Contracting for health services: effects of utilization and quality on the costs of the Basic Package of Health Services in Afghanistan (original) (raw)
2008, Bulletin of the World Health Organization
Objective To research the effects of changes in health service utilization and quality on the costs of the Basic Package of Health Services (BPHS) in 13 provinces of Afghanistan. Methods The study grouped data from 355 health facilities and more than 4000 health posts into 21 data points that represented 21 different nongovernmental organization contracts for service delivery between April 2006 and March 2007. Data were pooled from five data sets on expenditure, service utilization, quality (i.e. client satisfaction and the availability of essential medicines and female health-care providers), pharmaceuticals, and security and remoteness scores. Pearson's partial correlation and multiple linear regression models were used to examine correlations between expenditure and other study variables. Findings Fixed costs were found to comprise most of the cost of BPHS contracts. There was no correlation between cost and utilization rate or security. The distance to the health facility was negatively correlated with costs (R ² = 0.855, F-significance < 0.001). The presence of female health workers, indicative of good quality in this cultural context, was negatively correlated with security (r : = -0.70; P < 0.001). There was a significant correlation between the use of curative services and client satisfaction but not between the use of preventive services and client satisfaction (R ² = 0.389 and 0.272 for two types of health facilities studied). Conclusion Access to health services can be extended through contracting mechanisms in a post-conflict state even in the presence of security problems. Neither the per capita cost nor the number of visits per capita appeared to be a good predictor of the cost of covering different population groups and geographical areas. Bulletin of the World Health Organization 2008;86:xxx-xxx. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. املقالة. لهذه الكامل النص نهاية يف الخالصة لهذه العربية الرتجمة
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