Cost of delivering primary healthcare services through public sector in India

Background & objectives: Public health spending on primary healthcare has increased by four times (in real terms) over the last decade and continues to constitute more than half of the total public health expenditure. The present study estimated the cost of providing healthcare services at sub centre (SC) and primary health centre (PHC) level in four selected States of India. Methods: A total of 51 SCs and 33 PHCs were selected across the four States (Himachal Pradesh, Odisha, Kerala and Tamil Nadu) of India. The economic cost of delivering health services at these facilities was assessed using bottom-up costing methodology during the reference year of 2014-2015. The cost of capital items was annualized and allocation of shared resources was based on appropriate apportioning statistics. Results: The mean annual cost of providing health services at SC and PHC was ? 0.69 million (US$ 11,392) and ? 5.1 million (US$ 83,837), respectively. Nearly 3/4th and 2/3rd of this cost at the level of SC (74%) and PHC (63%) were spent on salaries. In terms of unit cost, the costs per antenatal care and postnatal care visit were ? 221 (173-276) and ? 333 (244-461), respectively, at SCs. Similarly, the costs of per patient outpatient consultation and per bed day hospitalization at PHC level were ? 121 (91-155) and ? 1168 (955-1468), respectively. Interpretation & conclusions: The cost estimates from the present study can be used in economic evaluations, assessing technical efficiency and also for providing valuable information during scale-up of health facilities.

Study on role of rural health training centre (RHTC) as a supporting component to a primary health care system for NRHM programme in district Muzaffarnagar (UP).

Background: The role of RHTC set up under MCI requirement of medical colleges is rising in implementation of NRHM phase 2 programme (2012 onwards); as private medical colleges are expanding in India and they can be an important supporter in public-private partnership for national health programmes. Objective of current study was to assess the role of rural health training centre as a supporting component to a primary health care system for NRHM programme. Methods: The present study was carried out by comparative evaluation of the rural health and training centre of a private medical college with a sub-centre (Muzaffarnagar) on key RCH services of NRHM: a) Family planning materials distribution, b) ANC services and c) Immunization services. Inclusion criteria: Proper ethical approval from both primary health care system and private medical college authorities were obtained for the study. Study design: Prospective evaluation based study on ANM in SC & SN in RHTC in NRHM programme for 1 year duration from 1st January 2013 to 31st December 2013. Data analysis: The statistical data was analysed by Epi-info version 7.1.3. Results: The ANC services, family planning services and immunization services delivered under NRHM programme was found to statistically significantly contributed (P <0.05) by SN of RHTC as compared to ANM of SC in area of Bilaspur, Muzaffarnagar (Uttar Pradesh). Conclusion: RHTC of a private medical college in Muzaffarnagar (UP) is significantly contributing and supporting in RCH services of NRHM programme for primary health care system. RHTC of medical colleges can be an asset for public private partnership in NRHM programme.