WHAT DOES PRIMARY HEALTH-CARE COST AND CAN WE AFFORD TO FIND OUT - RATIONALE AND METHODOLOGY FOR A COST-ANALYSIS OF THE DIEPKLOOF-COMMUNITY-HEALTH-CENTER, SOWETO

Accurate information on the costs of providing primary health care (PH C) services is now an urgent priority for health policy makers and pla nners, if the Government's stated commitment to an adequate PHC system is to be realised. Cost information is also a critical management too l for both public and private sector providers. In this context, the i nability of public sector PHC providers to generate accurate cost acco unting information is a serious shortcoming. In an attempt to address this lack of local PHC cost data, a detailed analysis of the costs of PHC services was undertaken at the Diepkloof Community Health Centre ( DK) in Soweto during 1990. The study aimed to assess the cost of each service provided at DK and where possible, to identify areas of ineffi ciency.This paper is the first of two that report the findings of this study. It briefly describes the methodology employed and presents the major results. These raise several important management issues. Most importantly, the study suggests that there is excess capacity in the a dministrative and in several of the clinical areas of this community h ealth centre; this implies that the average cost per service could be reduced in several areas. Certain services, such as home visits, are p articularly expensive and require careful evaluation. The policy impli cations of this analysis are also examined. The high cost of several s ervices implies that extension of this type of PHC service to all urba n and rural areas is likely to be unaffordable. The limitations of gen eralisations based on data from one health care setting are recognised , as are the effects of possible improvements in efficiency and econom ies of scale on these conclusions. The relatively high costs of this s etting also suggest comparisons with other PHC settings. Tentative com parisons with other public and private sector settings are given. The absence of comparisons of quality of care and outcomes between setting s, means that such comparisons should be made with caution. The paper also examines the cost of this kind of research and speculates on its benefits.