Assessing frontline HIV service provider efficiency using data envelopment analysis: a case study of Philippine social hygiene clinics (SHCs)

Abstract

Background Globally, local and frontline HIV service delivery units have been deployed to halt the HIV epidemic. However, with the limited resources, there is a need to understand how these units can deliver their optimum outputs/outcomes efficiently given the inputs. This study aims to determine the efficiency of the social hygiene clinics (SHC) in the Philippines as well as to determine the association of the meta-predictor to the efficiencies. Methods In determining efficiency, we used the variables from two data sources namely the 2012 Philippine HIV Costing study and 2011 Integrated HIV Behavioral and Serologic Surveillance, as inputs and outputs, respectively. Various data management protocols and initial assumptions in data matching, imputation and variable selection, were used to create the final dataset with 9 SHCs. We used data envelopment analysis (DEA) to analyse the efficiency, while variations in efficiencies were analysed using Tobit regression with area-specific meta-predictors. Results There were potentially inefficient use of limited resources among sampled SHC in both aggregate and key populations. Tobit regression results indicated that income was positively associated with efficiency, while HIV prevalence was negatively associated with the efficiency variations among the SHCs. Conclusions We were able to determine the inefficiently performing SHCs in the Philippines. Though currently inefficient, these SHCs may adjust their inputs and outputs to become efficient in the future. While there were indications of income and HIV prevalence to be associated with the efficiency variations, the results of this case study may only be limited in generalisability, thus further studies are warranted. Electronic supplementary material The online version of this article (10.1186/s12913-019-4163-5) contains supplementary material, which is available to authorized users.

A Scoping Review of Factors Contributing to the High HIV Incidence in the Philippines: Directions for Developing Preventive Interventions and Research Program

“…Thirteen (43.3%) sources of evidence reported microeconomic and macroeconomic factors such as an individual's occupation and socioeconomic status, high cost of HIV testing and treatment, and a country's economy were associated with HIV prevalence [17,19,22,24,25,30,32,35,38,[40][41][42]45]. Occupational-related factors such as TSWs and OFWs are two vulnerable populations that have increasing HIV incidence [17,22,23,35,41].…”

“…A low socioeconomic status was identified as a risk for HIV spread due to the lack of financial capacity to get tested and the high cost of HIV testing and medical care in the Philippines [19,22,24,29,33,40]. Geographical areas with inefficient and low-funded social hygiene clinics (SHCs) have higher HIV prevalence compared to SHCs with more efficiency and funds [42]. At a macro level, low-to middle-income countries (LMIC) with lesser gross domestic product (GDP) are associated with negative HIV outcomes [30,32].…”

“…Eleven studies (36.7%) reported the environment as a factor fueling the HIV epidemic [16,20,22,[28][29][30][33][34][35]38,42]. The evidence recognizes the role of geographical location [22,29,30], lack of accessibility to healthcare services [20], and prisons [28] as environmental factors that could potentially influence the spread of HIV.…”

“…PLHIVs who experience stigma among healthcare providers may affect their participation in healthcare and adversely impact their HIV health outcomes. Areas with ineffective social hygiene clinics have higher HIV prevalence [42]. The lack of availability of resources for HIV testing and treatment in healthcare systems hinders individuals from seeking HIV care when needed [20,38].…”

“…Seven studies (23.5%) reported the role of political factors in influencing HIV epidemiology [16,20,24,32,37,42,43]. Government laws and regulations can shape HIV program implementation.…”