Cost analysis of the basic package, resource utilisation and financing of health services at Halley Stott Health Centre and Umbumbulu Clinic in KwaZulu-Natal.

OBJECTIVES: A cost analysis study compared the package of health services, costs, resource utilisation (drugs and staff) and financing mechanisms at Halley Stott Health Centre and Umbumbulu Clinic with those of other primary care providers in KwaZulu-Natal. Options identified were used to improve efficiency, resource allocations and financing of health services in KwaZulu-Natal.

DESIGN/OUTCOME MEASURES: The direct accounting method was used to calculate unit costs for the following cost centres--paediatrics and adult curative consultations, antenatal/postnatal care, family planning, the under-5s clinic and the mobile services. Staff efficiency was assessed using the Centre for Health Policy method based on workload estimates, while the International Network for the Rational Use of Drugs indicators were used to assess the efficiency of drug usage.

RESULTS: There was considerable variation in the package of services provided at all the health facilities; the average costs ranged from R5.94 to R134.76 and the unit costs ranged from R29.30 to R161.92 for curative care. The bulk of the resources (64-73%) were spent on personnel costs, providing mainly curative care. Under-utilisation of antenatal care, the under-5s clinic and paediatric consultations were reflected in reduced time utilisation and lower levels of staff efficiency, while family planning services were over-utilised, which reflected a relative staff shortage. The components of health services provided at the two health facilities exceeded those recommended by the World Bank.

CONCLUSIONS: Cost analysis has the potential to quantify staff and drug efficiency, facilitate resource allocation and improve health service efficiency. Defining the package of health services for each province contributes to the development of the nationally agreed basic package of health services, and enables managers and policy-makers to choose different options rationally, control costs, shift resources and achieve equity.