The relationship between management practices and the efficiency and quality of voluntary medical male circumcision services in four African countries

• Published in: PloS one Vol. 14; no. 10; p. e0222180
• Main Authors: Salas-Ortiz, Andrea, La Hera-Fuentes, Gina, Nance, Nerissa, Sosa-Rubí, Sandra G, Bautista-Arredondo, Sergio
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.10.2019; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Africa South of the Sahara - epidemiology; AIDS; Authorship; Biology and Life Sciences; Care and treatment; Circumcision; Circumcision, Male - economics; Circumcision, Male - standards; Circumcision, Male - statistics & numerical data; Delivery of Health Care; Disease prevention; Efficiency; Funding; Health care; Health care facilities; Health economics; Health Facilities; Health services; Health Services - standards; HIV; HIV infections; HIV Infections - economics; Human immunodeficiency virus; Humans; Information processing; Internet; Low income groups; Male; Management; Medical care; Medical diagnosis; Medicine and health sciences; Operations research; People and Places; Public health; Quality; Quality management; Regression analysis; Regression models; Risk factors; Services; Statistical models; Studies; Sub-Saharan Africa; Viruses; Africa South of the Sahara; Sub-Saharan Africa; Mexico; California; Kenya; United States > US; Rwanda
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0222180

Given constrained funding for Human Immunodeficiency Virus (HIV) programs across Sub-Saharan Africa, delivering services efficiently is paramount. Voluntary medical male circumcision (VMMC) is a key intervention that can substantially reduce heterosexual transmission-the primary mode of transmission across the continent. There is limited research, however, on what factors may contribute to the efficient and high-quality execution of such programs. We analyzed a multi-country, multi-stage random sample of 108 health facilities providing VMMC services in sub-Saharan Africa in 2012 and 2013. The survey collected information on inputs, outputs, process quality and management practices from facilities providing VMMC services. We analyzed the relationship between management practices, quality (measured through provider vignettes) and efficiency (estimated through data envelopment analysis) using Generalized Linear Models and Mixed-effects Models. Applying multivariate regression models, we assessed the relationship between management indices and efficiency and quality of VMMC services. Across countries, both efficiency and quality varied widely. After adjusting for type of facility, country and scale, performance-base funding was negatively correlated with efficiency -0.156 (p < 0.05). In our analysis, we did not find any significant relationships between quality and management practices. No significant relationship was found between process quality and management practices across 108 VMMC facilities. This study is the first to analyze the potential relationships between management and service quality and efficiency among a sample of VMMC health facilities in sub-Saharan Africa and can potentially inform policy-relevant hypotheses to later test through prospective experimental studies.