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

Autoři: Andrea Salas-Ortiz aff001;  Gina La Hera-Fuentes aff001;  Nerissa Nance aff001;  Sandra G. Sosa-Rubí aff001;  Sergio Bautista-Arredondo aff001
Působiště autorů: Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico aff001;  University of York, York, United Kingdom aff002;  University of Newcastle, Newcastle, Australia aff003;  School of Public Health, University of California, Berkeley, California, United States of America aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



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.

Klíčová slova:

Health services administration and management – HIV diagnosis and management – Kenya – Outpatients – South Africa – Rwanda – Zambia


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2019 Číslo 10
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