Costing maternal health services in South Tanzania

Abstract

The following paper presents the methodology and results of a costing exercise of maternal health services in Tanzania. The main objective of this study was to determine the actual costs of antenatal and obstetric care in different health institutions in a district in Tanzania as a basis of more efficient resource allocation. A costing tool was developed that allows the calculation of costs of service units, such as deliveries and antenatal care, and separates these costs from the costs of other services. Time consumed by each activity was used as an allocation key. For that purpose, we recorded the personnel consumption with different time-study methodologies. This approach was tested and implemented in Mtwara Urban District, South Tanzania. The results were analyzed by a spreadsheet program. The paper presents average costs for different costing units of maternal care. Among other findings, we found that the cost of a normal vaginal delivery is US $12.30 in a dispensary and US $6.30 in the hospital--a result that needs explanation, as usually one would expect that hospitals are more cost-intensive than first-line facilities. However, dispensaries are grossly underutilized so that the costs per service unit are rather high. The cost for surgical delivery (only in hospitals) was found to be US $69.26 and the average cost per antenatal care consultation (only at dispensaries) was US $2.50. We conclude that improved planning of elective services is a prerequisite for more effective and efficient use of personnel resources. In addition, the definition of medically and economically sound standards, in particular staffing standards, is critical to make cost analysis an effective management tool to guide rational resource allocation.

Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study

“…Since productivity is one aspect of efficiency, the unit costs therefore reflected efficiency in the provision of MNC services [8,15]. This premise was based on the assumption that, skilled care during pregnancy and childbirth was very likely to reduce maternal mortality, so the number of ANC contacts and the number of professionally assisted childbirths were very good proxy indicators for outcomes and impacts [8]. Efficiency measures how much output a health center or dispensary can produce using a certain amount of input.…”

“…Cost studies help to demonstrate how resources have been spent, what resources are needed to provide specific services, areas where costs could be reduced and where output could be increased and thus improve efficiency in the provision of health services [8-10]. There is still only a limited amount of information of this type regarding the specific provision of ANC and childbirth services.…”

“…There is still only a limited amount of information of this type regarding the specific provision of ANC and childbirth services. The few studies conducted in Tanzania have looked at MNC costs in urban settings [8], at faith based hospitals [11] or taken the consumer/household perspective on costs of MNC [12]. Other studies on MNC were conducted in other developing countries [9,10,13-19].…”

Public Health Promotion: Autonomy of the Emergency Nurse Practitioner

“…The cost of a delivery in an emergency clinic is $12.30. The cost for surgical delivery is $69.26 [30]. Improved planning of resource allocation can only improve services and allow for more a more adequate mix of services.…”

“…This is necessary to analyze the efficiency in which resources have been allocated. About $0.84 was spent per individual for maternal services and total costs of pregnancy were about $20 per pregnancy [30]. Allocation of resources is essential in this current global economic climate where money is limited.…”