Research Reports on MFCM and MSc Projects

Abstract

This discussion describes how the techniques of cost efficiency and cost effectiveness were used in Botswana to help in choosing between alternative ways of delivering primary health care: by mobile air and land services or by static permanently staffed clinics. In 1973-74 the government spent about 7.50 pounds per capita on health care for people living less than 5 miles from a hospital; for the 50% of the population living more than 25 miles from a hospital and 10 miles from a clinic, the government spent only .90 pounds per capita. A mobile land service making monthly visits to communities extending into the Kalahari Desert, and air service using a Cessna 185 aircraft serving a similar area, and 4 fixed clinics were examined with regard to the cost efficiency and cost effectiveness of the delivery of primary health care. From January to June 1975, questionnaire was used to gather demographic particulars and details of diagnosis and treatment from patients seen by the services. Both capital and recurrent costs were obtained for fixed clinics as well as costs for 1 trip each by the mobile land and air services. To help to decide which patients were likely to have been diagnosed and treated effectively an outcome classification was agreed upon after discussions with several doctors. With regard to cost efficiency, the land mobile and fixed clinics were similar, while the air service was just over twice as expensive per patient contact. In regard to cost effectiveness, the cost of the fixed clinics was about 1/8 that of the land service and about 1/14 that of the air service, due almost totally to the larger proportion of patients seen at the fixed clinics where it was considered, due to continuous availability of care, that effective treatment was likely. The proportion of patients in whom effective care was thought to be likely when seen by the periodic mobile services was much smaller. All the patients contacted by the mobile services were seen by a doctor, but only a minority of patients were seen by a doctor at the fixed clinics only. During visits made by the mobile services very little preventive health care was carried out. If greater emphasis had been placed upon such preventive measures as immunization then the cost effectiveness of the mobile services could have been increased appreciably. The study findings suggest that mobile health services have a limited place in the delivery of primary care in Botswana. This is particularly true for services using aircraft. Fixed permanently staffed clinics are to be preferred mainly because they offer greater continuity of care.