Provider Costs of PMTCT Services in Zimbabwe: A Time-Driven Activity-Based Costing Analysis

Background Prevention of Mother-to-Child Transmission of HIV (PMTCT) is central to maternal and child health in Zimbabwe. However, with the growing pressures on the health financing landscape, identifying opportunities for efficiency gains is critical. This study aimed to determine the provider costs of PMTCT services, identify key cost drivers, and inform resource allocation. Methods A cross-sectional Time-Driven Activity-Based Costing (TDABC) analysis was conducted across ten health facilities in Zimbabwe, from clinics up to central hospitals. Data were collected on personnel, medicines and consumables, space and equipment, laboratory, and overheads. Process maps for PMTCT pathways were developed, and time equations were used to calculate unit costs per patient. Cost analysis was used to estimate the lifetime cost implications were prevention fails. Results Guiding a mother-baby pair through the PMTCT cascade ($549) cost less than prevention failure. Paediatric ART ($450·56) cost over twice maternal ART ($209·30), with lifetime treatment costs reaching $5 210·78 for maternal seroconversion and $9 526·18 for infant infection. Every dollar invested in PMTCT avoided $17 in treatment costs. Key cost drivers were laboratory tests (42%), medicines (28%), and personnel (16%). Costs were lowest at primary clinics ($160·84). Monitoring HIV-negative mothers cost $48·78. Deviations from testing algorithm were common due to stockouts and workload. Conclusion PMTCT is a cost-saving intervention that requires Zimbabwe to prioritize decentralizing services, secure the supply chain for essential commodities and personnel, and formally reviewing its testing algorithm to improve outcomes. These findings offer an evidence-based roadmap to support continued investment in PMTCT.