Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective

Abstract

BackgroundThere is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services.MethodsThis is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical and Newborn Care (BEmONC) services provided in one RHC and six Comprehensive Emergency Obstetrical and Newborn Care (CEmONC) services in the other. Data were collected using staff interviews and record review to compile resource inputs and service volumes, and analyzed using the CORE Plus tool. Unit costs are based on actual costs of MNH services and are calculated for actual volumes in 2011 and for volumes projected to meet need with optimal resource inputs.ResultsThe unit costs per service for actual 2011 volumes at the BEmONC RHC were antenatal care (ANC) visit USD$ 18.78, normal delivery US$ 84.61, newborn care US$ 16.86 and a postnatal care (PNC) visit US$ 13.86; and at the CEmONC RHC were ANC visit US$ 45.50, Normal Delivery US$ 148.43, assisted delivery US$ 167.43, C-section US$ 183.34, Newborn Care US$ 41.07, and PNC visit US$ 27.34. The unit costs for the projected volumes needed were lower due to optimal utilization of resources. The percentage distribution of expenditures at both RHCs was largest for salaries of technical staff, followed by salaries of administrative staff, and then operating costs, medicines, medical and diagnostic supplies.ConclusionsThe unit costs of MNH services at the two contracted out government rural facilities remain higher than is optimal, primarily due to underutilization. Provider cost analysis using standard treatment guideline (STG) based service costing frameworks should be applied across a number of health facilities to calculate the cost of services and guide development of evidence based resource envelopes and performance based contracting.

Cost of antenatal care for the health sector and for households in Rwanda

“…In contrast the estimates from other countries have been considerably higher: $215 for Cuba, $39 for Thailand [ 8 ] and $ 35.8 in Argentina [ 18 ]. Studies that have considered a provider perspective presented results close to those of this study and to each other: the mean cost of antenatal care was $16 in Tanzania [ 19 ], $18 in Ghana [ 20 ], and $18.78 in Pakistan [ 21 ].…”

“…This was consistent with results of Livin et al [ 9 ], who reported drugs and consumables as the main contributors to total ANC cost. However, other studies have reported human resources as the most costly input to antenatal care [ 18 , 19 , 21 ]. More generally, personnel is often reported as the input with the highest cost in primary health care [ 20 , 22 – 24 ].…”

Partnerships and the Good-Governance Agenda: Improving Service Delivery Through State–NGO Collaborations

“…Studies available at the time of the fieldwork (World Bank 2006a), as well as independent fieldwork conducted in the two districts (Faisalabad and Lodhran) where the program has been implemented, showed that PRSP was able to record dramatic improvements in performance: the problem of staff absenteeism disappeared, patient turnout improved, government-supplied medicines which in the past always seemed to be out of stock were now available, and all these improvements were recorded within the existing budget. International evaluations and research studies continue to note BHU privatization in Pakistan as a successful case of public-private partnership within the health sector for improved social-service delivery to the poor (Hatcher et al 2014).…”

Public-Private Partnership Policy in Primary Health Care: A Scoping Review

“…It is also important how to collect data and calculate these indices. A study by Hatcher et al 34 in Pakistan examined the unit cost of 2 rural primary health centers that had been assigned to a private company. The results of the study showed that the unit costs of these centers were higher than expected.…”