Costing Adult and Adolescent
Male Circumcision in Kenya,
Zambia, Zimbabwe and Uganda
Urbanus Kioko (PHD)
University of Nairobi
Arusha, Tanzania
10 June 2010
Currently offering MMC services
 Meets existing policies for
comprehensive MMC services
 Represents geographic diversity
 Represents diversity of sites where MMC
services will be scaled-up

Country
Kenya
Zambia
Zimbabwe
Uganda
Number of Sites Costed
30
17
4
27
Kenya Hospitals
Fixed
Outreach
Direct Costs
$8.11
Consumables
Personnel
Training
$11.62
$4.60
Subtotal
$24.32
22%
32%
8.68
24.04
21%
57%
13%
67%
0.83
33.55
2%
79%
8%
2.24
5%
13%
7%
4%
1.18
3.61
0.50
3%
9%
1%
2%
1.24
8.76
42.32
378
3%
21%
100%
Indirect costs
Equipment
Maintenance/Utility
$2.92
$4.55
Support personnel costs
Mgmt./supervision costs
$2.44
$1.33
Mobilisation
Subtotal
$0.74
$11.99
TOTAL
# of MC Clients/Yr/Facility
$36.31
845
33%
100%
Kenya Health Center
Fixed Outreach
Direct Costs (US$)
$8.15
Consumables
Personnel
Training
$3.04
$4.36
$9.04
$22.61
$0.64
Subtotal
$15.55
$32.29
Equipment
Maintenance/Utility
$2.28
$2.28
$1.67
$2.00
Support personnel costs
Mgmt. and supervision costs
Mobilisation
Subtotal
$3.82
$0.95
$1.40
$10.74
$2.59
$0.79
$1.67
TOTAL
# of MC Clients/Yr/Facility
$26.30
2044
Indirect costs (US$)
$8.73
$41.02
445
Kenya Dispensaries
Fixed
Outreach
Direct Costs (US$)
Consumables
Personnel
Training
$12.57
$25.99
$2.98
$8.87
$18.57
$0.73
Subtotal
$41.55
$28.17
Indirect costs (US$)
Equipment
$2.93
$1.92
Maintenance/Utility
Support personnel costs
Mgmt and supervision costs
Mobilisation
$2.33
$4.57
$1.13
$1.06
$1.08
$3.24
$0.38
$1.39
Subtotal
TOTAL
# of MC Clients/Yr/Facility
$12.01
$53.56
326
$8
$36.17
530
Zimbabwe
Fixed
%
Outreach
%
Consumables
Non-consumables
Personnel costs
$28.13
$0.96
$19.09
48%
2%
32%
$28.13
$1.01
$19.12
40%
1%
27%
Training costs
Subtotal
Indirect costs
Equipment/capital costs
$ 0.34
$48.43
1%
82%
$0.26
$48.52
0%
69%
$0.45
$3.24
$4.42
$2.28
$10.39
$58.82
9600
1%
6%
8%
4%
18%
100%
$3.56
$12.29
$4.67
$1.25
$21.77
$70.29
4800
5%
17%
7%
2%
31%
100%
Direct Costs
Maintenance/Utility
Support personnel
Indirect Labor/Mgmt.
Subtotal
TOTAL
# of MC Clients
Zambia
Direct Costs
%
Labor
$8.95
16.40%
Materials
$8.54
15.65%
Training
N.A.
Subtotal
$17.49
32.05%
Equipment
$21.27
38.98%
Maintenance/Utility
$13.80
25.29%
Indirect Labor/Management
$2.01
3.68%
Subtotal
$37.08
67.95%
TOTAL
$54.57
100.00%
Indirect Costs
# of MC Clients/Yr/Facility
328
# of MC Clients/Yr
Difficult to capture demand creation,
training and management costs
 Excludes traditional MC
 Does not address question about how unit
costs might change with different
methods of service delivery
 Limitation of the data used for estimating
unit costs—may not be very accurate
 Preliminary data-further analysis/validation
of the unit costs

 The
unit cost of MC varies significantly
particularly due to:
› Scale (# of clients seen at each site)
› Type of site (public, private)
› Location of site (urban, peri-urban, rural)
› Type of service delivery method
(integrated, outreach, mobile)
› Surgical instrument method/kit(disposable
kits, non-disposable kits, etc.)
› Persons responsible for delivery (e.g., nurse,
surgeon, clinical officer)
Likely to generate more accurate data
over time-2-3 yrs
 Need to update the unit costs-2-3 years
after the 1st costing exercise


Disseminate findings from countries
where costing was performed

Repeat costing exercise to update and
validate cost estimates every 2-3 years