Costing Adult and Adolescent Male Circumcision in Kenya, Zambia, Zimbabwe and Uganda Urbanus Kioko (PHD) University of Nairobi Arusha, Tanzania 10 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

CountryNumber of Sites Costed Kenya30 Zambia17 Zimbabwe4 Uganda27

Kenya HospitalsFixedOutreach Direct Costs Consumables $8.1122% % Personnel $ % % Training $ % % Subtotal$ % % Indirect costs Equipment $2.92 8% % Maintenance/Utility $ % % Support personnel costs $2.44 7% % Mgmt./supervision costs $1.33 4% % Mobilisation $0.74 2% % Subtotal$ % % TOTAL$ % % # of MC Clients/Yr/Facility

Kenya Health CenterFixed Outreach Direct Costs (US$) Consumables $8.15 $9.04 Personnel $3.04 $22.61 Training $4.36 $0.64 Subtotal$15.55 $32.29 Indirect costs (US$) Equipment $2.28 $1.67 Maintenance/Utility $2.28 $2.00 Support personnel costs $3.82 $2.59 Mgmt. and supervision costs $0.95 $0.79 Mobilisation $1.40 $1.67 Subtotal$10.74 $8.73 TOTAL$26.30$41.02 # of MC Clients/Yr/Facility

Kenya DispensariesFixed Outreach Direct Costs (US$) Consumables $12.57 $8.87 Personnel $25.99$18.57 Training $2.98$0.73 Subtotal$41.55$28.17 Indirect costs (US$) 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

Zimbabwe Fixed% Outreach % Direct Costs Consumables $ %$ % Non-consumables$0.96 2%$1.011% Personnel costs$ %$ % Training costs$ %$0.260% Subtotal$ %$ % Indirect costs Equipment/capital costs$0.45 1%$3.565% Maintenance/Utility$3.24 6%$ % Support personnel$4.42 8%$4.677% Indirect Labor/Mgmt.$2.28 4%$1.252% Subtotal$ %$ % TOTAL$ %$ % # of MC Clients

Zambia Direct Costs% Labor$ % Materials$ % TrainingN.A. Subtotal$ % Indirect Costs Equipment$ % Maintenance/Utility$ % Indirect Labor/Management$ % Subtotal$ % TOTAL$ % # 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 1 st costing exercise

 Disseminate findings from countries where costing was performed  Repeat costing exercise to update and validate cost estimates every 2-3 years