The impact of HIV/SRH service integration on workload: analysis from the Integra Initiative in two African settings.

BACKGROUND: There is growing interest in integration of HIV and sexual and reproductive health (SRH) services as a way to improve the efficiency of human resources (HR) for health in low- and middle-income countries. Although this is supported by a wealth of evidence on the acceptability and clinical effectiveness of service integration, there is little evidence on whether staff in general health services can easily absorb HIV services. METHODS: We conducted a descriptive analysis of HR integration through task shifting/sharing and staff workload in the context of the Integra Initiative - a large-scale five-year evaluation of HIV/SRH integration. We describe the level, characteristics and changes in HR integration in the context of wider efforts to integrate HIV/SRH, and explore the impact of HR integration on staff workload. RESULTS: Improvements in the range of services provided by staff (HR integration) were more likely to be achieved in facilities which also improved other elements of integration. While there was no overall relationship between integration and workload at the facility level, HIV/SRH integration may be most influential on staff workload for provider-initiated HIV testing and counselling (PITC) and postnatal care (PNC) services, particularly where HIV care and treatment services are being supported with extra SRH/HIV staffing. Our findings therefore suggest that there may be potential for further efficiency gains through integration, but overall the pace of improvement is slow. CONCLUSIONS: This descriptive analysis explores the effect of HIV/SRH integration on staff workload through economies of scale and scope in high- and medium-HIV prevalence settings. We find some evidence to suggest that there is potential to improve productivity through integration, but, at the same time, significant challenges are being faced, with the pace of productivity gain slow. We recommend that efforts to implement integration are assessed in the broader context of HR planning to ensure that neither staff nor patients are negatively impacted by integration policy

The societal costs of methamphetamine use in Western Cape Province

Methamphetamine (meth) use results in various costs accruing to the meth user, society, and government. Internal and external costs of the pandemic are widespread, affecting the healthcare and social welfare systems, policing, private security, and the judicial and corrective services system. This study quantifies these costs for the Western Cape; identifying the magnitude of the cost of illness and additional social costs by category and determines which interventions are likely to reduce these overall costs. This study used a combination of a top-down and a bottom-up approach for the costing of various categories. The meth prevalence rate used was derived from the number of primary meth users who sought meth treatment in 2013 as reported to SACENDU. Additional data on expenditure and costs were obtained from government annual reports, personal interviews and data from previous studies

Sugar-sweetened beverages in Nigeria: Affordability and expenditure and price elasticities

This research examines how consumers in Nigeria respond to income and price changes of carbonated soft drinks (CSDs). I first analysed the trend in CSD and fruit juice affordability between 2005 and 2018. I subsequently estimated the own-price, cross-price and income elasticities of sugar, CSDs, chocolate drinks, milk and sachet water for Nigeria in 2013, 2016 and a pooled sample. I used the relative income price to examine CSD and fruit juice affordability over time in Nigeria for both off-trade and on-trade consumption. For estimating the own-price, cross-price and expenditure elasticities, I used the Nigeria Household Survey, Panel (2013 and 2016) data, using the Almost Ideal Demand System. I applied Deaton's unit value model and used unit values as prices and used the Heckman procedure to correct for selection bias. For CSDs, the own-price elasticities ranged from - 0.8 to -1.8. All income (approximated by household expenditure) elasticities were positive implying all the commodities are normal goods. The income elasticity of demand lies at approximately 0.4 for CSDs. The results suggest that Nigeria can curb the consumption of excess sugar, in particular excess sugar in CSDs, by raising the price by implementing an excise tax on the sugar content in CSDs. Future research should estimate the health gains and government revenue that can be generated from such a tax. Such estimates are crucial to motivate for a sugar tax

Effect of price and income on the demand for sugar-sweetened beverages in Nigeria: an analysis of household consumption data using an almost ideal demand system (AIDS)

Objectives To estimate the own-price, cross-price and income elasticities for carbonated soft drinks (CSDs), malt drinks, chocolate powder, sachet water and sugar in Nigeria. These elasticities can be used to estimate the potential demand response to the recently-introduced sugar tax in Nigeria.Setting The study uses household data from the 2018/2019 Nigeria Living Standards Survey (NLSS).Participants The NLSS is a national household survey. 21 114 households were included in the final sample for this analysis.Primary and secondary outcomes We used Deaton’s almost ideal demand system, which controls for the goods’ quality, to estimate the effect of price and income changes on the demand for CSDs, chocolate powder, malt drinks, sachet water and sugar.Results We found that the own-price elasticity (ordered from most to least price-responsive) was −0.99 (p<0.01) for sachet water, −0.76 (p<0.01) for CSDs, –0.72 (p<0.01) for chocolate powder, −0.62 (p<0.01) for sugar and –0.19 (p<0.01) for malt drinks. The cross-price elasticities indicate that malt drinks and chocolate powders are substitutes of CSDs. The income elasticities indicate that all the commodities are normal goods. Sachet water had the highest income elasticity at 0.62 (p<0.01), followed by chocolate powder at 0.54 (p<0.01), CSDs at 0.47 (p<0.01), malt drinks at 0.43 (p<0.01) and sugar at 0.13 (p<0.01).Conclusion Even though the price elasticities for CSDs, malt drinks and chocolate powder are less than one, in absolute terms, they are significantly different from zero. Increases in the sugar-sweetened beverage tax could curb the demand for these beverages, and, in turn, reduce the incidence and prevalence of sugar-attributable diseases

The Data on Alcohol and Tobacco in Africa (DATA) project

Background and challenges to implementation Research-driven tobacco and alcohol control policies need country-specific data. Although several institutions collect data on tobacco and alcohol, few tools exist for discovering and accessing these data in Africa. The goal of the Data on Alcohol and Tobacco in Africa (DATA) Project is to catalogue economic data on tobacco and alcohol in Africa and publish these data for research purposes. The pilot stage of the project focuses on Botswana, Kenya, Namibia, Senegal, and South Africa, with the goal of expanding across Africa. Intervention or response The DATA Project establishes relationships with data producers and obtains permission to share their data on the project's site. The Project documents our experience in securing data and identifies best practices for increasing open access to data. The Project curates all secured data, shares these in research-ready datasets, uses metadata to describe data available in external repositories and redirects users to these sites. It also collates time-series data from various publicly available sources into referenced data sheets. Our work saves researchers the time and effort involved in finding and collating data. Results and lessons learnt Currently 69 datasets are listed on the DATA Project's site. These include open access data as well as discovery metadata and links to relevant data available on other sites. Our findings reveal that despite the availability of relevant tobacco and alcohol data, data producers are not using the available tools to facilitate data visibility and access from their websites. We find that data collectors are still reluctant to make their data Open. Conclusions and key recommendations We hope to encourage Open access to data, by providing the essential infrastructure and expertise for data sharing. Additionally, we wish to advance the quality of these data, through data users' feedback. Our efforts should increase Open access data for alcohol and tobacco control in Africa

Open Access The impact of HIV/SRH service integration on workload: analysis from the Integra Initiative in two African settings

Background: There is growing interest in integration of HIV and sexual and reproductive health (SRH) services as a way to improve the efficiency of human resources (HR) for health in low- and middle-income countries. Although this is supported by a wealth of evidence on the acceptability and clinical effectiveness of service integration, there is little evidence on whether staff in general health services can easily absorb HIV services. Methods: We conducted a descriptive analysis of HR integration through task shifting/sharing and staff workload in the context of the Integra Initiative- a large-scale five-year evaluation of HIV/SRH integration. We describe the level, characteristics and changes in HR integration in the context of wider efforts to integrate HIV/SRH, and explore the impact of HR integration on staff workload. Results: Improvements in the range of services provided by staff (HR integration) were more likely to be achieved in facilities which also improved other elements of integration. While there was no overall relationship between integration and workload at the facility level, HIV/SRH integration may be most influential on staff workload for provider-initiated HIV testing and counselling (PITC) and postnatal care (PNC) services, particularly where HIV care and treatment services are being supported with extra SRH/HIV staffing. Our findings therefore suggest that there may be potential for further efficiency gains through integration, but overall the pace of improvement is slow

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings.

OBJECTIVE: To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. DESIGN: A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. METHODS: Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider's perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. RESULTS: The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to$Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. CONCLUSION: For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements

Distribution of unit cost (Int$ 2013) by input type.

<p>Distribution of unit cost (Int$ 2013) by input type.</p

Summary of models of integration evaluated.

<p>Summary of models of integration evaluated.</p