Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jun 9:8:12.
doi: 10.1186/1478-7547-8-12.

Cost recovery of NGO primary health care facilities: a case study in Bangladesh

Khurshid Alam  1 , Shakil Ahmed
Affiliations

Cost recovery of NGO primary health care facilities: a case study in Bangladesh

Khurshid Alam et al. Cost Eff Resour Alloc. .

Abstract

Background: Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG) targets the financial sustainability of such facilities is crucial.

Methods: The study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value). Sensitivity analysis was done using 3% discount rate.

Results: The cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient.

Conclusion: The cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase utilization, efficient planning, resource allocation and their optimum use. It also requires controlling variable costs and preventing any wastage of resources.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Total costs of BRAC Shushastha, July 2004-June 2005.
Figure 2
Figure 2
IPD income and utilization of BRAC Shushastha, July 2004-June 2005.
Figure 3
Figure 3
OPD income and utilization of BRAC Shushastha, July 2004-June 2005.
See this image and copyright information in PMC

References

    1. MHHDC. Human Development in South Asia 2004: The Health Challenge. Islamabad: Oxford University Press; 2005.
    1. Lawn JE, Rohde J, Rifkin S, Were M, Paul VK, Chopra M. Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise. The Lancet. 2008;8:917–927. doi: 10.1016/S0140-6736(08)61402-6. - DOI - PubMed
    1. Lewin S, Lavis JN, Oxman AD, Bastías G, Chopra M, Ciapponi A, Flottorp S, Martí SG, Pantoja T, Rada G. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. The Lancet. 2008;8:928–939. doi: 10.1016/S0140-6736(08)61403-8. - DOI - PubMed
    1. Walley J, Lawn JE, Tinker A, De Francisco A, Chopra M, Rudan I, Bhutta ZA, Black RE. Primary health care: making Alma-Ata a reality. The Lancet. 2008;8:1001–1007. doi: 10.1016/S0140-6736(08)61409-9. - DOI - PubMed
    1. Bangladesh Health Watch 2006. Bangladesh Health Watch Report: The State of Health in Bangladesh 2006: Challenges of Achieving Equity in Health. Dhaka: BRAC University James P. Grant School of Public Health;

LinkOut - more resources