Low Unit Cost Research Articles

An Empirical Study on the Determinants of Housing Prices in Beijing and Model Optimization

This paper aims to investigate the potential factors influencing housing prices in Beijing and optimize the prediction model. Using the Kaggle dataset "Housing Price in Beijing", multiple factors affecting housing prices were examined, including square footage, bedroom count, bathroom count, follower count, the presence of an elevator, and subway proximity. The study initially established a multiple linear regression model (MLR) and then optimized the model through variable selection and hypothesis testing. The final model indicates that square footage, bathroom count, follower count, elevator presence, and subway accessibility significantly impact housing prices. Additionally, subway proximity positively correlates with housing prices, while increased square footage is negatively associated with price, possibly due to lower unit costs for larger properties and the higher market demand for smaller homes. By validating the model's performance using a test dataset, the final model demonstrates effective predictive capability and offers insights for future model improvements.

Cost of integrated immunization campaigns in Nigeria and Sierra Leone: bottom-up costing studies

BackgroundTo improve the efficient use of scarce resources, low- and middle-income countries and development partners are increasingly encouraged to deliver multiple vaccines and other interventions in a single integrated campaign. However, little is known regarding the cost of delivering vaccines through integrated campaigns, and the extent to which efficiencies are achieved. To fill this evidence gap, we estimated the cost of integrated immunization campaigns in Nigeria and Sierra Leone, and the potential savings from integration.MethodsWe conducted a retrospective ingredients-based costing study from a payer perspective of a campaign held in 2019 in Sierra Leone with measles-rubella vaccine and oral polio vaccine, during which nutrition supplements were also offered in part of the country, and yellow fever campaigns held in three states in Nigeria in 2019 and 2020, where in one state (Anambra) meningococcal A vaccines were co-delivered. We collected data from 108 health facilities, all relevant administrative levels, and implementing partners. We estimated the full financial and economic cost of each campaign, the average unit cost of delivery, as well as the cost by activity and resource type. We also estimated the cost savings from integration in Anambra state by modelling out the cost of the alternative of two standalone campaigns.ResultsThe average financial delivery cost was $0.34 per dose in Sierra Leone, and the economic cost was $0.73 per dose. In Nigeria, the financial cost per dose was $0.29–$0.35 across the three states, and the economic cost per dose was $0.62–$0.85. Facilities and wards delivering more doses achieved a lower financial and economic unit cost of delivery, demonstrating evidence of economies of scale. We estimated that Anambra may have saved at least $1,204,133 in financial resources by integrating yellow fever and meningitis A vaccine delivery, amounting to $0.17 per dose delivered. When including opportunity costs, the economic cost saving was estimated at $0.34 per dose delivered.ConclusionsThe study offers evidence on what it costs to deliver integrated campaigns, and shows that integrated delivery is likely to result in significant cost savings. Where high delivery volumes can be achieved, integrated campaigns can benefit from economies of scale. The findings can be used to inform planning and budgeting for immunization campaigns in low- and middle-income countries.

Regulated Pricing Decisions and Diagnostic Test Choices in Personalized Medicine: Navigating the Implications Within Legal Frameworks.

The emerging risk of personalized medicine is driving drug manufacturers to seek collaborations with advanced diagnostic firms, aiming to improve detection and treatment outcomes. However, the government's regulated pricing in personalized medicine affects manufacturers' strategic decisions, particularly regarding the selection of diagnostic partners. In this context, this study investigates whether the government should regulate the price of personalized medicine and how the government's regulated pricing decisions affect drug manufacturers' diagnostic test choices. A stylized analytical model was developed, employing game-theoretic analysis. Numerical studies are also conducted to validate our results. The study reveals that in the absence of the government's regulated pricing, drug manufacturers benefit from partnering with high-level diagnostic firms, enhancing consumer surplus and social welfare. However, when the government regulates pricing, the choice of partnering with a high-level diagnostic firm depends on specific conditions, such as low patient sensitivity to treatment failure and a low unit cost coefficient of diagnostic effort. The government's decision to regulate prices is influenced by three key parameters: patients' sensitivity to treatment failure, the unit cost coefficient of the diagnostic test effort, and the proportion of the price of specialized drugs in the regulated pricing. The findings underscore the importance of legal frameworks in the personalized medicine industry. The absence of the government's regulated pricing incentivizes collaborations with high-level diagnostic firms, enhancing consumer surplus and social welfare. However, government intervention in pricing makes such decisions contingent on specific conditions, requiring nuanced regulatory policies that balance the interests of patients, manufacturers, and diagnostic firms.

Optimal supply chain green innovation and subsidy strategy: producer subsidy versus consumer subsidy

PurposeConsidering two types of subsidies for producers (supplier and manufacturer) and one for consumers based on product greenness and sales quantity, this study aims to formulate optimal supply chain green innovation and subsidy strategies, and to achieve this goal with the support of information systems.Design/methodology/approachThis study introduces a composite green-product supply chain where suppliers focus on green innovation for component greenness and manufacturers focus on green innovation for manufacturing process greenness. Game theory modeling is applied to investigate the differences of product greenness, supply chain members’ profit and social welfare under different government subsidy strategies.FindingsIncreasing the unit greenness subsidy coefficient can boost product greenness and supply chain members’ profits, but does not always raise social welfare. When the government exclusively offers subsidies to producers, subsidies should be allocated to suppliers when there is a significant disparity in supply chain green innovation costs. Conversely, it is more beneficial to subsidize manufacturers. Consumer subsidies have the potential to enhance both environmental and economic performance in the supply chain compared with producer-exclusive subsidies, but may not always maximize social welfare when supply chain members have low unit costs associated with green innovation.Originality/valueThis study examines the optimal decisions for green supply chain innovation and government subsidy strategies. Supply chain members and the government can use the information system to collect and evaluate the cost of upstream and downstream green innovation, and then develop reasonable collaborative green innovation and subsidy strategies.

Surface Modification of a Zeolite Microfiltration Membrane: Characterization and Application to the Treatment of Colored and oily Wastewaters

Membrane-based technologies used for water treatment can be an excellent alternative to handle wastewater including both conventional and emerging pollutants as they can provide technological (e.g., high quality of treated water) and economic (e.g., small footprint and low unit cost of production) advantages over other water treatment processes. Recently, low cost ceramic membranes fabricated from natural resources like kaolinitic clay, bentonite clay, phosphate are increasingly used owing to their low-cost starting materials, low sintering temperature and their excellent additional properties. Moreover, the modification of the surface by grafting process provides membranes appropriate for low UF process (dp < 10 nm) and suitable for micropollutants removal at relatively high permeate flux value which can be maintained during filtration due to antifouling characteristics of the UF active layer. In this work, the surface of microfiltration membranes made from natural zeolite was chemically modified by grafting with 1 H, 1 H, 2 H, 2 H-perfluorodecyltriethoxysilane molecule named PFAS. Various characterization methods and techniques, including scanning electron microscopy (SEM), mercury porosimetry, FTIR, TGA, and contact angle, were used to check the properties of the membranes surface before and after grafting. The grafted membranes pore size and porosity were reduced, as proved by SEM images. The determination of the water permeability shows a reduction from 1218 L.h−1.m−2.bar −1 to 204 L.h−1.m−2.bar −1 which confirm the surface densification. The application of the grafted membrane to the treatment of Indigo Blue (IB) colored solution and oily wastewater was investigated to evaluate the performances of this membrane in terms of permeate flux and pollutants retention. The filtration results revealed a good retention of color and oil, exceeding 95% for both parameters. Therefore, it is interesting to recommend this new low-cost membrane for the treatment of industrial wastewater containing recalcitrant pollutants such as color. The study of the effect of the treated colored solution on plant growth, shows that the presence of some residual nutrients required for crops growth, might make the IB treated water beneficial for irrigation purposes.

Fabrication of self‐supported catalysts via electrodeposition for proton exchange membrane water electrolysis: Emphasizing on the porous transport layers

AbstractThe potential of proton exchange membrane water electrolysis (PEMWE) is enormous in tackling worldwide environmental and energy issues in the face of increasing risks associated with climate change and energy scarcity. Nevertheless, the economic competitiveness of hydrogen production is hindered by the challenging operating conditions in acidic environments, resulting in a lower unit cost compared to alternative energy sources. Hence, numerous global research endeavors persist in enhancing the efficiency of essential components in PEMWE systems, specifically the porous transport layer (PTL). Additionally, investigating the interface between catalyst layer (CL) and PTL, which is directly associated with system performance, is imperative for future sustainability and cost reduction. This review focuses on the analysis of fabrication techniques, materials, and structural configurations to enhance the performance of PTLs. Additionally, we suggest the use of self‐supported catalysts as potential solutions to enhance mass and charge transfer at the interface between CLs and PTLs, hence facilitating the production of hydrogen on a wide scale. In the last section we provide an overview of the future trajectory and potential of next‐generation PEMWE in the context of efficient hydrogen production.

THE RELIABILITY EVALUATION OF THE DECK MACHINERY AND GALLEY EQUIPMENT OF A BULK CARRIER BY UTILIZING THE FAILURE RECORDS

Among various modes of transportation, maritime transportation holds critical importance since it provides substantial carrying capacity with low unit costs. To perform seamless and efficient operations in maritime transportation plays a pivotal role in achieving sustainable development goals and the International Maritime Organization (IMO) targets. The execution of uninterrupted operations can only be carried out with the existence of reliable systems. Creating reliable systems onboard is possible through the implementation of planned and proactive maintenance strategies and leveraging experiences gained from past failures. 10-year failure records of bulk carriers have been scrutinized within the scope of system reliability to determine critical equipment and units. The data has been categorized into subgroups under four fundamental headings, and subsequent reliability analyses have been conducted on each subgroup. Within the subgroups, the reliability of navigation equipment should be improved since it has the highest failure rate and its malfunction can cause very serious marine accidents. This equipment is followed by fire-fighting systems, cargo equipment, and GMDSS instruments which are essential for ship operations based on reliability results. Therefore, regular failure records, planned and proactive maintenance strategies, and also extra efforts should be performed on this equipment to ensure sustainable and seamless operations in the maritime sector.

Energy and exergoeconomic analyses of parallel cross feed multi effect desalination system driven by twin-screw compressor with water injection

This work proposes the design of a parallel cross-feed multi-effect desalination system with a twin-screw compressor, incorporating water injection to enhance system performance. The improvement is achieved by injecting water during the compression process to increase the isentropic efficiency of compression. The mathematical model is solved using Engineering Equation Solver software, and the resulting mass and energy balance equations are validated against literature data. The system is analyzed and evaluated from energy, exergy, and exergy-economic perspectives, and compared with the performance of the conventional configuration in terms of specific power consumption, exergy efficiency, and cost of produced water. The impact of various operating conditions, such as the number of effects, steam temperature, compressor efficiency, and injection pressure, on specific power consumption, exergy efficiency, exergy destruction, and final product cost, is examined in this study. Additionally, factors like interest rate, plant life expectancy, and electricity cost are investigated for their effect on the final product cost. The study demonstrates that replacing the normal compressor with a twin-screw compressor result in more than a 15 % reduction in specific power consumption, approximately 4 % less exergy destruction (indicating higher exergy efficiency), and a 14 % lower unit cost of freshwater.

Realizing Superior Durability of Water Electrolyzer Using Anion Exchange Membrane with an Interstitial Alkyl Chain: From a Single Cell to Large‐Sized 1‐cell Stack

AbstractAnion exchange membrane water electrolysis (AEMWE) has gained attention as an attractive alternative to alkaline and proton exchange membrane water electrolysis (PEMWE) due to its high efficiency and low hydrogen unit cost. However, the long‐term durability of AEMWE is ≈10 times lower than that of PEMWE, which typically operates for 40 000 h. Here, a new design strategy is presented for aryl ether‐free PFPBPF‐QA anion exchange membranes with interstitial alkyl chains in the conducting groups and polymer backbone. The rationally designed PFPBPF‐4‐QA, with a suitable ion exchange capacity, shows high ionic conductivity, mechanical properties, alkaline stability, and stronger membrane‐ionomer contact properties at the catalyst layers. A single AEMWE cell using PFPBPF‐4‐QA demonstrated a voltage decay rate of 2 mV kh−1 at 1.0 A cm−2, which is significantly lower than that reported for AEMWEs and Nafion‐based PEMWEs. Additionally, a large‐sized 1‐cell AEMWE stack utilizing PFPBPF‐4‐QA with an active area of 63.6 cm2 achieved an energy conversion efficiency of 80.2% and a voltage decay rate of 1.5 mV kh−1 for 2 000 h, with over 90% of the initial efficiency maintained for over 49 095 h based on an exponential fitting calculation.

Toward a water-sensitive precinct with stormwater harvesting: a case study in South Africa

ABSTRACT The study assessed static management, i.e., without planned periodic maintenance of the storage (no sediment dredging) denoted as SC1, or with maintenance denoted as SC2. The second approach was dynamic management based on applying Real-Time Control (RTC) techniques to scenario SC1 and scenario SC2 denoted as RTC-1 and RTC-2, respectively. The dynamic management of the UCT dam with RTC-1 and RTC-2 approaches increase yield by 2.1 and 1.1 ml, respectively. Additionally, RTC-1 and RTC-2 approaches increase volumetric reliability by 5.3 and 2.5%, respectively, while maintaining the required level of service of a stormwater harvesting system. SC1 and SC2 results in water savings of up to 21.15 and 21.45 ZAR/kl, respectively, while RTC-1 and RTC-2 could save up to 19.35 and 19.45 ZAR/kl. Thus, static configurations results in water savings approximately 9% in comparison to RTC. In addition, static configurations harvested stormwater at a relatively lowest unit cost in comparison to RTC configurations. Notwithstanding this finding, the RTC system exhibits a great potential in reshaping the stormwater harvesting system to simultaneously deliver water conservation and stormwater management.

OpenCell: A low-cost, open-source, 3-in-1 device for DNA extraction.

High-cost DNA extraction procedures pose significant challenges for budget-constrained laboratories. To address this, we introduce OpenCell, an economical, open-source, 3-in-1 laboratory device that combines the functionalities of a bead homogenizer, a microcentrifuge, and a vortex mixer. OpenCell utilizes modular attachments that magnetically connect to a central rotating brushless motor. This motor couples to an epicyclic gearing mechanism, enabling efficient bead homogenization, vortex mixing, and centrifugation within one compact unit. OpenCell's design incorporates multiple redundant safety features, ensuring both the device's and operator's safety. Additional features such as RPM measurement, programmable timers, battery operation, and optional speed control make OpenCell a reliable and reproducible laboratory instrument. In our study, OpenCell successfully isolated DNA from Spinacia oleracea (spinach), with an average yield of 2.3 μg and an A260/A280 ratio of 1.77, demonstrating its effectiveness for downstream applications such as Polymerase Chain Reaction (PCR) amplification. With its compact size (20 cm x 28 cm x 6.7 cm) and lightweight design (0.8 kg), comparable to the size and weight of a laptop, OpenCell is portable, making it an attractive component of a 'lab-in-a-backpack' for resource-constrained environments in low-and-middle-income countries and synthetic biology in remote field stations. Leveraging the accessibility of 3D printing and off-the-shelf components, OpenCell can be manufactured and assembled at a low unit cost of less than $50, providing an affordable alternative to expensive laboratory equipment costing over $4000. OpenCell aims to overcome the barriers to entry in synthetic biology research and contribute to the growing collection of frugal and open hardware.

A Spatial History of Seaports in South Asia

Seaports provide material foundations for globalization. In the long history of global mobile connectivity that now forms globalization, the Indian Ocean is the world's oldest arena of expansive long-distance sea travel. People have sailed monsoon winds among coastal environments connecting Europe, Africa, India, and China since prehistoric times. Indian Ocean ports grew in number, size, wealth, and permanence over the centuries and anchored the rise of seaborne empires connecting Asia, Africa, Europe, and the Americas. Modernity traveled among industrial port cities along with lower unit costs for shipping and a dramatically increasing scale of shipping in volume, value, distance, and speed. Capital investments in seaport infrastructure grew with the scale of mobility through ports connecting producers and consumers by land and sea in commodity chains that eventually embraced people around the world with increasingly intricate, expansive interdependence, and also with ever more entrenched spatial inequity. The result is the current global seaport space of interwoven connectivity strung along the coastlines of globalization on all the continents.

Long-Term Performance of Flexible Pavements Containing Crumb Rubber Modified Asphalt in Louisiana

The use of crumb rubber modifiers (CRMs) in asphalt mixtures plays a significant role in creating a sustainable circular economy. This study aims to evaluate the field performance of CRM asphalt sections with service years greater than eight. Five field projects were evaluated. Each project had one or two CRM sections constructed alongside a companion control section. Five types of CRM products were considered. A 16-mesh proprietary CRM, a Rouse-80 powder (R-80), and a Neste Wright powder were used in the wet blending process. Further, a 16-mesh generic crumb rubber, a PlusRideTM shredded rubber, and R-80 were used in a dry blend. Field performance data, including rutting, roughness, and cracking, were collected and analyzed. Moreover, economic analysis was performed to ascertain the cost-effectiveness (CE) of constructing CRM sections. Furthermore, laboratory performance indicators measured during construction were analyzed to ascertain their ability to rank field performance. Generally, CRM sections exhibited significantly similar or better ride quality, cracking and rutting resistance, and pavement condition index than their corresponding control sections. In some cases, the styrene-butadiene-styrene polymer modifier showed better cracking resistance in the control sections than the CRMs. CRM asphalt sections generally exhibited higher CE than their corresponding control sections because of their high initial unit costs. The Rouse wet CRM asphalt section in field project 4, which had a relatively lower unit cost, was found to be cost-effective compared to its corresponding control section. The limited laboratory mechanical performance parameters considered were ineffective in consistently ranking field performance indicators.

The Cost and Cost-Effectiveness of an Integrated Wasting Prevention and Screening Intervention Package in Burkina Faso and Mali

BackgroundLittle is known about costs and cost effectiveness of interventions that integrate wasting prevention into screening for child wasting. ObjectivesThis study’s objective was to estimate the cost and cost-effectiveness of an intervention that integrated behavior change communication (BCC) and small-quantity lipid-based nutrient supplements (SQ-LNS) into platforms for wasting screening in Burkina Faso (a facility-based platform, where BCC was enhanced compared with standard care) and Mali (a community-based platform, with standard BCC). MethodsActivity-based costing was used to estimate the cost per child-contact for the intervention and the comparison group, which did not receive the intervention. Costs were ascertained from accounting records, interviews, surveys, and observations. The number of child-contacts was calculated using population size estimates and average attendance rates for each service. Costs per disability-adjusted life year (DALY) averted were estimated using a Markov model populated with data from the parent trials on impact of wasting incidence and treatment coverage. ResultsIn the intervention group in Burkina Faso, the cost per child-contact of facility-based screening was $0.85 of enhanced BCC was $4.28, and of SQ-LNS was $8.86. In Mali, the cost per child-contact of community-based screening was $0.57, standard BCC was $0.72, and SQ-LNS was $4.14. Although no SQ-LNS costs were incurred in the comparison groups (hence lower total costs), costs per child-contact for screening and BCC were higher because coverage of these services was lower. The intervention package cost $1073 per DALY averted in Burkina Faso and $747 in Mali. ConclusionsIntegration of wasting prevention into screening for child wasting led to higher total costs but lower unit costs than standard screening due to increased coverage. Greater cost-effectiveness could be achieved if BCC were strengthened and led to improved caregiver health and nutrition practices and if screening triggered appropriate use of services and higher treatment coverage.

High-speed fluidic processing circuits for dynamic control of haptic and robotic systems.

Fluidic logic circuits simplify system design for soft robotics by eliminating bulky components while enabling operation in a range of hostile environments that are incompatible with electronics but at the expense of limited computational capabilities and response times on the order of seconds. This paper presents a four-terminal fluidic transistor optimized for fast switching times, reduced component count, low unit cost, and high reproducibility to achieve complex fluidic control circuits while maintaining flow rates of liters per minute. A ring oscillator using three fluidic transistors achieves oscillation frequencies up to a kilohertz with full signal propagation, tolerating billions of cycles without failure. Fundamental processor circuits like a full adder and a 3-bit analog-to-digital converter require just seven transistors each. A decode circuit drives a high-resolution soft haptic display with refresh times below the human perception threshold for latency, and an electronics-free control circuit performs closed-loop position control of a pneumatic actuator with disturbance rejection, demonstrating the value across domains.

Rational agricultural land use

The goal is to study the importance of rational use of land area for cultivation of crops. At the same time, a decisive role is assigned to increasing their productivity in order to ensure food security of the republic. Methods – economic-statistical, factor analysis and marketing research. Results – the need to improve the mechanism for the return and redistribution of empty unused in agriculture has been identified. It was determined that their status should be increased in order to be involved in agricultural turnover. The forecast for the sown area and the efficiency of cultivating crops has been calculated. The authors note that the return of unused lands to agricultural use will increase their productivity by up to 32%, and will also meet the need for agricultural products. Conclusions - it is necessary to accelerate the process of transferring this category of land to the state for their full exploitation for agricultural purposes, since the area of arable land for agricultural purposes is decreasing, which negatively affects the productivity of some agricultural plants. Rational land use in agriculture and solving the country's food problem contribute to increasing soil fertility, combating erosion, which poses a significant threat to the sustainability of agroecosystems, and reducing their degradation. In countries with developed economies, a systematic land accounting method is used. Its distinctive characteristic is the ability to carry out registration and accounting activities with land plots within the region and low unit costs. In Kazakhstan, it is advisable to use this approach in relation to agricultural lands, a significant share of which constitutes the country’s land fund. The proposed methods will reduce the number of abandoned land masses, increase investment attractiveness, and also support peasant (private) farms.

Assessment of a sustainable multigeneration system integrating supercritical CO2 Brayton cycle and LNG regasification: Thermodynamic and exergoeconomic evaluation

This study proposes a cost-effective multigeneration system that integrates a supercritical carbon dioxide (sCO2) power cycle with a liquefied natural gas (LNG) regasification process. The system aims to deliver electricity, cooling, heating, and hydrogen simultaneously. Utilizing the temperature difference between the sCO2 cycle and the LNG thermal sink, an ammonia-water-based absorption refrigeration cycle (ARC) recovers waste heat from the sCO2 power cycle, producing cooling. The elevated ammonia concentration at the ARC's condenser outlet is leveraged by a heat pump system for heating production. Concurrently, cold energy from LNG is used to recover latent heat from the condenser and heat rejected from the sCO2 power cycle, providing inputs for additional electrical power through an NG turbine. The system incorporates a PEM electrolyzer (PEME) for hydrogen production. A comprehensive examination, including energy, exergy, and exergoeconomic analyses, evaluates system performance. A sensitivity analysis illustrates the impacts of key parameters. In the baseline scenario, the system achieves energy and exergy efficiencies of 62.79% and 54.89%, with a low product unit cost of 11.35 ($/GJ). The system demonstrates substantial net power output (259.184 MW), cooling capacity (88.938 MW), heating capacity (2.839 MW), and hydrogen production (391.68 kg/h). This robust performance, coupled with cost-effectiveness, positions the proposed system as a versatile and impactful solution for sustainable and environmentally friendly energy applications.

Decentralized Targeting of Agricultural Credit Programs: Private Versus Political Intermediaries

Abstract We conduct a field experiment in India comparing two ways of delegating selection of microcredit clients among smallholder farmers to local intermediaries: a private trader (TRAIL), versus a local–government appointee (GRAIL). Selected beneficiaries in both schemes were equally likely to take up and repay loans, and experienced similar increases in borrowing and farm output. However farm profits increased and unit costs of production decreased significantly only in TRAIL. While there is some evidence of superior selection by ability and landholding in TRAIL, the results are mainly driven by greater reduction of unit production costs for TRAIL treated farmers than GRAIL treated farmers of similar ability or landholding. We develop and test a model where the TRAIL agents’ role as middlemen in the agricultural supply chain enabled and motivated them to offer treated farmers business advice, which helped them lower unit costs.

Bottom-Illuminated Photothermal Nanoscale Chemical Imaging with a Flat Silicon ATR in Air and Liquid.

We demonstrate a novel approach for bottom-illuminated atomic force microscopy and infrared spectroscopy (AFM-IR). Bottom-illuminated AFM-IR for measurements in liquids makes use of an attenuated total reflection setup where the developing evanescent wave is responsible for photothermal excitation of the sample of interest. Conventional bottom-illuminated measurements are conducted using high-refractive-index prisms. We showcase the advancement of instrumentation through the introduction of flat silicon substrates as replacements for prisms. We illustrate the feasibility of this technique for bottom-illuminated AFM-IR in both air and liquid. We also show how modern rapid prototyping technologies enable commercial AFM-IR instrumentation to accept these new substrates. This new approach paves the way for a wide range of experiments since virtually any established protocol for Si surface functionalization can be applied to this sample carrier. Furthermore, the low unit cost enables the rapid iteration of experiments.

Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe.

A retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service delivery models: Non-governmental-organisation (NGO) directly managed model (Chitungwiza and New Africa House sites), NGO partner managed site (Mutare site), private-public-partnership (PPP) model (Chitungwiza Profam Clinic), and NGO directly managed outreach (operating from New Africa House site. In addition client cost exit interviews (client perspective) were conducted among 856 female clients exiting integrated services at three of the sites. Our costing approach involved first a facility bottom-up costing exercise (February to April 2015), conducted to quantify and value each resource input required to provide individual SRH and HIV services. Secondly overhead financial expenditures were allocated top-down from central office to sites and then respective integrated service based on pre-defined allocation factors derived from both the site facility observations and programme data for the prior 12 months. Costs were assessed in 2015 United States dollars (USD). Costs were assessed for HIV testing and counselling, screening and treatment of sexually transmitted infections, tuberculosis screening with smear microscopy, family planning, and cervical cancer screening and treatment employing visual inspection with acetic acid and cervicography and cryotherapy. Variability in costs per visit was evident across the models being highest for cervical cancer screening and cryotherapy (range: US$6.98-US$49.66). HIV testing and counselling showed least variability (range; US$10.96-US$16.28). In general the PPP model offered integrated services at the lowest unit costs whereas the partner managed site was highest. Significant client costs remain despite availability of integrated sexual and reproductive health and HIV services free of charge in our Zimbabwe study setting. Situating services closer to communities, incentives, transport reimbursements, reducing waiting times and co-location of sexual and reproductive health and HIV services may help minimise impact of client costs.