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ORIGINAL ARTICLE
Open Access

Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe

Collin Mangenah, Webster Mavhu, Karin Hatzold, Andrea K Biddle, Getrude Ncube, Owen Mugurungi, Ismail Ticklay, Frances M Cowan and Harsha Thirumurthy
Global Health: Science and Practice July 2016, 4(Supplement 1):S68-S75; https://doi.org/10.9745/GHSP-D-15-00201
Collin Mangenah
aCentre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
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Webster Mavhu
aCentre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
bUniversity College London, London, United Kingdom
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Karin Hatzold
cPopulation Services International, Harare, Zimbabwe
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Andrea K Biddle
dUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Getrude Ncube
eMinistry of Health and Child Care, Harare, Zimbabwe
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Owen Mugurungi
eMinistry of Health and Child Care, Harare, Zimbabwe
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Ismail Ticklay
fUniversity of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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Frances M Cowan
aCentre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
bUniversity College London, London, United Kingdom
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Harsha Thirumurthy
dUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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    TABLE 1 Component Cost of EIMC Performed by Nurse-Midwives and Doctors, 2014
    Nurse-MidwivesDoctors
    Vertical ProgramIntegrated ProgramVertical Program
    Cost CategoryCost (US$) per EIMC% Contribution to Unit CostCost (US$) per EIMC% Contribution to Unit CostCost (US$) per EIMC% Contribution to Unit Cost
    Direct Costs
     Device10.0025.710.0029.710.0020.1
     Consumable supplies13.4835.013.4840.013.4827.0
     Nonconsumable supplies0.270.70.270.80.270.5
     Waste management1.805.01.805.01.804.0
     Personnel10.5727.06.53a19.019.1138.0
     Training1.514.01.324.03.878.0
    Subtotal (Direct)37.6397.033.4099.048.5398.0
    Indirect Costs
     Capital equipment0.080.00.000.00.080.0
     Support personnelb1.163.00.32c1.01.162.0
    Subtotal (Indirect)1.243.00.321.01.242.0
    Grand Total38.8733.7249.77
    • Abbreviation: EIMC, early infant male circumcision.

    • ↵a Assumes civil servants salary for nurse-midwives.

    • ↵b Clinic clerk and caretaker.

    • ↵c Assumes 10% of civil servants salary for caretaker and receptionist.

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    TABLE 2 One-Way Sensitivity Analysis of Costs of EIMC Performed by Nurse-Midwives and Doctors, 2014
    EIMC Unit Cost (US$)
    Cost CategoryNurse-MidwivesDoctors
    Personnel salaries
     Base case (study salaries)38.8749.77
     Public sectora (integrated)34.00N/C
    Capacity utilization (EIMC/day)
     244.36N/C
     440.23N/C
     6 (base case)38.8749.77
     838.18N/C
    Staff time for EIMC procedure (using outlier times observed), minutes
     1237.69N/C
     18 for nurse-midwives; 16 for doctors (base case)38.8749.77
     4846.19N/C
    Staff time for EIMC procedure (using 25%–75% interquartile range), minutes
     13 (25th percentile)37.92N/C
     18 for nurse-midwives; 16 for doctors (base case)38.8749.77
     30 (75th percentile)41.94N/C
    Effect of nursing staff leave (due to burnout), weeks
     4638.93N/C
     48 (base case)38.8749.77
    • Abbreviations: EIMC, early infant male circumcision; N/C, no change.

    • ↵a Public-sector salaries inclusive of benefits are US$26,400 for a doctor, US$8,400 for a nurse-midwife, US$3,000 for a receptionist, and US$1,800 for a caretaker.

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Global Health: Science and Practice: 4 (Supplement 1)
Global Health: Science and Practice
Vol. 4, No. Supplement 1
July 01, 2016
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Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
Collin Mangenah, Webster Mavhu, Karin Hatzold, Andrea K Biddle, Getrude Ncube, Owen Mugurungi, Ismail Ticklay, Frances M Cowan, Harsha Thirumurthy
Global Health: Science and Practice Jul 2016, 4 (Supplement 1) S68-S75; DOI: 10.9745/GHSP-D-15-00201

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Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
Collin Mangenah, Webster Mavhu, Karin Hatzold, Andrea K Biddle, Getrude Ncube, Owen Mugurungi, Ismail Ticklay, Frances M Cowan, Harsha Thirumurthy
Global Health: Science and Practice Jul 2016, 4 (Supplement 1) S68-S75; DOI: 10.9745/GHSP-D-15-00201
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