Costing Adult and Adolescent Male Circumcision in Kenya,

Zambia, Zimbabwe and Uganda

Urbanus Kioko (PHD)University of Nairobi

Arusha, Tanzania10 June 2010

Currently offering MMC services Meets existing policies for

comprehensive MMC services Represents geographic diversity Represents diversity of sites where

MMC services will be scaled-up

Country Number of Sites Costed

Kenya 30

Zambia 17

Zimbabwe 4

Uganda 27

Kenya Hospitals Fixed OutreachDirect Costs

Consumables $8.11 22% 8.68 21%Personnel $11.6

232%

24.04 57%Training $4.60 13% 0.83 2%Subtotal $24.3

267%

33.55 79%Indirect costs

Equipment $2.92 8% 2.24 5%Maintenance/Utility $4.55 13% 1.18 3%

Support personnel costs $2.44 7% 3.61 9%

Mgmt./supervision costs $1.33 4% 0.50 1%

Mobilisation $0.74 2% 1.24 3%Subtotal $11.9

933%

8.76 21%TOTAL $36.3

1100% 42.32 100

%

# of MC Clients/Yr/Facility

845 378

Kenya Health Center Fixed Outreach

Direct Costs (US$)

Consumables $8.15 $9.04Personnel $3.04 $22.61Training $4.36 $0.64Subtotal $15.55 $32.29

Indirect costs (US$)

Equipment $2.28 $1.67Maintenance/Utility $2.28 $2.00

Support personnel costs $3.82 $2.59

Mgmt. and supervision costs $0.95 $0.79

Mobilisation $1.40 $1.67Subtotal $10.74 $8.73TOTAL $26.30 $41.02

# of MC Clients/Yr/Facility 2044 445

Kenya Dispensaries

Fixed Outreach

Direct Costs (US$)

Consumables $12.57 $8.87

Personnel $25.99 $18.57

Training $2.98 $0.73

Subtotal $41.55 $28.17Indirect costs (US$)

Equipment $2.93 $1.92

Maintenance/Utility $2.33 $1.08

Support personnel costs $4.57 $3.24

Mgmt and supervision costs $1.13 $0.38

Mobilisation $1.06 $1.39

Subtotal $12.01 $8

TOTAL $53.56 $36.17

# of MC Clients/Yr/Facility

326 530

Zimbabwe Fixed % Outreach %

Direct Costs

Consumables $28.13 48% $28.13 40%Non-consumables $0.96 2% $1.01 1%Personnel costs $19.09 32% $19.12 27%Training costs $ 0.34 1% $0.26 0%Subtotal $48.43 82% $48.52 69%Indirect costs

Equipment/capital costs

$0.451% $3.56 5%

Maintenance/Utility $3.24 6% $12.29 17%Support personnel $4.42 8% $4.67 7%Indirect Labor/Mgmt. $2.28 4% $1.25 2%Subtotal $10.39 18% $21.77 31%TOTAL $58.82 100

%$70.29

100%# of MC Clients 9600 4800

Zambia Direct Costs %

Labor $8.95 16.40%Materials $8.54 15.65%Training N.A.  Subtotal $17.49 32.05%

Indirect Costs

Equipment $21.27 38.98%Maintenance/Utility $13.80 25.29%Indirect Labor/Management $2.01 3.68%Subtotal $37.08 67.95%

TOTAL $54.57 100.00%# of MC Clients/Yr/Facility 328

# of MC Clients/Yr

Difficult to capture demand creation, training and management costs

Excludes traditional MC Does not address question about how

unit costs might change with different methods of service delivery

Limitation of the data used for estimating unit costs—may not be very accurate

Preliminary data-further analysis/validation of the unit costs

The unit cost of MC varies significantly particularly due to:› Scale (# of clients seen at each site)› Type of site (public, private)› Location of site (urban, peri-urban, rural)› Type of service delivery method

(integrated, outreach, mobile)› Surgical instrument method/kit(disposable

kits, non-disposable kits, etc.)› Persons responsible for delivery (e.g.,

nurse, surgeon, clinical officer)

Likely to generate more accurate data over time-2-3 yrs

Need to update the unit costs-2-3 years after the 1st costing exercise

Disseminate findings from countries where costing was performed

Repeat costing exercise to update and validate cost estimates every 2-3 years