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Integration of health services might be an efficient strategy for managing multiple chronic conditions in sub-Saharan Africa, considering the scope of treatments and synergies in service delivery. Proven to promote compliance, integration may lead to increased economies-of-scale. However, evidence on the socio-economic consequences of integration for providers and patients is lacking.
We assessed the clinical resource use, staff time, relative service efficiency and overall societal costs associated with integrating HIV, diabetes and hypertension services in single one-stop clinics where persons with one or more of these conditions were managed. We collected data on resources used from all participants and on out-of-pocket costs in a sub-sample of participants, while a facility-level costing study was conducted at each facility.
Health worker time per participant was assessed in a time-motion morbidity-stratified study among participants. Nested bootstrapping from these samples accounted for uncertainties.
A data envelopment approach was used to benchmark the efficiency of the integrated services. Last, we estimated the budgetary consequences of integration, based on prevalence-based projections until , for both country populations.
