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. 2022 Dec 1;26(12):1128-1136.
doi: 10.5588/ijtld.21.0481.

Efficiency of TB service provision in the public and private health sectors in Ethiopia

M Minwyelet Terefe  1 , H Eyob  1 , T Letta  2 , E Nadew  1 , T Assefa  1 , B Hailu  1 , L Cunnama  3 , I Garcia Baena  4 , A Vassall  5 , S Sweeney  5 , Y V Laurence  5
Affiliations

Efficiency of TB service provision in the public and private health sectors in Ethiopia

M Minwyelet Terefe et al. Int J Tuberc Lung Dis. .

Abstract
in English, French

BACKGROUND: The Ethiopian Government has identified efficiency of TB services as a key priority in planning and budgeting. Understanding the magnitude and sources of inefficiencies is key to ensuring value for money and improved service provision, and a requirement from donors to justify resource needs. This study identifies the cost of providing a wide range of TB services in public and private facilities in Ethiopia.METHODS: Financial and economic unit costs were estimated from a health provider´s perspective, and collected retrospectively in 26 health facilities using both top-down (TD) and bottom-up (BU) costing approaches for each TB service output. Capacity inefficiency was assessed by investigating the variation between TD and BU unit costs where the factor was 2.0 or more.RESULTS: Overall, TD unit costs were two times higher than BU unit costs. There was some variation across facility ownership and level of care. Unit costs in urban facilities were on average 3.8 times higher than in rural facilities.CONCLUSION: We identified some substantial inefficiencies in staff, consumable and capital inputs. Addressing these inefficiencies and rearranging the TB service delivery modality would be important in ensuring the achievement of the country´s End TB strategy.

CONTEXTE: Le gouvernement éthiopien estime que l’efficacité des services antituberculeux est une priorité essentielle en matière d’organisation et de prévisions budgétaires. Il est essentiel de comprendre l’étendue et l’origine de ce qui ne fonctionne pas afin de garantir un bon rapport coût-avantages, d’améliorer la fourniture des services et de répondre aux exigences des donneurs afin de justifier les besoins en ressources. Cette étude a identifié les coûts de la fourniture d’une vaste gamme de services antituberculeux dans les établissements privés et publiques d’Éthiopie.

MÉTHODES: Les coûts unitaires financiers et économiques ont été estimés du point de vue du prestataire de services, et recueillis de manière rétrospective dans 26 centres de soins en utilisant l’approche descendante (TD) et ascendante (BU) d’évaluation des coûts pour le rendement de chaque service antituberculeux fourni. L’inefficacité des capacités a été évaluée en analysant la variation entre les coûts unitaires TD et BU associée à un facteur de 2,0 ou plus.

RÉSULTATS: Dans l’ensemble, les coûts unitaires TD étaient deux fois plus élevés que les coûts unitaires BU. Une certaine variation a été observée en fonction des propriétaires des centres et du niveau de soins. Les coûts unitaires dans les centres de soins urbains étaient en moyenne 3,8 fois plus élevés que ceux dans les centres ruraux.

CONCLUSION: Nous avons identifié d’importants points d’inefficacité au niveau du personnel, des consommables et de l’apport en capital. Il serait important de remédier à ces points d’inefficacités et de redéfinir les modalités de fourniture des soins antituberculeux afin de pouvoir satisfaire les objectifs fixés pour le pays par la stratégie de l’OMS pour mettre fin à la TB.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

Figure 1
Figure 1
Graphs showing TD vs. BU unit costs for inpatient bed days and outpatient visits by input type. USD = US dollar; BU = bottom-up; TD = top-down; MCH = Maternal and Child Health; DOT = directly observed therapy; LTBI = latent TB infection; MDR-TB = multidrug-resistant TB; DS-TB = drug-susceptible TB.
Figure 2
Figure 2
Graph showing TD vs. BU unit costs for TB and HIV diagnostic tests by input type. USD = US dollar; BU = bottom-up; TD = top-down; MTB = Mycobacterium tuberculosis; RIF = rifampicin; ZN = Ziehl-Neelsen; CXR = chest X-ray.
Figure 3
Figure 3
Top-down and bottom-up unit costs of vaccination, prevention, detection & diagnosis and treatment types, populations, and regimens by facility types and costing approach. 2nd Line TB treatment = treatment for drug-resistant tuberculosis. USD: United States dollars; BU: bottom-up; TD: top-down; NGO: non-governmental organisation.
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References

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