Table 1

Cost of Integrated Prevention Campaign (IPC) versus Estimated Scale-Up Replication, per 1,000 individuals (USD)

IPC

Replication

Reason(s) for difference (in order of magnitude)


Planning

$735

1.8%

$96

0.3%

Replication and scale efficiency; increased reliance on Kenyan staffing/wages.

Explanation: The IPC planning required developing a new campaign, a time-consuming process done by a foreign consultant. In the SUR:

1) Planning activities adapt the initial campaign plan, and then work from one planning template for numerous settings.

2) Staff are Kenyan (81% lower salary), and no foreign travel.

The lower cost was confirmed in a subsequent IPC.


Social Mobilization

2,141

5.1%

828

2.6%

Scale efficiency; no launch event/concert; Kenyan staffing

Explanation: Three efficiencies for SUR:

1) The media strategy covers a large area, lowering production and broadcast costs per covered campaign zone.

2) The launch gathering/music event is omitted.

3) Staff are Kenyan, with 81% lower salary.

The lower cost was confirmed in subsequent IPC and in a formal bid for a provincial social mobilization.


Set-up

2,860

6.9%

975

3.0%

Kenyan staffing; scale & training efficiencies

Explanation: In IPC: foreigners and a one-time training. In SUR:

1) Staff are Kenyan, with 81% lower salary.

2) Training costs are spread over more campaign participants.

3) Detailed micro-planning is adapted from the IPC.


Management

2,428

5.8%

793

2.5%

Kenyan staffing; reduced due to routinization & experienced staff

Explanation: In IPC: six months' senior manager involvement for a new campaign design, largely foreign. In SUR:

1) Staff are Kenyan, with 81% lower salary.

2) Manager role more time-limited, with routine practices in place.

3) Costs are spread over more campaign participants.


Implementation

33,494

80.4%

27,772

86.8%


Commodities

22,776

21,373

Small scale efficiency.

Explanation: The manufacturer will cover shipping for filters and nets.


Personnel

8,975

5,401

Kenyan managers reduced due to experienced staff; scale efficiency; Kenyan wages; support staff reductions.

Explanation: In the initial campaign managers were mainly foreign, and often idle after the first days. Efficiencies in SUR reflect:

1) Fewer managers on-site (1 per site) and off-site, confirmed by field experience in the original and subsequent IPC.

2) Kenyan compensation is 81% below foreign

3) Some non-clinical support staffing is reduced, eg security.

4) Increase from 20 to 25 HIV counselors per site allows more clients per site and thus 20% lower per-client fixed costs.

The cost per client of direct service personnel (e.g., HIV counselors) is the same in the IPC and SUR.


Services

968

821

Modest scale efficiency.

Explanation: Lower domestic transport costs.


Contingency

0

0.0%

1,520

4.8%

Added for replication.


Total

41,657

100%

31,985

100%


Kahn et al. BMC Health Services Research 2011 11:346   doi:10.1186/1472-6963-11-346

Open Data