Outputs, cost and efficiency of public sector centres for prevention of mother to child transmission of HIV in Andhra Pradesh, India

Lalit Dandona¹^,2^,3^,4^,5 , SG Prem Kumar¹^,2 , YK Ramesh^{^}² , M Chalapathi Rao² , Elliot Marseille⁶ , James G Kahn⁶ and Rakhi Dandona¹^,2^,3^,5

¹George Institute for International Health – India, Hyderabad, India

²Health Studies Area, Centre for Human Development, Administrative Staff College of India, Hyderabad, India

³George Institute for International Health, University of Sydney, Sydney, Australia

⁴School of Public Health, University of Sydney, Sydney, Australia

⁵Faculty of Medicine, University of Sydney, Sydney, Australia

⁶Institute for Health Policy Studies and AIDS Research Institute, University of California, San Francisco, USA

author email corresponding author email^Deceased

BMC Health Services Research 2008, 8:26doi:10.1186/1472-6963-8-26


Published:	31 January 2008

Abstract

Background

Prevention of mother to child transmission (PMTCT) is an important part of the effort to control HIV. PMTCT services are mostly provided at public sector government hospitals in India. Systematic data on the cost and efficiency of providing PMTCT services in India are not available readily for further planning.

Methods

Cost and output data were collected at 16 sampled PMTCT centres in the south Indian state of Andhra Pradesh using standardized methods. The services provided were analysed, and the relation of unit cost of services with scale was assessed.

Results

In the 2005–2006 fiscal year, 125,073 pregnant women received PMTCT services at the 16 centres (range 2,939 to 20,896, median 5,679). The overall HIV positive rate among those tested was 1.67%. Of the total economic cost, the major components were personnel (47.3%) and recurrent goods (31.7%). For the 16 PMTCT centres, the average economic cost per post-HIV-test counselled pregnant woman was Indian Rupees (INR) 98.9 (US$ 2.23), ranging 2.7-fold from INR 71.4 (US$ 1.61) to INR 189.9 (US$ 4.29). The economic cost per mother-neonate pair who received nevirapine had a higher variation, ranging 41-fold for the 16 centres from INR 4,354 (US$ 98) to INR 179,175 (US$ 4,047), average INR 10,210 (US$ 231), with very high unit cost at some centres where HIV prevalence among pregnant women and the total volume of services were both low. Scale had a significant inverse relation with both of the unit costs, per post-HIV-test counselled pregnant woman and per mother-neonate pair who received nevirapine. In addition, HIV prevalence among pregnant women had a significant inverse relation with unit cost per mother-neonate pair who received nevirapine.

Conclusion

Although the variation between PMTCT centres for unit cost per post-HIV-test counselled pregnant woman was modest that per mother-neonate pair receiving nevirapine was over 40-fold. The extremely high unit cost for each mother-neonate pair receiving nevirapine at some centres suggests that the new approach of combining PMTCT services with voluntary counselling and testing services that has recently been started in India could potentially offer better efficiency.