COST OF PROVIDING SEXUALLY-TRANSMITTED DISEASE SERVICES IN BANGKOK

Objective: The main purpose of this study was to assess the economic c osts of sexually transmitted disease (STD) treatment and to identify o pportunities for sustaining Bangkok's STD clinics. Design: A cost anal ysis was used to assess the resources required to provide (i) STD serv ices, (ii) additional services at STD clinics during the evening, and (iii) outreach activities with commercial sex workers. The cost analys is included a review of opportunities to increase sustainability throu gh cost recovery and institutional restructuring. Results: The study r evealed that the cost of providing services does differ significantly across the five clinics analysed, with recurrent costs of day-clinic S TD care varying from US$13-37 per patient reached. An analysis of expa nded evening hours at STD clinics suggested that an investment of US$6 2 000 per year allowed an additional 2000 patients to receive STD trea tment and that evening hours appear to offer greater convenience to pa tients. It was also found that outreach activities initiated by the ST D clinics and carried out in brothels have been used inexpensively (US $0.20 per woman reached) to reach commercial sex workers with critical information on STDs, including HIV. An analysis of opportunities for cost recovery at public STD clinics indicated that although some resou rces can be recovered, government support will continue to be required . The cost recovery option believed to be most feasible for promoting sustainability was a proposed charge of US$2-4 for STD clinic attender s. This charge was projected to allow each clinic to recover between 1 1% and 22% of their recurrent costs. Conclusion: This study concluded that there are numerous opportunities for promoting the financial sust ainability of STD services at public clinics. It was also concluded th at the existing outreach program is extremely inexpensive and is reach ing people who are in need of the services that are being offered. How ever, this study was not able to determine if it would be worthwhile t o reopen public STD clinics during evening hours. (C) 1998 Lippincott Williams & Wilkins.