1. Costing Adult and Adolescent Male Circumcision in Kenya, Zambia, Zimbabwe and Uganda Urbanus Kioko (PHD) University of Nairobi Arusha, Tanzania 10 June 2010

2.  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

3. CountryNumber of Sites Costed Kenya30 Zambia17 Zimbabwe4 Uganda27

4. Kenya HospitalsFixedOutreach Direct Costs Consumables $8.1122% 8.68 21% Personnel $11.62 32% 24.04 57% Training $4.60 13% 0.83 2% Subtotal$24.32 67% 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$11.99 33% 8.76 21% TOTAL$36.31 100% 42.32100% # of MC Clients/Yr/Facility 845378

5. 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 2044445

6. 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 326530

7. Zimbabwe Fixed% Outreach % Direct Costs Consumables $28.13 48%$28.1340% Non-consumables$0.96 2%$1.011% Personnel costs$19.09 32%$19.1227% Training costs$ 0.34 1%$0.260% Subtotal$48.43 82%$48.5269% Indirect costs Equipment/capital costs$0.45 1%$3.565% Maintenance/Utility$3.24 6%$12.2917% Support personnel$4.42 8%$4.677% Indirect Labor/Mgmt.$2.28 4%$1.252% Subtotal$10.39 18%$21.7731% TOTAL$58.82100%$70.29 100% # of MC Clients 96004800

8. Zambia Direct Costs% Labor$8.95 16.40% Materials$8.54 15.65% TrainingN.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

11. # of MC Clients/Yr

12.  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

13.  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)

14.  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

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