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The Cost of Voluntary Medical Male Circumcision in South Africa

Author

Listed:
  • Michel Tchuenche
  • Eurica Palmer
  • Vibhuti Haté
  • Ananthy Thambinayagam
  • Dayanund Loykissoonlal
  • Emmanuel Njeuhmeli
  • Steven Forsythe

Abstract

Given compelling evidence associating voluntary medical male circumcision (VMMC) with men’s reduced HIV acquisition through heterosexual intercourse, South Africa in 2010 began scaling up VMMC. To project the resources needed to complete 4.3 million circumcisions between 2010 and 2016, we (1) estimated the unit cost to provide VMMC; (2) assessed cost drivers and cost variances across eight provinces and VMMC service delivery modes; and (3) evaluated the costs associated with mobilize and motivate men and boys to access VMMC services. Cost data were systematically collected and analyzed using a provider’s perspective from 33 Government and PEPFAR-supported (U.S. President's Emergency Plan for AIDS Relief) urban, rural, and peri-urban VMMC facilities. The cost per circumcision performed in 2014 was US$132 (R1,431): higher in public hospitals (US$158 [R1,710]) than in health centers and clinics (US$121 [R1,309]). There was no substantial difference between the cost at fixed circumcision sites and fixed sites that also offer outreach services. Direct labor costs could be reduced by 17% with task shifting from doctors to professional nurses; this could have saved as much as $15 million (R163.20 million) in 2015, when the goal was 1.6 million circumcisions. About $14.2 million (R154 million) was spent on medical male circumcision demand creation in South Africa in 2014—primarily on personnel, including community mobilizers (36%), and on small and mass media promotions (35%). Calculating the unit cost of VMMC demand creation was daunting, because data on the denominator (number of people reached with demand creation messages or number of people seeking VMMC as a result of demand creation) were not available. Because there are no “dose-response” data on demand creation ($X in demand creation will result in an additional Z% increase in VMMC clients), research is needed to determine the appropriate amount and allocation of demand creation resources.

Suggested Citation

  • Michel Tchuenche & Eurica Palmer & Vibhuti Haté & Ananthy Thambinayagam & Dayanund Loykissoonlal & Emmanuel Njeuhmeli & Steven Forsythe, 2016. "The Cost of Voluntary Medical Male Circumcision in South Africa," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-17, October.
    • Handle: RePEc:plo:pone00:0160207
    DOI: 10.1371/journal.pone.0160207
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    References listed on IDEAS

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    1. Kevin Duffy & Moses Galukande & Nick Wooding & Monica Dea & Alex Coutinho, 2013. "Reach and Cost-Effectiveness of the PrePex Device for Safe Male Circumcision in Uganda," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-6, May.
    2. James G Kahn & Elliot Marseille & Bertran Auvert, 2006. "Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting," PLOS Medicine, Public Library of Science, vol. 3(12), pages 1-10, December.
    3. Olalekan A Uthman & Taiwo Aderemi Popoola & Mubashir M B Uthman & Olatunde Aremu, 2010. "Economic Evaluations of Adult Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men in Sub-Saharan Africa: A Systematic Review," PLOS ONE, Public Library of Science, vol. 5(3), pages 1-7, March.
    4. Jun hao LEI & Liang ren LIU & Qiang WEI & Shi bing YAN & Lu YANG & Tu run SONG & Hai chao YUAN & Xiao LV & Ping HAN, 2015. "Circumcision Status and Risk of HIV Acquisition during Heterosexual Intercourse for Both Males and Females: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-9, May.
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    1. Michel Tchuenche & Vibhuti Haté & Dacia McPherson & Eurica Palmer & Ananthy Thambinayagam & Dayanund Loykissoonlal & Emmanuel Njeuhmeli & Steven Forsythe, 2016. "Estimating Client Out-of-Pocket Costs for Accessing Voluntary Medical Male Circumcision in South Africa," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-10, October.
    2. Juan Dent & Nuno Gaspar & Emmanuel Njeuhmeli & Katharine Kripke, 2019. "Age targeting and scale-up of voluntary medical male circumcision in Mozambique," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-14, February.
    3. Katharine Kripke & Ping-An Chen & Andrea Vazzano & Ananthy Thambinayagam & Yogan Pillay & Dayanund Loykissoonlal & Collen Bonnecwe & Peter Barron & Eva Kiwango & Delivette Castor & Emmanuel Njeuhmeli, 2016. "Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-13, July.

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