A cost analysis of rural primary health care (PHC) services in KwaZulu-Natal
It has been found that South Africa has very limited costing information of health services at both primary and higher levels of care. Therefore, a study was conducted in Ingwavuma health district, a rural setting in KZN, evaluating costs of primary health care (PHC) services. The primary objective of the study was to evaluate the costs of providing PHC services in a rural setting and to compare costs of providing PHC services at different levels of care. Costs data were collected through interview and record reviews from Manguzi hospital, a district hospital, and nine clinics operating within the hospital's catchment area. Cost comparisons between Manguzi clinics and between the clinic and hospital levels were undertaken. Variations in terms of costs between similar facilities (clinics) were discovered, with some clinics being more costly compared to others. Such variations can be explained by some input costs, e.g. personnel which varied considerably between facilities. Variations in the personnel costs between similar facilities were found to be linked with staff distribution patterns and facility utilisation. In addition, variations in terms of costs were also discovered between services provided within one facility. For instance, expenditure ﬁgures revealed that the largest proportion of resources was spent on curative services. Tuberculosis and mental health services consumed a minimum amount of resources, namely about 1%. Further comparison of Manguzi results with those of the Centre for Health Policy (CHP) was undertaken. Costs analyses of PHC services provided at Manguzi clinics with similar facilities compared to other sites. namely Agincourt (a rural setting), and Alexandra Health Centre (AHC) (an urban setting), were undertaken. Manguzi and Agincourt have similar costs of PHC services. However, AHC has relatively higher costs compared to the other two sites. This is probably because Manguzi and Agincourt are both rural. Finally, analysis on scaling-up PHC services in Manguzi to the essential package target of 3.5 utilisations per person per year shows that there would be no additional staff costs required. The current staffing levels in Manguzi seem to be sufficient to provide a comprehensive PHC package of 3.5 visits per person per year.
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