Abstract
BackgroundThere is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. This study analysed the overall cost of providing health services in selected primary health centres and how much of the cost is attributed to the provision of antenatal and delivery services.MethodsThe study has a cross-sectional design and quantitative data was collected between July and December 2010. Twelve government run primary health centres in the Kassena-Nankana and Builsa districts of Ghana were randomly selected for the study. All health-care related costs for the year 2010 were collected from a public service provider’s perspective. The step-down allocation approach recommended by World Health Organization was used for the analysis.ResultsThe average annual cost of operating a health centre was $136,014 US. The mean costs attributable to ANC and delivery services were $23,063 US and $11,543 US respectively. Personnel accounted for the largest proportion of cost (45%). Overall, ANC (17%) and delivery (8%) were responsible for less than a quarter of the total cost of operating the health centres. By disaggregating the costs, the average recurrent cost was estimated at $127,475 US, representing 93.7% of the total cost. Even though maternal health services are free, utilization of these services at the health centres were low, particularly for delivery (49%), leading to high unit costs. The mean unit costs were $18 US for an ANC visit and $63 US for spontaneous delivery.ConclusionThe high unit costs reflect underutilization of the existing capacities of health centres and indicate the need to encourage patients to use health centres .The study provides useful information that could be used for cost effectiveness analyses of maternal and neonatal care interventions, as well as for policy makers to make appropriate decisions regarding the allocation and sustainability of health care resources.
Highlights
There is a paucity of knowledge on the cost of health care services in Ghana
This study aims to fill this crucial gap by examining the costs associated with running a health care centre as well as the specific costs associated with antenatal care (ANC) and delivery services
The costs attributed to ANC and delivery differ remarkably among the health centres, and the results show that the utilization rate for ANC was higher than for delivery at the health centres
Summary
There is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. The worldwide maternal mortality ratio (MMR), or the number of women who die during pregnancy and childbirth per 100,000 live births, declined from 299 in 1990 to 202 in 2011, representing a 1.9% average annual rate of decline. Given the limited health care resources in Ghana, coupled with the wide range of maternal and neonatal care (MNC) services provided free of charge for all women, efficient use of these resources is essential. Despite the need to maximize resources, few cost studies have been conducted in Ghana, and as a result there is little information on the costs of antenatal care (ANC) and delivery services
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