Costing of PHC (Primary Health Care) was the project funded by UNICEF (United Nations Children’s Fund), Nepal in collaboration with Kathmandu University School of Medical Sciences (KUSMS), the Ministry of Health and Population (MoHP), and various municipalities to define PHC taking into consideration the new federal structure which provisions local bodies (municipalities) to provide basic health services and they act as local governments who are in the position to prepare health policies and programs on their own.
We did a bottom-up approach to collect data from the different tiers of government. We conducted a desk work for the project and developed the PHC Investment case. Before proceeding further with the workshop at Municipalities we briefly conducted an induction/consultation meeting with the Dhulikhel municipality and its stakeholders to get an overall overview of the municipal structure for the health system and collected feedback and comments.
At the local level, we gathered information from three diverse municipalities: Dhulikhel Municipality, Birgunj Metropolitan, and Khadachakra Municipality which were selected on the basis of Geographical location, Population density, and Urban and rural setting. We conducted a two-day workshop with the active participation of different stakeholders of the health care system of the municipality to define the PHC package from the local providers’ perspectives, and the costing of primary health care services based on the seven major components prioritized in the investment case viz. Family planning/infertility/safe abortion, safe motherhood, adolescent health, communicable diseases, Non-Communicable diseases/ Mental health and Geriatric health, childhood and infancy, and disaster risk reduction and cost drivers were the major focus of the workshops. Additionally, we collected secondary data available at the municipality level and did a series of interviews with the key representatives of the municipality (Health Coordinator), PHC (Health Assistant), and ward representative (Ward Chairperson).
At the provincial level, the one-day provincial meeting was organized in the respective provinces of selected municipalities at Bagmati province-Hetauda, Madesh Province-Janakpur, and Karnali Province-Surkhet. In the provincial workshop, the issues raised at the local level and ways to improve the basic health care packages were discussed and conducted a workshop on a thematic basis.
Followed by the provincial workshop, a consultative national workshop has been organized with the participation of personnel from MoHP, different developmental partners, and health finance experts. The final report was prepared after the consultative national workshop by addressing the issues and comments raised by the participants.
The purpose of all these activities was to define the PHC package from the providers’ and beneficiaries’ perspectives and estimate the cost of the PHC package.
Costing of PHC
To estimate the cost of PHC we used the One Health Tool (OHT) while the Lives Saved Tool (LiST) was used to estimate the impact of coverage change on maternal and child mortalities. The estimation was done from the year 2020 to 2030.
Feedback from the health service providers at the local level revealed that the BHSP (Basic Health Service Package) needs to be upgraded and new interventions need to be added in order to address the existing health transition and demand for health care. It included disaster risk reduction and prevention of injuries including NCDS, adolescent health, geriatric and mental health.
As for the costing part, the per capita cost calculated for PHC is 11.5 USD for the year 2023 which will increase up to 15.8 USD by the year 2030. The major cost drivers are human resources, followed by infrastructure and program costs, etc. The costing by intervention packages shows that NCDs (Non – Communicable Diseases) and RMNCAH (Reproductive maternal, newborn, child, and adolescent health) account for more than two-thirds of the total program-wise costs.
This project was possible because of the following team members;
- Dr. Biraj Karmacharya (Lead)
- Dr. Reshu Agrawal Sangtani (Economist)
- Sudip Shrestha
- Bibek Raj Giri
- Suyasha Koirala
- Lisasha Poudel
- Bihari Sharan Kuikel
- Prasanna Rai