Costs of primary health care at the Alexandra Health Centre

This study provides a detailed analysis of costs and expenditure patterns at a primary health care centre serving an impoverished community of about 200000 people. Data were collected on costs and utilisation of services at the Alexandra Health Centre and University Clinic (AHC) for the financial year ending March 1990. Capital and running costs were kept separate. The sources of data collection were statistics routinely collected in the different sections of the clinic, the accounting records, staff duty rosters and a prospective study done to collect information to apportion drug costs and to calculate the cost of a prescription. The audited operating expenditure at AHC for the 1990 financial year was R3,9 million, or R4,45 million with donations (mainly drugs and staff). Sixty-three per cent of total costs went on staff, 16% on drugs and supplies, 9% on buildings, furniture and transport, 3% on laboratory services, 2% on security and 8% on other items. The outpatients department accounted for 57% of expenditure, the 24-hour unit 37% and the outreach section 6%. Looked at another way, 66% went on curative services, 32% on preventive and promotive (including 13% on maternity costs) services, and 2% on rehabilitation services. The average cost per visit to each of 14 services is presented. The cost of a visit to casualty is R38,85, to the antenatal clinic R18,65 and to the child health outreach programme for immunisation R6,67. The component costs of each visit are analysed. The major cost component of a consultation is usually clinical staff, and detailed staff allocations for each section are given. Reasons for some of the wide variations observed are then discussed. The costs of providing health at the AHC appear to be less than in either the private sector or similar public sector facilities.