Background: The cost of implementing early infant male circumcision (EIMC) is an important factor in scale-up decisions. This is a comparative cost analysis of EIMC performed by nurse-midwives and doctors using the AccuCirc device in Zimbabwe.
Methods: Between August 2013 and July 2014, nurse-midwives performed EIMC on 500 male infants using AccuCirc in a field trial. This analysis looked at the overall unit cost and identified key cost drivers of EIMC performed by nurse-midwives and compared these with costing data previously collected during a randomized non-inferiority comparison trial of two devices (AccuCirc and the Mogen clamp) in which doctors performed EIMC.
Results: The unit costs of EIMC performed by nurse-midwives and doctors in vertical programs were US$38.87 and US$49.77, respectively. Key cost drivers of EIMC were consumable supplies, personnel costs, and the device price. In this cost analysis, major cost drivers that explained the differences between EIMC performed by nurse-midwives and doctors were personnel and training costs, both of which were lower for nurse-midwives.
Conclusions: EIMC unit costs were lower when performed by nurse-midwives compared with doctors. To minimize costs, countries planning to scale up EIMC should consider using nurse-midwives, who are in greater supply than doctors
and are the main providers at the primary health care level, where most infants are born.
This paper is part of a supplement of Global Health: Science and Practice developed in partnership with UNICEF and PEPFAR. The articles featured in this collection offer insights into country experiences with introducing EIMC services, and highlight important considerations for policy, service delivery, costs, and demand creation.