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Estimating unbiased economies of scale of HIV prevention projects: A case study of Avahan

Lépine, A; Vassall, A; Chandrashekar, S; Blanc, E; Le Nestour, A; (2015) Estimating unbiased economies of scale of HIV prevention projects: A case study of Avahan. Social Science & Medicine , 131 pp. 164-172. 10.1016/j.socscimed.2015.03.007. Green open access

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Abstract

Governments and donors are investing considerable resources on HIV prevention in order to scale up these services rapidly. Given the current economic climate, providers of HIV prevention services increasingly need to demonstrate that these investments offer good ‘value for money’. One of the primary routes to achieve efficiency is to take advantage of economies of scale (a reduction in the average cost of a health service as provision scales-up), yet empirical evidence on economies of scale is scarce. Methodologically, the estimation of economies of scale is hampered by several statistical issues preventing causal inference and thus making the estimation of economies of scale complex. In order to estimate unbiased economies of scale when scaling up HIV prevention services, we apply our analysis to one of the few HIV prevention programmes globally delivered at a large scale: the Indian Avahan initiative. We costed the project by collecting data from the 138 Avahan NGOs and the supporting partners in the first four years of its scale-up, between 2004 and 2007. We develop a parsimonious empirical model and apply a system Generalized Method of Moments (GMM) and fixed-effects Instrumental Variable (IV) estimators to estimate unbiased economies of scale. At the programme level, we find that, after controlling for the endogeneity of scale, the scale-up of Avahan has generated high economies of scale. Our findings suggest that average cost reductions per person reached are achievable when scaling-up HIV prevention in low and middle income countries.

Type: Article
Title: Estimating unbiased economies of scale of HIV prevention projects: A case study of Avahan
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.socscimed.2015.03.007
Publisher version: https://doi.org/10.1016/j.socscimed.2015.03.007
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: India, Economies of scale, Efficiency, Cost data, Causal inference, HIV prevention, Scale-up, Avahan
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10070177
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