The cost of scaling up primary health-care services—comparisons from studies in six countries: economic research using systematic sampling

Collins, David H.; Jarrah, Zina; Ndizeye, Cedric; Cros, Marion

doi:10.1016/s0140-6736(13)61284-2

Cited by 4 publications

(5 citation statements)

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“…The cost per child completing referral increased with the level of health facility. However this variability in cost by health centre level needs to further be scrutinised as they may indicate variability in quality of care provided at the various levels of health facilities [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is because there is no minimum wage policy in Uganda and the average income foregone could not be estimated by some of the participants in this study due to limitations in the questionnaire. There were limited health facility costing studies conducted in Uganda, the best available evidence was from a study by Medical Sciences for Health (MSH) in which the minimum health care package at health centres in Uganda was costed [ 24 ]. The MSH study used the cost and revenue plus (CORE Plus) analysis tool to model direct and indirect costs associated with delivery of a health services by service protocol.…”

Section: Methodsmentioning

confidence: 99%

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Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda

Nanyonjo

Bagorogoza

Kasteng

et al. 2015

BMC Health Serv Res

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BackgroundIntegrated community case management (iCCM) relies on community health workers (CHWs) managing children with malaria, pneumonia, diarrhoea, and referring children when management is not possible. This study sought to establish the cost per sick child referred to seek care from a higher-level health facility by a CHW and to estimate caregivers’ willingness to pay (WTP) for referral.MethodsCaregivers of 203 randomly selected children referred to higher-level health facilities by CHWs were interviewed in four Midwestern Uganda districts. Questionnaires and document reviews were used to capture direct, indirect and opportunity costs incurred by caregivers, CHWs and health facilities managing referred children. WTP for referral was assessed through the ‘bidding game’ approach followed by an open-ended question on maximum WTP. Descriptive analysis was conducted for factors associated with referral completion and WTP using logistic and linear regression methods, respectively. The cost per case referred to higher-level health facilities was computed from a societal perspective.ResultsReasons for referral included having fever with a negative malaria test (46.8 %), danger signs (29.6 %) and drug shortage (37.4 %). Among the referred, less than half completed referral (45.8 %). Referral completion was 2.8 times higher among children with danger signs (p = 0.004) relative to those without danger signs, and 0.27 times lower among children who received pre-referral treatment (p < 0.001). The average cost per case referred was US$ 4.89 and US$7.35 per case completing referral. For each unit cost per case referred, caregiver out of pocket expenditure contributed 33.7 %, caregivers’ and CHWs’ opportunity costs contributed 29.2 % and 5.1 % respectively and health facility costs contributed 39.6 %.The mean (SD) out of pocket expenditure was US$1.65 (3.25). The mean WTP for referral was US$8.25 (14.70) and was positively associated with having received pre-referral treatment, completing referral and increasing caregiver education level.ConclusionThe mean WTP for referral was higher than the average out of pocket expenditure. This, along with suboptimal referral completion, points to barriers in access to higher-level facilities as the primary cause of low referral. Community mobilisation for uptake of referral is necessary if the policy of referring children to the nearest health facility is to be effective.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda

Nanyonjo

Bagorogoza

Kasteng

et al. 2015

BMC Health Serv Res

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“…The study also showed that the projected volume of MNH services needed by the primary catchment populations of each RHC in this study exceeded that provided at either RHC in 2011 despite the absence of other skilled MNH service providers in either catchment area. This relatively low volume of service demand is a dilemma faced by health facilities serving smaller, remote and more dispersed low income populations as reported in a multi-country study where the majority of PHC facilities were found to be under-utilized and under-resourced especially in terms of staffing [ 22 ]. Given their actual MNH service staffing and workloads, both study RHCs were underutilized and the BEmONC RHC was understaffed.…”

Section: Discussionmentioning

confidence: 99%

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

Hatcher

Shaikh

Fazli

et al. 2014

BMC Health Serv Res

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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.

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“…In parallel, as facilities and staffing are generally under-resourced in many developing countries, plans for scaling-up primary health services (eg, additional recruitment or training of CHWs, upgrading health facilities or health information systems) should be taken into account as it may be more important to ensure health system preparedness to meet the expected service needs and demands. 51 …”

Section: Discussionmentioning

confidence: 99%

mCARE, a digital health intervention package on pregnancy surveillance and care-seeking reminders from 2018 to 2027 in Bangladesh: a model-based cost-effectiveness analysis

LeFevre

Ali³

et al. 2021

BMJ Open

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ObjectiveWe estimated the cost-effectiveness of a digital health intervention package (mCARE) for community health workers, on pregnancy surveillance and care-seeking reminders compared with the existing paper-based status quo, from 2018 to 2027, in Bangladesh.InterventionsThe mCARE programme involved digitally enhanced pregnancy surveillance, individually targeted text messages and in-person home-visit to pregnant women for care-seeking reminders for antenatal care, child delivery and postnatal care.Study designWe developed a model to project population and service coverage increases with annual geographical expansion (from 1 million to 10 million population over 10 years) of the mCARE programme and the status quo.Major outcomesFor this modelling study, we used Lives Saved Tool to estimate the number of deaths and disability-adjusted life years (DALYs) that would be averted by 2027, if the coverage of health interventions was increased in mCARE programme and the status quo, respectively. Economic costs were captured from a societal perspective using an ingredients approach and expressed in 2018 US dollars. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties.ResultsWe estimated the mCARE programme to avert 3076 deaths by 2027 at an incremental cost of $43 million relative to the status quo, which is translated to $462 per DALY averted. The societal costs were estimated to be $115 million for mCARE programme (48% of which are programme costs, 35% user costs and 17% provider costs). With the continued implementation and geographical scaling-up, the mCARE programme improved its cost-effectiveness from $1152 to $462 per DALY averted from 5 to 10 years.ConclusionMobile phone-based pregnancy surveillance systems with individually scheduled text messages and home-visit reminder strategies can be highly cost-effective in Bangladesh. The cost-effectiveness may improve as it promotes facility-based child delivery and achieves greater programme cost efficiency with programme scale and sustainability.

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The cost of scaling up primary health-care services—comparisons from studies in six countries: economic research using systematic sampling

Cited by 4 publications

References 0 publications

Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda

Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda

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

mCARE, a digital health intervention package on pregnancy surveillance and care-seeking reminders from 2018 to 2027 in Bangladesh: a model-based cost-effectiveness analysis

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