Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania

Abstract

Background: Access to surgical care is poor in Tanzania. The country is at the implementation stage of its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP; 2018-2025) aiming to scale up surgery. This study aimed to calculate the costs of providing surgical care at the district and regional hospitals. Methods: Two district hospitals (DHs) and the regional referral hospital (RH) in Arusha region were selected. All the staff, buildings, equipment, and medical and non-medical supplies deployed in running the hospitals over a 12 month period were identified and quantified from interviews and hospital records. Using a combination of step-down costing (SDC) and activity-based costing (ABC), all costs attributed to surgeries were established and then distributed over the individual types of surgeries. These costs were delineated into pre-operative, intra-operative, and post-operative components. Results: The total annual costs of running the clinical cost centres ranged from $567k at Oltrumet DH to $3453k at Mt Meru RH. The total costs of surgeries ranged from $79k to $813k; amounting to 12%-22% of the total costs of running the hospitals. At least 70% of the costs were salaries. Unit costs and relative shares of capital costs were generally higher at the DHs. Two-thirds of all the procedures incurred at least 60% of their costs in the theatre. Open reduction and internal fixation (ORIF) performed at the regional hospital was cheaper ($618) than surgical debridement (plus conservative treatment) due to prolonged post-operative inpatient care associated with the latter ($1177), but was performed infrequently due mostly to unavailability of implants. Conclusion: Lower unit costs and shares of capital costs at the RH reflect an advantage of economies of scale and scope at the RH, and a possible underutilization of capacity at the DHs. Greater efficiencies make a case for concentration and scale-up of surgical services at the RHs, but there is a stronger case for scaling up district-level surgeries, not only for equitable access to services, but also to drive down unit costs there, and free up RH resources for more complex cases such as ORIF.

A Journey Undertaken by Families to Access General Surgical Care for their Children at Muhimbili National Hospital, Tanzania; Prospective Observational Cohort Study

“…This will ensure timely access to surgical care, reduce the number of preventable referrals and overcrowding at higher-level hospitals [ 30 ]. Unit costs and the relative shares of capital costs are generally lower at primary-level hospital [ 31 ]. Effective treatment depends on all steps of a healthcare system working harmoniously, from timely seeking and reaching healthcare, appropriate triage for surgery or referral, to proper transportation for care in an adequately resourced facility for better outcomes [ 32 ].…”

Surgical capacity, productivity and efficiency at the district level in Sub-Saharan Africa: A three-country study

“…Instead, there may be a waste of resources unless, as in the case of Malawi, such additional resources consist of surgically active personnel. An earlier study in Tanzania [ 37 ] also demonstrated that clinicians’ surgical skills and staff skills-mix are major factors that determine efficiency of resource use and economies of scale. However improvements in surgical skills will not result in increased volume and efficiency if other rate-limiting steps are not removed simultaneously.…”

Healthcare provider cost of antimicrobial resistance in two teaching hospitals in Ghana

“…We performed primary and secondary cost analyses using gross costing approaches ( Hellebo et al. , 2021 ; Ifeanyichi et al. , 2022 ).…”

“…Therefore, we performed a secondary analysis of the centre-specific costs of AMR by multiplying the estimated provider cost per bed day by the estimated LOS due to AMR for each cost centre/department. The analysis was, in essence, a check of the robustness of the crude estimates in the primary analysis ( Ifeanyichi et al. , 2022 ).…”