ArticleSocial science & medicine (1982)2016
Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures.
Article in Social science & medicine (1982), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The state and significant drivers of health systems efficiency in Africa: A systematic review and meta-analysis.Journal of global health · 2023Pooled it
- Integrating HIV services and other health services: A systematic review and meta-analysis.PLoS medicine · 2021Pooled it
- Assessing the cost implications of integrating and scaling up HIV services for key populations in Kenya and Malawi.Health policy and planning · 2026Article
- Time to bring female genital schistosomiasis out of neglect.British medical bulletin · 2024Article
- Integration measurement and its applications in low- and middle-income country health systems: a scoping review.BMC public health · 2023Article
- The costs and financing needs of delivering Kenya's primary health care service package.Frontiers in public health · 2023Article
- Levels, trends, and determinants of effectiveness on the hierarchical medical system in China: Data envelopment analysis and bootstrapping truncated regression analysis.Frontiers in public health · 2022Article
- Can integrated care improve the efficiency of hospitals? Research based on 200 Hospitals in China.Cost effectiveness and resource allocation : C/E · 2021Article
- Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe.BMJ global health · 2021Article
- Efficiency, quality, and management practices in health facilities providing outpatient HIV services in Kenya, Nigeria, Rwanda, South Africa and Zambia.Health care management science · 2021Article
- Integrating Sexual and Reproductive Health Services Within HIV Services: WHO Guidance.Frontiers in global women's health · 2021Article
- Using HIV self-testing to increase the affordability of community-based HIV testing services.AIDS (London, England) · 2020Article
- Higher contraceptive uptake in HIV treatment centers offering integrated family planning services: A national survey in Kenya.Contraception · 2020Article
- Equity and efficiency of maternal and child health resources allocation in Hunan Province, China.BMC health services research · 2020Article
- Assessing frontline HIV service provider efficiency using data envelopment analysis: a case study of Philippine social hygiene clinics (SHCs).BMC health services research · 2019Article
- Article
- How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations.Social science & medicine (1982) · 2019Article
- Observational
- Quality of care: measuring a neglected driver of improved health.Bulletin of the World Health Organization · 2017Article
- Emtonjeni-A Structural Intervention to Integrate Sexual and Reproductive Health into Public Sector HIV Care in Cape Town, South Africa: Results of a Phase II Study.AIDS and behavior · 2017Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Theoretically, integration of vertically organized services is seen as an important approach to improving the efficiency of health service delivery. However, there is a dearth of evidence on the effect of integration on the technical efficiency of health service delivery. Furthermore, where technical efficiency has been assessed, there have been few attempts to incorporate quality measures within efficiency measurement models particularly in sub-Saharan African settings. This paper investigates the technical efficiency and the determinants of technical efficiency of integrated HIV and sexual and reproductive health (SRH) services using data collected from 40 health facilities in Kenya and Swaziland for 2008/2009 and 2010/2011. Incorporating a measure of quality, we estimate the technical efficiency of health facilities and explore the effect of integration and other environmental factors on technical efficiency using a two-stage semi-parametric double bootstrap approach. The empirical results reveal a high degree of inefficiency in the health facilities studied. The mean bias corrected technical efficiency scores taking quality into consideration varied between 22% and 65% depending on the data envelopment analysis (DEA) model specification. The number of additional HIV services in the maternal and child health unit, public ownership and facility type, have a positive and significant effect on technical efficiency. However, number of additional HIV and STI services provided in the same clinical room, proportion of clinical staff to overall staff, proportion of HIV services provided, and rural location had a negative and significant effect on technical efficiency. The low estimates of technical efficiency and mixed effects of the measures of integration on efficiency challenge the notion that integration of HIV and SRH services may substantially improve the technical efficiency of health facilities. The analysis of quality and efficiency as separate dimensions of performance suggest that efficiency may be achieved without sacrificing quality.
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