HOSPITAL OR HEALTH-CENTER - A COMPARISON OF THE COSTS AND QUALITY OF URBAN OUTPATIENT SERVICES IN MASERU, LESOTHO

Urban hospital outpatient clinics in developing countries are said to be overburdened and some policy experts are proposing a new intermedia te tier of advanced health centres between hospitals and health centre s to solve this problem (termed 'reference centres' by the World Healt h Organization). In Maseru, Lesotho, hospital congestion led the Minis try of Health to decide to build reference centres. To delineate preci sely how these centres should operate, research was carried out on the existing system comparing utilization, quality and cost between healt h centre and hospital outpatient care. The study showed that throughpu t per clinician at the hospital and the city health centres was simila r; that the hospital service saw a greater proportion of adults and mo re men; that the technical care quality was similar; and, that health centre staff took longer with patients and had higher interpersonal co nsultation scores. Average costs at the hospital were 39 per cent grea ter, but, the calculated net costs to the provider at the hospital and at government centres were very similar once user fees had been taken into account. The results questioned the assumptions underlying the d ecision to build reference centres in Maseru, and also the relevance o f a new tier to solve health service delivery problems in the city. Th e study highlights the need for national and municipal planners to exa mine carefully existing health services with respect to utilization, q uality and cost before adopting urban reference centres as a standard solution to congested hospitals.