TY - JOUR
T1 - Costing essential services package provided by a non-governmental organization network in Bangladesh
AU - Zeng, Wu
AU - Halasa, Yara A.
AU - Cros, Marion
AU - Akhter, Halida
AU - Nandakumar, Allyala Krishna
AU - Shepard, Donald S.
N1 - Funding Information:
This study was supported by USAID/DFID-funded NGO Health Service Delivery Project (NHSDP). H.A. is an employee of NHSDP. She helped data collection and study coordination, but was not responsible for the study design or conclusions.
Funding Information:
Jointly funded by the United States Agency for International Development (USAID) and the United Kingdom Department for International Development (DFID), the NGO Health Service Delivery Project (NHSDP) supports the delivery of primary health care through a nationwide network of NGOs and NGO-supported clinics—Smiling Sun network. This network consists of 25 NGOs, attracting and providing health services to those who can pay while simultaneously extending its reach to the poor. Currently, the project has a network of 388 static clinics, 10 252 satellite clinics, and 7638 community service providers (CSPs) in all 64 districts of Bangladesh, serving ~25 million populations, accounting for nearly 16% of total population of 159 million in 2014.1
Publisher Copyright:
© The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - The health profile of Bangladesh has improved remarkably, yet gaps in delivering quality health care remain. In response to the need for evidence to quantify resources for providing health services in Bangladesh, this study estimates unit costs of providing the essential services package (ESP) in the not-for-profit sector. This study used a stratified sampling approach to select 18 static clinics, which had fixed facilities, from 330 non-profit clinics under Smiling Sun network in Bangladesh. Costs were estimated from the providers' perspective, using both top-down and bottom-up methods, from July 2014 to June 2015. In total, there were 1115 observations (clients) for the 13 primary care services analysed. The estimated 2015 average costs per visit were: Antenatal care ($7.03), postnatal care ($4.57), control of diarrheal diseases ($1.32), acute respiratory infection ($1.53), integrated management of child illness ($2.02), sexually transmitted infections ($4.70), reproductive tract infections ($3.56), tuberculosis ($41.65), limited curative care ($4.30), immunization ($2.23), family planning ($0.72), births by normal delivery ($29.45) and C-section ($114.83). Unit costs varied widely for each service, both between individual patients and among clinic level means. The coefficient of variation for the 13 services averaged 66%, implying potential inefficiencies. In addition, 32.9% of clients were not offered any lab test during the first antenatal visit. The unit cost of essential services differed by the type and location of clinics. Ultra clinics, on average, incurred 37% higher costs than vital (outpatient type) clinics, and urban clinics spent 40% more than rural clinics to deliver a unit of service. The study suggests that inefficiency and quality concerns exist in health service delivery in some facilities. Increasing the volume of clients through demand-side mechanisms and standardization of services would help address those concerns. Unit costs of services provide essential information for estimating resource needs for scaling up the ESPs.
AB - The health profile of Bangladesh has improved remarkably, yet gaps in delivering quality health care remain. In response to the need for evidence to quantify resources for providing health services in Bangladesh, this study estimates unit costs of providing the essential services package (ESP) in the not-for-profit sector. This study used a stratified sampling approach to select 18 static clinics, which had fixed facilities, from 330 non-profit clinics under Smiling Sun network in Bangladesh. Costs were estimated from the providers' perspective, using both top-down and bottom-up methods, from July 2014 to June 2015. In total, there were 1115 observations (clients) for the 13 primary care services analysed. The estimated 2015 average costs per visit were: Antenatal care ($7.03), postnatal care ($4.57), control of diarrheal diseases ($1.32), acute respiratory infection ($1.53), integrated management of child illness ($2.02), sexually transmitted infections ($4.70), reproductive tract infections ($3.56), tuberculosis ($41.65), limited curative care ($4.30), immunization ($2.23), family planning ($0.72), births by normal delivery ($29.45) and C-section ($114.83). Unit costs varied widely for each service, both between individual patients and among clinic level means. The coefficient of variation for the 13 services averaged 66%, implying potential inefficiencies. In addition, 32.9% of clients were not offered any lab test during the first antenatal visit. The unit cost of essential services differed by the type and location of clinics. Ultra clinics, on average, incurred 37% higher costs than vital (outpatient type) clinics, and urban clinics spent 40% more than rural clinics to deliver a unit of service. The study suggests that inefficiency and quality concerns exist in health service delivery in some facilities. Increasing the volume of clients through demand-side mechanisms and standardization of services would help address those concerns. Unit costs of services provide essential information for estimating resource needs for scaling up the ESPs.
KW - Bangladesh
KW - Costing
KW - essential services package
KW - maternal and child services
KW - unit cost
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U2 - 10.1093/heapol/czx105
DO - 10.1093/heapol/czx105
M3 - Article
C2 - 28973120
AN - SCOPUS:85040691046
SN - 0268-1080
VL - 32
SP - 1375
EP - 1385
JO - Health policy and planning
JF - Health policy and planning
IS - 10
ER -