Costing of Voluntary Medical Male Circumcision Service Provision in South Africa

©Richard Lord, courtesy of the Population Council

The issue
Private practitioners have offered voluntary medical male circumcision (VMMC) services to clients in South Africa for a number of years and are able to do so in a safe, efficient, and cost effective way. Private sector providers present a strategic potential to increase access to VMMC services, as they draw clients who may not necessarily go to public facilities for services, thereby reaching pockets of the population that may have otherwise gone unreached. However, the private sector unit cost for VMMC service provision, and the cost variation across the private sector are not well known. Additionally, the cost drivers are not sufficiently understood.

Our approach
Using instruments and approaches from a prior costing study of male circumcision provided through public facilities in South Africa, Project SOAR determined the unit cost of VMMC provided in 13 private sector facilities in three provinces (Gauteng, Mpumalanga and KwaZulu Natal). The study found that the unit cost (including the cost of training and continuous quality improvement) to provide VMMC at private facilities was R1,487. Cost drivers were largely consumables (41 percent) and direct labor (34 percent). Other components of unit costs were continuous quality improvement (13 percent), overhead and support staff (4 percent each), training (2 percent), and equipment and vehicle/transport (1 percent each). Contrary to popular belief that private sector operational costs differ significantly from those incurred in the public sector, this study found that the average unit cost of providing VMMC in private facilities (R1,487) is not fundamentally different from the unit cost of providing the same service in government and PEPFAR-supported facilities (R1,431).

The impact
Results from this study will inform discussion with private insurance providers in South Africa about standardization VMMC tariffs. It also provides a strong rationale for reimbursing private sector providers for circumcisions of uninsured clients.