Abstract

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.

Highlights

  • There is dearth of evidence on provider cost of contracted out services for Maternal and Newborn Health (MNH)

  • Little attention has been paid to costing of contracted out services, for Maternal and Newborn Health (MNH) services, and the evidence base is weak for policy makers to estimate resources required for scaling up contracting

  • The average cost for the actual volumes is based on the actual mix of MNH services provided, whereas the average cost for the projected volumes is based on the service mix according to the package of MNH services to be received by every mother according to the MNCH national treatment guidelines, which incorporate the WHO recommended package of MNH services [17]

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Summary

Introduction

There is dearth of evidence on provider cost of contracted out services 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. Little attention has been paid to costing of contracted out services, for Maternal and Newborn Health (MNH) services, and the evidence base is weak for policy makers to estimate resources required for scaling up contracting. The objective of this study was to ascertain unit costs and distribution of expenditures at contracted out RHCs in remote rural settings for the actual volumes of MNH services provided in year 2011, and for the estimated higher volumes of services needed by the catchment population. The knowledge generated through this study will enable policy makers to develop optimal resource envelopes and set performance targets for contracting out MNH services in order to accelerate progress towards achieving Millennium Development Goals (MDGs) 4 and 5

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