Within high HIV prevalence settings, the integration of HIV and SRH services
has been widely regarded as beneficial in not only improving individual
outcomes and reducing HIV transmission, but also improving the efficiency of
service delivery. However, while ample evidence exists on the behavioural,
health and social outcomes, evidence on the economic benefits of integrating
these services remains scarce which is a barrier to creating effective policy.
This thesis therefore aimed to contribute to the understanding of the optimal
organisation of HIV and SRH services in high and medium HIV prevalence
settings. To achieve this aim, data was collected from 40 health facilities
providing integrated HIV and SRH services in Kenya and Swaziland. Costs of
providing these integrated services were estimated and the impacts of
integration (among other organizational and contextual factors) on the
technical and cost efficiency explored using non-parametric and parametric
methods respectively. This thesis presents the first study to analyse both
technical and cost efficiency in this context. It further extends the literature on
efficiency measurement in low and middle income settings by considering two
particularly relevant aspects of health care provision: quality of care and the
impact of organisational and contextual factors on the technical efficiency of
health facilities.
The findings from this thesis are especially relevant to the on-going discussions
of the optimal organisation of HIV and SRH services in resource constrained
settings. These findings not only show that inefficiencies exist in the provision
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of integrated HIV and SRH services but underscore the importance of
investigating both technical and cost efficiency as the results differ depending
on the type of efficiency analysed.