Institutional Efficiency and Sustainable Response to Hiv/aids in Nyanza and Western Kenya

Abstract

Introduction: Sustainable Development Goal number three (SDG3) targets to attain healthy lives and well-being for all at all ages with greater focus on HIV/AIDS. By end of 2015, the number of people living with HIV/AIDs globally totaled 36.7 million of whom 34.9 million are adults, 17.8 million are women, 1.5 million are children below 15 years and 25.5 million (69per cent) living in Africa of which estimated 1.5 million are in Kenya (PEPFAR, 2017). PEPFAR is one of the prime donors of HIV/AIDs programs in Kenya. Specifically, PEPFAR has funded faith based hospitals located in Western and Nyanza parts of Kenya since 2011. One of the expectations of Pepfar 3.0 strategy is to integrate efficiency in HIV/AIDs program delivery the bottom line being achieving more with less. Following this development, various initiatives have been developed, notably the 90-90-90 rule by UNAIDs (NASCOP, 2016). Under the rule, all HIV/AIDs partners are required to identify 90 percent of PLHIV, provide 90 percent of them with ART, and achieve viral suppression in at least 90 percent of those on ART. Problem statement: Global funding for HIV programs reduced byUS$511 million from US$7.5 billion in 2015 to US$7 billion in 2016 (Kaiser/UNAIDs, 2017). By extension, Pepfar funding of faith based hospitals in Western Kenya also declined from 2011 to 2015 while prevalence rates in the region have remained the highest in Kenya. The Faith Based Health Centres in Nyanza and Western Kenya do not have alternative sources of income to support HIV/AIDs initiatives within their locality and are 100% Pepfar dependent. This complicates matters more as Pepfar funding could end by 2022 (Kenya Aids Report, 2015). Reaching 90-90-90 targets with the limited resources requires working more efficiently. However, there has been limited focus on measuring efficiency in faith based facilities but rather, much focus has been on public health facilities. Many of the Faith Based hospitals under the Pepfar fund may not therefore meet the efficiency expectation due to lack of technical know-how or limited research resources in integrating efficiency in their operations. Objective: The four objectives of the study is to determine the level of efficiency for faith based health facilities tackling HIV/AIDs problem in Nyanza and Western Kenya between 2014 to 2016, determine the level of productivity of each health facility between 2014 to 2016, determine the optimal level of inputs for each health facility given respective efficiency levels and suggest policy decisions to take in order for the health facilities to remain efficient in the donor declining environment. Methodology: The study uses VRS Barnes, Charnes and Cooper (BCC) output oriented DEA model to measure respective efficiency scores per facility and the Malmquist Total Factor Productivity Index (TFP) to measure productivity growth between 2014 and 2015. Output variables used are the number of HIV Testing Services and number of patients enrolled on ART while inputs are the number of medical officers, Clinicians, Pharmacists, Nurses, Laboratory Technicians, Site Coordinators, Community health workers, social workers and Counselors. Key finding: Out of 47 site facilities, Thirty two (68%), sixteen (34%) and Seventeen (36%) of the site facilities were run inefficiently in 2014, 2015 and 2016 respectively. The Malmquist productivity index of annual mean was zero, a decrease by 100 percent between 2014-2016 due to a technical regress of 100%. Recommendation: The hospitals should consider adoption of demand wise differentiated HIV testing and care initiatives, transfer of staffing needs, invest more in health strengthening systems to be more efficient and increase collaboration in order to sustain HIV/AIDs initiatives.