Abstract
BackgroundThis paper proposes an approach to estimating the costs of demand creation for voluntary medical male circumcision (VMMC) scale-up in 13 countries of eastern and southern Africa. It addresses two key questions: (1) what are the elements of a standardized package for demand creation? And (2) what challenges exist and must be taken into account in estimating the costs of demand creation?Methods and FindingsWe conducted a key informant study on VMMC demand creation using purposive sampling to recruit seven people who provide technical assistance to government programs and manage budgets for VMMC demand creation. Key informants provided their views on the important elements of VMMC demand creation and the most effective funding allocations across different types of communication approaches (e.g., mass media, small media, outreach/mobilization). The key finding was the wide range of views, suggesting that a standard package of core demand creation elements would not be universally applicable. This underscored the importance of tailoring demand creation strategies and estimates to specific country contexts before estimating costs. The key informant interviews, supplemented by the researchers' field experience, identified these issues to be addressed in future costing exercises: variations in the cost of VMMC demand creation activities by country and program, decisions about the quality and comprehensiveness of programming, and lack of data on critical elements needed to “trigger the decision” among eligible men.ConclusionsBased on this study's findings, we propose a seven-step methodological approach to estimate the cost of VMMC scale-up in a priority country, based on our key assumptions. However, further work is needed to better understand core components of a demand creation package and how to cost them. Notwithstanding the methodological challenges, estimating the cost of demand creation remains an essential element in deriving estimates of the total costs for VMMC scale-up in eastern and southern Africa.
Highlights
By 2007, three clinical trials had provided compelling evidence that voluntary medical male circumcision (VMMC) reduces female-to-male HIV transmission by about 60% [1,2,3]
Based on this study’s findings, we propose a seven-step methodological approach to estimate the cost of VMMC scale-up in a priority country, based on our key assumptions
Notwithstanding the methodological challenges, estimating the cost of demand creation remains an essential element in deriving estimates of the total costs for VMMC scale-up in eastern and southern Africa
Summary
By 2007, three clinical trials had provided compelling evidence that voluntary medical male circumcision (VMMC) reduces female-to-male HIV transmission by about 60% [1,2,3]. The United States Agency for International Development (USAID) and UNAIDS have assisted countries in estimating the direct costs of scaling up VMMC services by supporting facility-based cost data collection to populate the Decision Makers’ Program Planning Tool, which estimates both the cost and HIV impact of various programming options [5,6]. Such costing studies have been conducted in Kenya, Namibia, South Africa, Uganda, Zambia, and Zimbabwe, and are underway in Tanzania and Malawi. It addresses two key questions: (1) what are the elements of a standardized package for demand creation? And (2) what challenges exist and must be taken into account in estimating the costs of demand creation?
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