRH services in Kenya and Swaziland’ guide.

The study reveals that in the 40 health facilities efficiency gains from the integration of HIV and SRH services were small. The facilities that made the highest efficiency gains were those with substantial fixed costs. The study also found there is the potential to reduce costs of delivery through better use of both human and capital resources. More evidence on human resources in integration can be found here.

Regarding economies of scope, the Integra study suggests that planners in all settings need to carefully consider the detailed processes and clinical practice required by each service, and which of these can be combined when services are integrated, before assuming substantial efficiency gains.

It should also be noted that integration has many aims (and consequences) and that efficiency considerations are only one factor in optimal service design. Policy makers are advised to be cautious in the estimation of cost savings from integration to optimally balance cost with other service delivery goals.

A full resource library containing this guide and other research findings from the Integra Initiative, is available free of cost in the Integration Initiatives Research Library.