Financial information at district level: experiences from five countries

Waddington, Catriona; Kello, Abdulhamid Bedri; Wirakartaku-Sumah, Djuhari; Ganiarto, Eko; Malik, Ridwan; Maneno, J; Thube, C; Wang'ombe, Joseph; Attanayake, Nimal; Silva, U De; Ndeki, Sidney

doi:10.1093/heapol/4.3.207

Cited by 5 publications

(3 citation statements)

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“…Thus far, only few studies have been carried out to determine the costs of maternal health services in developing countries. Very few of them have been conducted in sub-Saharan Africa [2,7,19,20]. The purpose of the present contribution was to determine the cost of maternal health services, including ANC, vaccination, delivery, postpartum care, and family planning (FP) services, in a district in South Tanzania and to assess the productivity of service delivery as one aspect of efficiency.…”

Section: Introductionmentioning

confidence: 99%

Costing maternal health services in South Tanzania

2007

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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.

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Section: Introductionmentioning

confidence: 99%

Costing maternal health services in South Tanzania

2007

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“…This is actually what we did for a 5-year period. The same data can also be used to calculate programme expenditures for a few activities such as primary health care, as shown for instance by Waddington et al (1989). The analysis would be much facilitated if each institution had its own budget and if the cost of items made available in kind to the district was known to the district health team.…”

Section: Discussionmentioning

confidence: 99%

“…The special surveys that would be required can neither be managed by local staff nor financed within the declining health budgets. An analysis of financial information, such as capital and recurrent budgets and actual expenditures, applicable at district level in developing countries, has been published by Waddington et al (1989).…”

Section: Introductionmentioning

confidence: 99%

Rapid assessment of an african district health system. Test of a planning tool

Nordberg

Oganga

Kazibwe

et al. 1993

Health Planning & Management

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Occasional rapid health care system assessments are potentially useful for planning, for monitoring health care systems development over time, and for comparing health systems in different areas. With the decentralization of health sector management, for example in Kenya, there is a growing need of such assessments at district and sub-district levels. Can rapid assessments be conducted at affordable cost at these levels? What variables and methods are feasible? This paper reports on a rapid health system assessment conducted in rural Kenya during 1991. It required the completion at each health facility of a self-administered questionnaire which included questions on resources, health care programmes, management, service output, and prominent problems. It also included interviews with officers in charge of each health institution in the sub-district and an examination of records and reports available at each facility. The paper presents the range of issues addressed, the indicators used, the methods applied, the problems encountered, the costs of the assessment, and a small selection of the findings. We conclude that the assessment model is manageable at district level with modest planning and analysis support from central level. Field staff need more precise instructions for completion of the questionnaire, and more population-based estimates need to be calculated. Reassessment taking place every 3-5 years should be adequate for monitoring the process of change in the local health care system.

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