Transcript Aguilera_Cost and Quality Indicators for HBC_DoH

Cost and Quality Indicators
for Home Community-Based
Care Service delivered by
NPOs in South Africa
Veni Naidu
Jean-Francois Aguilera
Peter Netshipale
Stephen Dike
Connie Kganakga
Johanna de Beer
Geoff Harris
Background
Objective of the Paper
Methods
Findings & Discussion
Recommendations
Background
HCBC
• HCBC programs started to
gain momentum since the
early 90’s and most were in
existence for the last 5
years.
• Provide primarily health and
social services
• DSD audit identified almost
1,500 HCBC programs in
SA in 2004
• Wide variations in type,
content and cost of services
Background
• Numerous studies have examined the cost
of HCBC services in Africa
– There is evidence that HCBC cost is lower
than facility-based care
• Only few studies on quality evaluation of
HCBC organizations
• Variety of services and costs between
NPOs make it difficult any comparison
Purpose of Study
To contribute to the development of
service delivery indicators for HCBC
services provided by NPOs
Development of Indicators
• Indicators were extracted from a survey done in
12 NPOs
– in-depth interview of management and caregivers
[Naidu, 2006]
• Assumptions on levels of performance for each
indicator were extracted from:
– Naidu’s survey
– experience from DOH
– Distinction between rural and urban NPOs was
applied
• Arbitrary ranges were applied to some indicators
(e.g. +/- 20%)
Cost Indicators
• 2 main cost measures
– Cost per contact hour
– Cost per beneficiary
• Cost were defined using
– The government-recommended HCBC caregiver rate
of R500
– Estimated number of visits per day (rural and urban,
including travel and estimated contact time)
– Estimated number of visits per beneficiary per week
– No. of working days for caregivers
Indicators
• Quality Indicators
– The total number of HCBC visits received by beneficiaries
– The total number of HCBC visits made by community caregivers
– Number of beneficiaries per community caregiver
– Use of HCBC kits and frequency of replenishment
– The percentage of community caregivers with 59-day HCBC
training
• Cost Indicators
– Cost per contact hour
– Cost per beneficiary per annum
Indicators for Urban and Rural
NPOs
Urban
1 visit/week for each HCBC
client (at least 1 hour
contact time)
Rural
1 visit/week for each HCBC
client (at least 1 hour
contact time)
3-5 home visits per day
(Annual 576-960 visits)
2-3 home visits per day
(Annual 384-576 visits)
12-20 beneficiaries per
caregiver
8-12 beneficiaries per
caregiver
Quality Indicators
Low
Acceptable
High
Visits per beneficiary per annum
Urban and Rural
<38
38-58
>58
Visits per caregiver per annum
Urban
<576
576-960
>960
Visits per caregiver per annum
Rural
<384
384-576
>576
Beneficiaries per caregiver
Urban
<12
12-20
>20
Beneficiaries per caregiver
Rural
<8
8-12
>12
Other Quality Indicators
Low
Use of HCBC
kits
% of caregivers
trained
(59-day HCBC
training)
Acceptable
Do not use Use kits but no
HBC kits
regular
replenishment
<33%
33-66%
High
Use kits with
regular
replenishment
>66%
Cost Indicators (ZAR)
Low
Direct cost per contact
hour
Urban
Direct cost per contact
hour
Rural
Direct cost per beneficiary
Urban
Direct cost per beneficiary
Rural
Acceptable
High
<6.25
6.25-10.42
>10.42
<10.42
10.42-15.63
>15.63
<300
300-500
>500
<500
500-750
>750
Findings and Discussion
Findings Quality Indicators
(N=12)
Low
Average No. of visits per
beneficiary per annum
Average number of visits per
caregiver per annum
Average No. of beneficiaries per
caregiver
Use and replenishment of HBC
kits
Training of community
caregivers (59-day training)
Acceptable High
7
2
3
4
6
2
3
3
6
7
5
0
5
1
6
Findings Cost Indicators
N=12
Low
Acceptable
High
Direct cost
per contact
hour
1
7
4
Direct cost
per
beneficiary
6
3
3
Allocation of Points - Quality
Indicators
Indicator
Low
Acceptable High
Visits per beneficiary per
annum
Visits per caregiver per annum
0
1
0
0
1
0
Number of beneficiaries per
caregiver
0
1
0
Regular replenishment of HBC
kits
0
1
2
Training of carers
0
1
2
Maximum total points
7
Allocation of Points - Cost
Indicators
Indicator
Low
Acceptable
High
Direct cost per contact hour
0
1
0
Cost per beneficiary per annum
0
1
0
Maximum total points
2
Total Points
• Quality
0
1
2
3
4
Unacceptable
5
6
7
Acceptable
• Cost
0
2
1
Unacceptable
Acceptable
Cost/Quality Matrix
Cost
Acceptable
Acceptable
1.
Unacceptable
2.
NPO 11
NPO 7
Quality
NPO 1
3.
4.
NPO 1
NPO 6
Unacceptable
NPO 2
NPO 2
NPO 10
NPO 3
NPO 4
NPO 5
NPO 8
NPO 9
NPO 12
Conclusions
• Model developed is promising
• Allows an insight on cost-efficiency for
funders
• Can trigger targeted action for targeted
NPOs
Limitations
• Small sample size
• Arbitrary ranges
• Assumptions on performance levels based on
small number of NPOs
• Important differences in terms of performance
between NPOs, making conclusions difficult
• The tool only allows a broad estimate of
potential areas of underperformance
– Additional evaluation on site is still necessary
Next step
• Model implementation on a larger sample
size for fine-tuning
• Different assumptions of performance
levels and ranges should be tested
• Different scales for allocations of points
should also be tested
• Larger study planned at DOH