Abstract
BackgroundLittle is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG) targets the financial sustainability of such facilities is crucial.MethodsThe study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value). Sensitivity analysis was done using 3% discount rate.ResultsThe cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient.ConclusionThe cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase utilization, efficient planning, resource allocation and their optimum use. It also requires controlling variable costs and preventing any wastage of resources.
Highlights
Little is known about the cost recovery of primary health care facilities in Bangladesh
The direct service providers absorbed 77% of total personnel costs and the rest of the personnel costs were incurred for non-service providers (LTs, ward boy (WB), cook, night guard and accountant)
Fixed costs Space rent Capital items Supervision Total fixed costs Variable costs Personnel Training Drug Non-drug medical Non-drug non-medical Operational costs Pathological Total variable costs Total costs tient consultations played a significant role in increasing the overall cost recovery of the facility
Summary
Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Sixty percent of health care services occur in the private sector [10], an expansive network of primary, secondary and tertiary government health facilities exists. As a continuous commitment of investing in human capital development, BRAC opened static health facilities called Shushastha (good health) in 1995 in order to serve as a back up to BRAC's existing communitybased MNCH, tuberculosis and other health interventions through providing curative health services
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