Productivity Analysis Using Actual and Normative Cost Data

Collins, David W.; Kagubare, J

doi:10.1142/9789811212413_0012

Cited by 4 publications

(6 citation statements)

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“…Even if the study limitations make the study results more indicative than definitive ( 29 ), they serve as an important baseline for understanding current investment in PHC in Nigeria. For more comprehensive insight into the costs and service provision of PHC in Nigeria, additional data collection would be beneficial.…”

Section: Discussionmentioning

confidence: 99%

“…Actual costs are calculated using data collected from a sample of health facilities which are expanded to the universe of facilities in the geographic area of interest. Normative costs represent the resources essential for efficient, quality service delivery ( 29 ). Normative costs are calculated using standard treatment protocols (STPs) developed for all services in a PHC service package, with the estimated populations in need of each service based on population size and expected service provision given estimated disease incidence and prevalence rates as well as utilization rates for promotional and preventive services.…”

Section: Methodsmentioning

confidence: 99%

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An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

Ogundeji,

Abubakar,

Ezeh

et al. 2023

Front. Public Health

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IntroductionThe availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states.MethodsWe collected primary data from 50 health facilities (25 per state), including PHC facilities—health posts, health clinics, health centers—and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider’s perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state.ResultsWe found that average actual PHC costs per capita at PHC facilities—where most PHC services should be provided according to government guidelines—ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals—where approximately a third of PHC services are delivered in both states—the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano.DiscussionBridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

Ogundeji,

Abubakar,

Ezeh

et al. 2023

Front. Public Health

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“…Actual costs are calculated using data gathered from a sample of health facilities which are extrapolated to the entire universe of facilities in the area of interest. Normative costs represent the resources needed to provide the services with reasonable quality and efficiency ( 19 ). Normative costs are estimated using standard treatment protocols (STPs) for each health service and intervention ( 21 ) in the PHC package, with the estimated populations in need for each service based on the population size (reported by sub-counties) and expected service need given estimated rate of disease incidence and prevalence as well as utilization rates for promotional and preventive services.…”

Section: Methodsmentioning

confidence: 99%

“…To guide the implementation of these governmental reforms, evidence is needed on current PHC utilization and costs, as well as the expected costs for ensuring universal coverage of high-quality PHC services. Generating evidence based on resource needs, as opposed to historical utilization (which may reflect resource constraints), can facilitate sufficient resource mobilization and inform priority setting ( 19 ) by national and county governments as well as development partners. This study sought to estimate the primary care service delivery costs in public sector primary care facilities in six counties.…”

Section: Introductionmentioning

confidence: 99%

The costs and financing needs of delivering Kenya’s primary health care service package

Olago,

Suharlim,

Hussein

et al. 2023

Front. Public Health

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IntroductionFor many Kenyans, high-quality primary health care (PHC) services remain unavailable, inaccessible, or unaffordable. To address these challenges, the Government of Kenya has committed to strengthening the country’s PHC system by introducing a comprehensive package of PHC services and promoting the efficient use of existing resources through its primary care network approach. Our study estimated the costs of delivering PHC services in public sector facilities in seven sub-counties, comparing actual costs to normative costs of delivering Kenya’s PHC package and determining the corresponding financial resource gap to achieving universal coverage.MethodsWe collected primary data from a sample of 71 facilities, including dispensaries, health centers, and sub-county hospitals. Data on facility-level recurrent costs were collected retrospectively for 1 year (2018–2019) to estimate economic costs from the public sector perspective. Total actual costs from the sampled facilities were extrapolated using service utilization data from the Kenya Health Information System for the universe of facilities to obtain sub-county and national PHC cost estimates. Normative costs were estimated based on standard treatment protocols and the populations in need of PHC in each sub-county.Results and discussionThe average actual PHC cost per capita ranged from US$ 9.3 in Ganze sub-county to US$ 47.2 in Mukurweini while the normative cost per capita ranged from US$ 31.8 in Ganze to US$ 42.4 in Kibwezi West. With the exception of Mukurweini (where there was no financial resource gap), closing the resource gap would require significant increases in PHC expenditures and/or improvements to increase the efficiency of PHC service delivery such as improved staff distribution, increased demand for services and patient loads per clinical staff, and reduced bypass to higher level facilities. This study offers valuable evidence on sub-national cost variations and resource requirements to guide the implementation of the government’s PHC reforms and resource mobilization efforts.

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“…Normative costing is important to identify the resources needed as opposed to historical costs that can be constrained by funding limitations, supply issues, or allocation problems. 21 …”

Section: Methodsmentioning

confidence: 99%

Calculating the Costs of Implementing Integrated Packages of Community Health Services: Methods, Experiences, and Results From 6 sub-Saharan African Countries

Collins,

Griffiths,

Birse

et al. 2023

Glob Health Sci Pract

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Productivity Analysis Using Actual and Normative Cost Data

Cited by 4 publications

References 0 publications

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

The costs and financing needs of delivering Kenya’s primary health care service package

Calculating the Costs of Implementing Integrated Packages of Community Health Services: Methods, Experiences, and Results From 6 sub-Saharan African Countries

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