Abstract
Introduction Given constrained funding for Human Immunodeficiency Virus (HIV) programs across Sub-Saharan Africa, delivering services efficiently is paramount. Voluntary medical male circumcision (VMMC) is a key intervention that can substantially reduce heterosexual transmission —the primary mode of transmission across the continent. There is limited research, however, on what factors may contribute to the efficient and high-quality execution of such programs. Methods We analyzed a multi-country, multi-stage random sample of 108 health facilities providing VMMC services in sub-Saharan Africa in 2012 and 2013. The survey collected information on inputs, outputs, process quality and management practices from facilities providing VMMC services. We analyzed the relationship between management practices, quality (measured through provider vignettes) and efficiency (estimated through data envelopment analysis) using Generalized Linear Models and Mixed-effects Models. Applying multivariate regression models, we assessed the relationship between management indices and efficiency and quality of VMMC services. Results Across countries, both efficiency and quality varied widely. After adjusting for type of facility, country and scale, performance-base funding was negatively correlated with efficiency -0.156 (p < 0.05). In our analysis, we did not find any significant relationships between quality and management practices. Conclusions No significant relationship was found between process quality and management practices across 108 VMMC facilities. This study is the first to analyze the potential relationships between management and service quality and efficiency among a sample of VMMC health facilities in sub-Saharan Africa and can potentially inform policy-relevant hypotheses to later test through prospective experimental studies.
| Original language | English |
|---|---|
| Article number | e0222180 |
| Journal | PLOS ONE |
| Volume | 14 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 1 Oct 2019 |
Bibliographical note
Funding Information:This study was funded by the Bill and Melinda Gates Foundation, Grant number OPP1041653. The Principal Investigator of the grant was Sergio Bautista-Arredondo. We are grateful to our colleague Jenny Segura-Díaz for her valuable help as research assistant during the writing retreat where we drafted the first version of this paper. We also thank David Contreras-Loya for his comments on an earlier version of the manuscript. We acknowledge the contribution of the ORPHEA study team in the design of the ORPHEA study and data collection: Kenya: Joseph Wang’ombe, Richard Wamai and Omar Galárraga. Rwanda: Jeanine Condo and Sabin Nsanzimana. South Africa: Neil Martinson. Zambia: Felix Masiye, Abson Chompolola and Kumbutso Dzekedzeke. Mexico: Ada Kwan and Claire Chaumont. The ORPHEA study was funded by the Bill & Melinda Gates Foundation.
Publisher Copyright:
© 2019 Salas-Ortiz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.