HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries

<p>Abstract</p> <p>Background</p> <p>Economic theory and limited empirical data suggest that costs per unit of HIV prevention program output (unit costs) will initially decrease as small programs expand. Unit costs may then reach a nadir and start to increase if expansion continues beyond the economically optimal size. Information on the relationship between scale and unit costs is critical to project the cost of global HIV prevention efforts and to allocate prevention resources efficiently.</p> <p>Methods</p> <p>The "Prevent AIDS: Network for Cost-Effectiveness Analysis" (PANCEA) project collected 2003 and 2004 cost and output data from 206 HIV prevention programs of six types in five countries. The association between scale and efficiency for each intervention type was examined for each country. Our team characterized the direction, shape, and strength of this association by fitting bivariate regression lines to scatter plots of output levels and unit costs. We chose the regression forms with the highest explanatory power (R²).</p> <p>Results</p> <p>Efficiency increased with scale, across all countries and interventions. This association varied within intervention and within country, in terms of the range in scale and efficiency, the best fitting regression form, and the slope of the regression. The fraction of variation in efficiency explained by scale ranged from 26% – 96%. Doubling in scale resulted in reductions in unit costs averaging 34.2% (ranging from 2.4% to 58.0%). Two regression trends, in India, suggested an inflection point beyond which unit costs increased.</p> <p>Conclusion</p> <p>Unit costs decrease with scale across a wide range of service types and volumes. These country and intervention-specific findings can inform projections of the global cost of scaling up HIV prevention efforts.</p

HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries.

BackgroundEconomic theory and limited empirical data suggest that costs per unit of HIV prevention program output (unit costs) will initially decrease as small programs expand. Unit costs may then reach a nadir and start to increase if expansion continues beyond the economically optimal size. Information on the relationship between scale and unit costs is critical to project the cost of global HIV prevention efforts and to allocate prevention resources efficiently.MethodsThe "Prevent AIDS: Network for Cost-Effectiveness Analysis" (PANCEA) project collected 2003 and 2004 cost and output data from 206 HIV prevention programs of six types in five countries. The association between scale and efficiency for each intervention type was examined for each country. Our team characterized the direction, shape, and strength of this association by fitting bivariate regression lines to scatter plots of output levels and unit costs. We chose the regression forms with the highest explanatory power (R2).ResultsEfficiency increased with scale, across all countries and interventions. This association varied within intervention and within country, in terms of the range in scale and efficiency, the best fitting regression form, and the slope of the regression. The fraction of variation in efficiency explained by scale ranged from 26-96%. Doubling in scale resulted in reductions in unit costs averaging 34.2% (ranging from 2.4% to 58.0%). Two regression trends, in India, suggested an inflection point beyond which unit costs increased.ConclusionUnit costs decrease with scale across a wide range of service types and volumes. These country and intervention-specific findings can inform projections of the global cost of scaling up HIV prevention efforts

Indonesia: Innovation strategies and competitive forces to enter the European seafood market

Aims – This thesis examines the capabilities of the Indonesian seafood export industry to enter the European market, which is the world’s largest seafood importer. The aim is to offer a knowledge-based competitive marketing strategy which is analysed in four parts: Paper I: Competitive framework; Paper II: Legal barriers; Paper III: Demand for seafood trade innovation in Europe; Paper IV: The Indonesian supply advantage. Focus of study – Fisheries has the potential to become a leading contributor to Indonesia’s economic development. This case study examines empirically the export potential of the European (EU) market for Indonesian Blue Swimming Crab (BSC), which currently depends on the United States (US) market. The main research question is: What are the strengths and the potential barriers for introduction and export of Indonesian seafood like BSC into the European market? What are the key factors for improving the competitiveness and value chain effectiveness for Indonesian exporters entering the new European market? Theory, methodology and findings – The main argument in this thesis is that success in the introduction of new products into the European market relies on market oriented strategic management. Market orientation is defined as an industry-wide generation of market intelligence pertaining to current and future customer needs, the dissemination of that intelligence across the value chain, and industry-wide capability to response to it (Kohli and Jaworski, 1990; Grunert et al., 2010). This thesis investigates the information relevant to market intelligence and analyses required to uncover competitive strategic opportunities and barriers to entering new markets with new seafood products. A combination of secondary and primary data is used in the investigation and analyses. Secondary data was collected from literature, statistics and legal databases while primary data was collected by surveys of European seafood buyers and Indonesian seafood suppliers. In paper I, a framework for the collection and analysis of intelligence is developed to identify opportunities and barriers in the introduction of innovative seafood products in markets by combining marketing theories from Rogers (2003), Barney (2002) and Porter (1980; 2008). Seven major categories important for developing market oriented value chain product advantages and market introduction advantages are identified; (1) trade barrier regulation, (2) supply-demand balance in the actual market (3) consumers’ purchasing behaviour, (4) customers’ value chain control, (5) pressure from the raw material suppliers, (6) competitive pressure within the value chain from; investment in innovation performance, market oriented infrastructure, rivals and new entrants, and (7) competitive pressure of substitute products. Intelligence as data of strategic value may be revealed by identification of the offered market values, market rareness, imitation protection and organizational capabilities (the VRIO model) and the factors influencing market adoption of new products (see Paper III below). Some of the seven categories presented in paper I were empirically studied in papers II, III and IV (Chapter 5), and supported the investigation of market trends (Chapter 6). Paper II studies legal regulation and trade barriers based on the sociology of law. The main finding is that the legal trade barriers are not among the main problems that explain the previous downturn in Indonesian exports to the EU. Nevertheless, the study indicates that Indonesia’s surveillance and enforcement of its domestic laws is in need of improvement. The challenge for Indonesia is to improve the legal framework; a challenge that seems most easily addressed by a full harmonization of Indonesian food safety rules to the EU law and the establishment of an EU-Indonesia conformity assessment agreement. The finding emphasizes the importance of gathering information on the law regarding trade barriers early in the process of market entry. Paper III analyses the importance of marketing-strategic intelligence combining product, price, promotion and place (the 4Ps) relative to the purchaser’s process of decision-making for the adoption of new seafood products in the EU market: the relative advantage, compatibility with current industry conventions, complexity of use, trialability in the small scale and social observability (the 5 IDs). The findings showed significant interest in new seafood products in the studied distribution chains. Nevertheless, the adoption process for new products meets many hurdles have to be overcome. The findings show the importance of intelligence about the process of adoption of innovative products which goes through two decision stages: the decision takers focus, in the first stage, on 5 ID product properties, while in the second stage they focus on the relative advantages (value for money) in the product-price relationship. This finding is important for the stepwise design of the process of market intelligence collection and 4P strategies in the introduction of new products. Paper IV studies the competitive strength of the Indonesian crab industry in light of the seven competitive factors presented in Paper I. The findings suggest that the Indonesian crab industry is able to supply first-class crab products. Nevertheless, its competitiveness is hampered by lack of investment in effective development of market orientated innovative products. The findings further disclose the industry’s low capability of competitive rivalry and protection, both against domestic and foreign competitors. The industry has a need for orientation of the innovation in value chain and industrial strategies towards Europe as the target market based on up to date market intelligence. In sum this study suggests that Indonesian seafood industries have the potential for competitive export to the EU market due to its strength in factors such as: (1) adequate supply of raw materials; (2) capability in infrastructure; and (3) industrial experience from exporting competitive generic products to the US market. However, the analysis indicates that the Indonesian capability for market orientation and innovation will face challenges in developing long-term market oriented strategies that it are important to address in order to gain competitive advantages. Managerial implications – This thesis offers a conceptual framework for gathering intelligence and analysis of competitive market-oriented strategies of seafood value chains in a national and international perspective as well as an analysis of the current competitive capability of the Indonesian seafood industry. This comprehensive framework can be applied in further research as a tool for analysis of competitive forces. The framework may also support the decision makers’ evaluation of the market-oriented value chain strategy and the industrial environment

HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries-3

<p><b>Copyright information:</b></p><p>Taken from "HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries"</p><p>http://www.biomedcentral.com/1472-6963/7/108</p><p>BMC Health Services Research 2007;7():108-108.</p><p>Published online 12 Jul 2007</p><p>PMCID:PMC1936993.</p><p></p

HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries-6

<p><b>Copyright information:</b></p><p>Taken from "HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries"</p><p>http://www.biomedcentral.com/1472-6963/7/108</p><p>BMC Health Services Research 2007;7():108-108.</p><p>Published online 12 Jul 2007</p><p>PMCID:PMC1936993.</p><p></p

HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries-5

<p><b>Copyright information:</b></p><p>Taken from "HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries"</p><p>http://www.biomedcentral.com/1472-6963/7/108</p><p>BMC Health Services Research 2007;7():108-108.</p><p>Published online 12 Jul 2007</p><p>PMCID:PMC1936993.</p><p></p

Protecting health workers from infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships

Background: Health workers are at high risk of acquiring infectious diseases at work, especially in low and middle-income countries (LMIC) with critical health human resource deficiencies and limited implementation of occupational health and infection control measures. Amidst increasing interest in international partnerships to address such issues, how best to develop such collaborations is being actively debated. In 2006, a partnership developed between occupational health and infection control experts in Canada and institutions in South Africa (including an institute with a national mandate to conduct research and provide guidance to protect health workers from infectious diseases and promote improved working conditions). This article describes the collaboration, analyzes the determinants of success and shares lessons learned. Methods: Synthesizing participant-observer experience from over 9 years of collaboration and 10 studies already published from this work, we applied a realist review analysis to describe the various achievements at global, national, provincial and hospital levels. Expectations of the various parties on developing new insights, providing training, and addressing service needs were examined through a micro-meso-macro lens, focusing on how each main partner organization contributed to and benefitted from working together. Results: A state-of-the-art occupational health and safety surveillance program was established in South Africa following successful technology transfer from a similar undertaking in Canada and training was conducted that synergistically benefitted Northern as well as Southern trainees. Integrated policies combining infection control and occupational health to prevent and control infectious disease transmission among health workers were also launched. Having a national (South-South) network reinforced by the international (North–south) partnership was pivotal in mitigating the challenges that emerged. Conclusions: High-income country partnerships with experience in health system strengthening – particularly in much needed areas such as occupational health and infection control – can effectively work through strong collaborators in the Global South to build capacity. Partnerships are particularly well positioned to sustainably reinforce efforts at national and sub-national LMIC levels when they adopt a “communities of practice” model, characterized by multi-directional learning. The principles of effective collaboration learned in this “partnership of partnerships” to improve working conditions for health workers can be applied to other areas where health system strengthening is needed.Medicine, Faculty ofOther UBCNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult