The cost of rural health services in Papua New Guinea

Abstract

In 1988 a countrywide study was conducted on the costs of rural health services in Papua New Guinea. 16% of all health centres and subcentres were surveyed. Information was collected on physical facilities, recurrent costs, staff time allocation, service outputs and quality of services. Wide variation was found in the costs of rural health facilities overall, and significant differences were found between the costs and outputs of health centres and subcentres. Average levels of service output were found to be similar at church and government facilities but average levels of utilization by the population were higher at church facilities. Despite government policy on extension of preventive health care, a strong emphasis was found on curative care. Many facilities were found to have significant excess bed capacity. Recurrent financing for transportation and maintenance was found to be inadequate.

PIP: The results of the Papua New Guinea (PNG) government study of rural health care services costs in 1988 are reported. The purpose of the study was to enable policy makers to change policy or management decisions which would improve operating efficiency. 76 rural health facilities were surveyed on expenditures and costs, distribution of costs, volume of services, and assessment of quality. The random sample was stratified by combination of health center or subcenter, road or no road access, and region (Papuan, Highlands, Momase, Islands). Staffing, financial, and output information was collected for calendar and fiscal 1987 and personnel allocation of time to programs was for year 1988. It was found that the average recurrent expenditures of the 38 health centers and 38 subcenters was K80,562 and K22,647, respectively. 60% went for salaries and 20% on pharmaceuticals. Health centers also maintained transportation vehicles which contributed to higher costs. The average recurrent cost for a health center (K116,139) was 3 times that of a subcenter (K33,991). Variations between costs and expenditures reflect imputed costs of building and equipment maintenance. A comparison of estimated required maintenance expenditure and actual maintenance expenditure showed that very little of the required is actually spent on maintenance. Approximately 20% of the capital construction cost for a rural facility are needed annually to cover the recurrent costs of operating the facility. Capital costs were 3 times higher at health centers and at subcenters. Availability of beds and utilization differed markedly, i.e., 40% had 10 in excess of their requirement. The unused capacity amounts to K34,000-48,400. A large % of capital and recurrent costs went to inpatient (27-30%) and outpatient (25-41%) care and administration (17-24%), while little went to child health (3-10%), maternal care (6-11%), disease control (0-2%), or aid post supervision (0-1%). 70% of government staff time was allocated to inpatient and outpatient care, with 15% allocated to children's and maternal services. Church health centers functioned with 20% devoted to child and maternal health; this attributed to great outreach. Average cost of health services by facility and type of output (inpatient day, discharge, outpatient visit, child health visit, maternal) were computed. Case mix and severity of illness were not determined, however, health centers had significantly higher scores (p=.01) on the quality index. Church-affiliated centers had higher scores and higher utilization rates than government-run centers. Future effort needs to focus on increasing utilization. Research is needed to assess why curative care is emphasized. Provincial units have begun to utilize the methodology to analyze their areas, and a training module has been completed.