UCOS CostingStudy, HondurasAlfonso Rosales MD, MPH-TM email@example.com CORE Group Spring Meeting, Washington DC, May 2012
Background: Innovations– define and standardize the role of communities in order to increase institutional deliveries and strengthen CB obstetric and neonatal care within a national decentralization strategy;– create self-sustaining CB health units (UCOS) which integrate vertical Ministry of Health (MOH) programs and various cadres of volunteers; and– adapt and implement CB continuous quality improvement (CQI) systems for UCOS.
UCOS Costing StudyOverall objective: to determine overall serviceimplementation costsAdditional objectives: – comparison of costing of health service delivery for children under 5 between services delivered at community level (health volunteer) and health facility (nurse or doctor); – and determine out-of-pocket expenses for families receiving health-related services at various delivery points.
Methods – Cost Analysis study • Key informant interviews to health and volunteer personnel of all service distribution points, • survey of mothers of children under- 5 years of age • triangulation with other sources of information such as health facility and UCOS (community health units) registers of patients and their estimated service delivery costs according to market values.Category of cost Recurrent cost Capital costDIRECT Personnel, drugs and lab, Land, building, equipment transportation, communications, materialINDIRECT (user) Transportation, food, drugs, consult fee, time, diagnosis-cost
ResultsThe average cost for implementing one UCOS in the department ofFrancisco Morazán, Honduras is US $5,530; where 98.6% arerecurrent costs and 1.4% are capital costs Average cost per beneficiary is US $ 8.02 and $ 1,843 per community.
Results: Maternal and newborn delivery servicesthe lowest cost was found at the community level, which is38 times lower that the most costly service-private hospitalservice, and almost 11 times lower than the next providerlevel-maternal and child clinic.
Results: Maternal and newborn delivery services
Results: Maternal and newborn delivery services In terms of cost-saving to household expenditure on normal deliveries, home delivery is 85% less expensive to the household when compared to the nextlevel of service (maternal-child clinic), and almost three-time lower when delivery occurs at a hospital ($31, $58, and $87 respectively).
Figure 1. Maternal and newborn delivery servicesNormal delivery cost by point of delivery: Honduras GNI $1,880 Home delivery: $31 (WB, 2010) Health Expenditure perMaternal-Child Clinic:$58 capita: $177 (WHO, 2008) Hospital: $87 Lepaterique GNI $1,470 (UNDP, 2006) 6 per cent of GNI
Results: Under-5 delivery services Households covered by UCOS services had on average savings of US $7.81 per child-case when having services rendered by UCOS in comparison to services rendered by a government health post (CESAR), and US $9.86 when compared to services rendered by a MOH health center (CESAMO).
Under-5 delivery services: out-of-pocketexpenses by component Food Other 1% 2% Other 12% Transport 25% Time Food 31% 19% drugs 66% Time Drugs 24% UCOS 20%MOH Services