title: Cost of maternal health services in selected primary care centres in Ghana: a step down allocation approach.
abstract: BACKGROUND
  There is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. This study analysed the overall cost of providing health services in selected primary health centres and how much of the cost is attributed to the provision of antenatal and delivery services.
  
  
  METHODS
  The study has a cross-sectional design and quantitative data was collected between July and December 2010. Twelve government run primary health centres in the Kassena-Nankana and Builsa districts of Ghana were randomly selected for the study. All health-care related costs for the year 2010 were collected from a public service provider's perspective. The step-down allocation approach recommended by World Health Organization was used for the analysis.
  
  
  RESULTS
  The average annual cost of operating a health centre was $136,014 US. The mean costs attributable to ANC and delivery services were $23,063 US and $11,543 US respectively. Personnel accounted for the largest proportion of cost (45%). Overall, ANC (17%) and delivery (8%) were responsible for less than a quarter of the total cost of operating the health centres. By disaggregating the costs, the average recurrent cost was estimated at $127,475 US, representing 93.7% of the total cost. Even though maternal health services are free, utilization of these services at the health centres were low, particularly for delivery (49%), leading to high unit costs. The mean unit costs were $18 US for an ANC visit and $63 US for spontaneous delivery.
  
  
  CONCLUSIONS
  The high unit costs reflect underutilization of the existing capacities of health centres and indicate the need to encourage patients to use health centres .The study provides useful information that could be used for cost effectiveness analyses of maternal and neonatal care interventions, as well as for policy makers to make appropriate decisions regarding the allocation and sustainability of health care resources.
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany. madalaba@yahoo.com
authors.forename: Maxwell Ayindenaba
authors.initials: MA
authors.lastname: Dalaba
authors.forename: Patricia
authors.initials: P
authors.lastname: Akweongo
authors.forename: Germain
authors.initials: G
authors.lastname: Savadogo
authors.forename: Happiness
authors.initials: H
authors.lastname: Saronga
authors.forename: John
authors.initials: J
authors.lastname: Williams
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
authors.forename: Hengjin
authors.initials: H
authors.lastname: Dong
authors.forename: Svetla
authors.initials: S
authors.lastname: Loukanova
mesh_terms: D003365:Costs and Cost Analysis / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D005102:Health Expenditures; D006801:Humans; D008427:Maternal Health Services / Q000191:economics*; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics; D036301:Qualitative Research; D040841:Resource Allocation
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