COSTING OF PRIMARY CARE IN DEVELOPING COUNTRIES: HOW MUCH HEALTH CAN WE BUY FOR A FEW DOLLARS? pp. 81-99
Authors: (Steffen Flessa, Univ. of Greifswald, Faculty of Law and Economics, Dept. of Health Care Management, Greifswald, Germany, Paul Marschall, Univ. of Greifswald, Faculty of Law and Economics, Dept. of Health Care Management, Greifswald, Germany)
Abstract: Our knowledge of the cost of primary care in developing countries is limited. In particular, only few studies calculate the actual cost of preventive and curative services in first-line facilities in rural Africa. Consequently, health care planners have an inadequate understanding of the actual total cost, the cost per inhabitant or per service unit, so that health policies are frequently based on assumptions rather than on evidence. Since 2003 we have developed a cost-of-illness information system for the rural health district of Nouna, Burkina Faso. In this paper we present an analysis of the performance of 20 public health centres and pharmacies. Average and total costs are analysed using data on capital and recurrent costs. The step-down method is used to allocate costs. In addition, an estimate of standard costs is given for full coverage of the entire population. The analysis for the year reveals a great variation between the health centers concerning cost structures, average cost and efficiency. These variations result from differing quantity or quality of the services provided in each centre. The cost recovery rates were far from reaching break even, but there was a positive profit margin at each pharmacy. We conclude that the total costs of primary care would hardly rise if the coverage of the population were increased. As high fees prevent many diseased from seeking medical help, the cost recovery policy at the level of primary care has to be adjusted. These results are not fully representative for the cost of primary care in rural Africa as countries and locations differ strongly on this huge continent. However, our study demonstrates that costing of primary services in developing countries is possible and carries the opportunity of evidence-based health policies.