Cost and Quality Indicators for Home Community-Based Care Service delivered by NPOs in South Africa

1. Cost and Quality Indicators for Home Community-Based Care Service delivered by NPOs in South Africa Veni Naidu Jean-Francois Aguilera Peter Netshipale Stephen Dike Connie Kganakga Johanna de Beer Geoff Harris

2. BackgroundObjective of the PaperMethodsFindings & Discussion Recommendations

3. Background HCBC • HCBC programs started to gain momentum since the early 90’s and most were in existence for the last 5 years. • Provide primarily health and social services • DSD audit identified almost 1,500 HCBC programs in SA in 2004 • Wide variations in type, content and cost of services

4. Background • Numerous studies have examined the cost of HCBC services in Africa • There is evidence that HCBC cost is lower than facility-based care • Only few studies on quality evaluation of HCBC organizations • Variety of services and costs between NPOs make it difficult any comparison

5. To contribute to the development of service delivery indicators for HCBC services provided by NPOs Purpose of Study

6. Development of Indicators • Indicators were extracted from a survey done in 12 NPOs • in-depth interview of management and caregivers [Naidu, 2006] • Assumptions on levels of performance for each indicator were extracted from: • Naidu’s survey • experience from DOH • Distinction between rural and urban NPOs was applied • Arbitrary ranges were applied to some indicators (e.g. +/- 20%)

7. Cost Indicators • 2 main cost measures • Cost per contact hour • Cost per beneficiary • Cost were defined using • The government-recommended HCBC caregiver rate of R500 • Estimated number of visits per day (rural and urban, including travel and estimated contact time) • Estimated number of visits per beneficiary per week • No. of working days for caregivers

8. Indicators • Quality Indicators • The total number of HCBC visits received by beneficiaries • The total number of HCBC visits made by community caregivers • Number of beneficiaries per community caregiver • Use of HCBC kits and frequency of replenishment • The percentage of community caregivers with 59-day HCBC training • Cost Indicators • Cost per contact hour • Cost per beneficiary per annum

9. Urban 1 visit/week for each HCBC client (at least 1 hour contact time) 3-5 home visits per day (Annual 576-960 visits) 12-20 beneficiaries per caregiver Rural 1 visit/week for each HCBC client (at least 1 hour contact time) 2-3 home visits per day (Annual 384-576 visits) 8-12 beneficiaries per caregiver Indicators for Urban and Rural NPOs

10. Quality Indicators

11. Other Quality Indicators

12. Cost Indicators (ZAR)

13. Findings and Discussion

14. Findings Quality Indicators(N=12)

15. Findings Cost IndicatorsN=12

16. Allocation of Points - Quality Indicators

17. Allocation of Points - Cost Indicators

18. Total Points • Quality 0 1 2 3 4 5 6 7 Unacceptable Acceptable • Cost 0 2 1 Unacceptable Acceptable

19. Cost/Quality Matrix Cost Unacceptable Acceptable

20. Conclusions • Model developed is promising • Allows an insight on cost-efficiency for funders • Can trigger targeted action for targeted NPOs

21. Limitations • Small sample size • Arbitrary ranges • Assumptions on performance levels based on small number of NPOs • Important differences in terms of performance between NPOs, making conclusions difficult • The tool only allows a broad estimate of potential areas of underperformance • Additional evaluation on site is still necessary

22. Next step • Model implementation on a larger sample size for fine-tuning • Different assumptions of performance levels and ranges should be tested • Different scales for allocations of points should also be tested • Larger study planned at DOH