Transcript KES Level 2

Costing Health and HIV services in
Kenya
Dr. Benson Chuma
SHOPS Kenya
Health Financing Coordinator
July 22, 2015
SHOPS is funded by the U.S. Agency for International Development.
Abt Associates leads the project in collaboration with:
Banyan Global
Jhpiego
Marie Stopes International
Monitor Group
O’Hanlon Health Consulting
Kenya must increase access to HIV services
to achieve an AIDS Free Generation
• World’s 4th largest population of
PLHIV, approximately 1.6
million people
• Adult Prevalence is 6%, with
approximately 100,000 new
infections per year
• Number of PLHIV on ART
744,116, total coverage
estimated 41 percent
Source: UNAIDS 2014, PEPFAR WAD 2014
2
Kenya’s private health sector is a large,
dynamic partner
51%
Health facilities are private
40%
Of all health financing comes from the private
sector
22%
Total health expenditures in private facilities
59%
THE managed by private sector financing
agents
3
Private health facilities are located in areas
with large populations of PLHIV
Nairobi: Private Health Facilities
Nairobi
Understanding where
and for what private
sector costs are incurred
is critical to ensure
efficiencies and project
scale up of provision of
private sector HIV
services
Source: eHealth-Kenya, 2015; NASCOP, 2014
4
Costing data for the private health sector is critical to
achieving the expansion of HIV services
Costing supports
strategic planning
and budgeting
Where and what
types of services
are patients
accessing, how
much are those
services costing?
Costing explains
the efficient use of
resources
Which facilities
are doing more
with less, and
which facilities
are doing less
with more?
5
Country wide sampling across different
counties, levels and ownership types
Collected data from 238 facilities
Two data collection efforts:
• Phase I (Feb – July 2013):
Partnered with GIZ to collect
data from 238 public and
private facilities
• Phase II (2014): Verified data at
30 private facilities and
generated service-specific
costs
Analysis done using MASH
(Management Accounting System
for Hospitals) excel tool to
generate facility specific costs
6
Overview of our costing approach
Inputs:
• Financial costs:
• Staff (incl. donated labor)
• Drugs/clinical supplies (incl.
some donated drugs)
• Indirect costs (e.g. admin,
maintenance)
• Utilization: OP/IP visits and
services
MASH OUTPUTS
Facility specific unit costs:
• Out patient visit
• Inpatient bed day
Generate service provision
costs for:
• HIV-VCT and ART
• Family planning
• Maternity-normal and
caesarian section
delivery services
7
OP unit costs varied across different levels and
ownership types
4,000
3,500
3,000
KES
2,500
2,000
1,618
1,160
1,500
1,000
500
745
959
610
608
467
673
702
-
Level 2 : Dispensary Level 3: Health Centre Level 4: County Referral Hospital
8
KES
Non-test costs comprised the bulk of HCT visit costs
with level 2 and 4 facilities having higher costs
1000
900
800
700
600
500
400
300
200
100
0
836
84
542
97
752
979
144
835
111
835
724
445
Level 2
Level 3
Non-test kit costs
Level 4
Test kit costs
All
facilities
Notes:
• Costs are provided
by level of care
combining both
FBO, NGO and
P4P facilities.
• KEMSA provided
2012 prices of
RTKs KES 90.12.
• Non test kit costs
include direct and
indirect costs.
• N=20
Level 2 and 4 facilities had higher double testing rates, 17% and
38% respectively, as compared to Level 3 facilities
9
ART at private facilities does not necessarily
cost more than PEPFAR estimates for LMIC
35,000
30,000
KES
25,000
20,000
15,000
10,000
5,000
0
Level 2
Level 3
FBO_NGO FBO_NGO
Level 3
P4P
Level 4
P4P
Level 4
P4P*
Level 4
PEPFAR
FBO_NGO
LMIC
Average
• Each bar represents a distinct facility
• An ART visit includes newly initiated and established clients at a Comprehensive Care Clinic
• Non drug costs include direct and indirect costs
10
Drug costs were significant cost drivers in
provision of ART care
Cost of an ART visit for Sampled Facilities (KES) N=6
Average cost of an ART visit (KES)
6,000
5,000
4,000
3,000
2,000
2,313
1,930
1,500
1,429
1,418
Level 3
FBO_NGO
Level 3
P4P
Level 4
P4P
2,556
1,000
-
Level 2
FBO_NGO
ART non-drug costs per visit
Level 4
P4P*
Level 4
FBO_NGO
ART drug costs per visit
11
Summary and next steps
• ART and OP costs varied across facilities, highlighting
potential to improve efficiency in private sector
• Private sector ART costs were not higher than global
averages, implying significant potential to leverage existing
private sector infrastructure to provide care
Study results can be used to:
• Enable private sector in LMIC countries in benchmarking on
costs of providing care efficiently
• Support decision making on how to sustainably leverage
private sector providers to increase access to HIV services
12
Benson Chuma
[email protected]
SHOPS is funded by the U.S. Agency for International Development.
Abt Associates leads the project in collaboration with:
Banyan Global
Jhpiego
Marie Stopes International
Monitor Group
O’Hanlon Health Consulting