COST OF PRIMARY HEALTH CARE IN PAKISTAN

Authors

  • Muhammad Ashar Malik
  • Wahid Gul
  • Saleem Perwaiz Iqbal
  • Farina Abrejo

Abstract

Background: Detailed cost analysis is an important tool for review of health policy and reforms. We provide an estimate of cost of service and its detailed breakup on out-door patient visits (OPV) to basic health units (BHU) in Pakistan. Method: Six BHUs were randomly selected from each of the five districts in Khyber Pukhtonkhawa (KPK) and two agencies in Federally Administered Tribal Areas (FATA) of Pakistan for this study. Actual expenditure data and utilization data in the year 2005–06 of 42 BHUs was collected from selected district health offices in KPK and FATA. Costs were estimated for outpatient visits to BHUs. Perspective on cost estimates was district-based health planning and management of BHUs. Results: Average recurring cost was PKR.245 (USD 4.1) per OPV to BHU. Staff salaries constituted 90% of recurrent cost. On the average there were 16 OPV per day to the BHUs. Conclusion: Recurrent cost per OPV has doubled from the previous estimates of cost of OPV inBaluchistan. The estimated recurrent cost was six times higher than average consultation charges with the private general practitioner (GP) in the country (i.e., PKR 50/ GP consultation). Performance of majority of the BHUs was much lower than the performance target (50 patients per day) set in the sixth five-year plan of the government ofPakistan. The Government of Pakistan may use these analyses to revisit the performance target, staffing and location of BHUs.Keywords: Primary healthcare, healthcare cost, administrative efficiency, health services accessibility

References

Pakistan Bureau of Statistics (2009). National Health Accounts of Pakistan 2005-06. Government of Pakistan, Statistics Division

Government of Pakistan, Health Institution, Beds and Personnel in Pakistan, 2000–2009, Federal Bureau of Statistics. Available on line at http://www.statpak.gov.pk/depts/fbs/statistics/social_statistics/health2.pdf accessed on 12th June 2011

Government of Pakistan. Sixth five year plan 1978–83, Chapter 19: Towards a Comprehensive National Coverage. Planning Commission, available online at http://www.pakistan.gov.pk/ministries/planninganddevelopment-ministry/index.htm accessed on 22 June 2011

Asian development bank. Project performance audit report on the Social action program (sector) project (loan 1301-Pak [sf]) in Pakistan. Manila. November 2001

Pakistan Bureau of Statistics, Reports of Pakistan Social and Living Standard Measurement Survey and Pakistan Integrated Household Survey, 1995-1996 to 2006-07, Available online at http://www.pbs.gov.pk/pslm-publications accessed on 12 June 2010

De Vries JL, Belding T.K and Rajab S.H. Analysis of costs and coverage of government financed primary health care services in Tanzania, Socioeconomic Planning Sciences 1983;17(1):39–47.

Barman P. Cost efficiency in primary healthcare: studies of health facilities in Indonesia, Health policy and planning. 1989;4(4):316–22

Anand K, Kapoor SK and Pandav CS. Cost Analysis of a primary centre in northern India, National Medical Journal of India 1993;6(4):160–3.

Green A, Bali, A. Naeem and Vassall. Using Costing as a district planning and management tool in Baluchistan, Pakistan. Health Policy and Planning. 2001;16(2);180–6.

The Futures Group International. Public-Private Partnership in Health Study (TA No. 2576-PAK) Final Report, Government of Pakistan, Asian Development Bank, World Health Organization, November, 1997.

Newbrander W, Yoder R, Fishstein P, Mubarak M. S, Lewis E, Bilby. Costing for Basic Package for Health Services for Afghanistan, Management Sciences for Health, Afghanistan Health Services Enhancement Project, Ministry of Health Government of Afghanistan, March 31 2003.

Drummond MP, Sculpher MJ, Torrance GW, O’Brien JB, Stoddart GL. Methods for the Economic Evaluation of Healthcare Programmes Third Edition Oxford University Press 2005.

Government of Khyber Pukhtonkhwa. Annual Development Plan for the year 2004-05, Establishment of Basic Health units at Babani, District Mardan,2006. ADP Number 252, Code 40031 Health Department.

Government of Pakistan. Economic Survey of Pakistan 2005-06, Finance Division Government of Pakistan, Available online at www.finance.gov.pk/survey/home.thm accessed on 22 June 2008.

Asian Development Bank. Project Completion Report, Social Action Programme Project II. Manila December 2004

Benjamin Loevinsohn, Inaam ul Haq, Agnes Couffinhal and Aakanksha Pande. Contracting-in management to strengthen publicly financed primary health services—The experience of Punjab, Pakistan, Health Policy 2009;91:17–2

Downloads

Published

2015-03-01