Cost analysis of integrated primary health care services in Pakistan

Primary health care is central to achieving Universal Health Coverage and better health outcomes; however, it requires adequate resources for effective implementation.

To estimate the cost of implementing an integrated primary health care package in Sindh Province, Pakistan.

We developed an integrated primary health care service package and standard treatment guidelines for each service provided at 12 basic health units across 4 districts of Sindh Province. We then collected and analysed cost and service volume data for the health units using the CORE Plus tool, under 3 service delivery scenarios.

Standard costs per service in health units that provided round-the-clock maternal care services decreased in scenarios 2 and 3 as service volumes increased, while standard costs did not decrease in health units that provided services for only 6 hours per day for 6 days a week. The average annual standard costs per 10 000 population in round-the-clock health units were US$ 38 315 for scenario 1, US$ 47 139 for scenario 2 and US$ 56 719 for scenario 3. For health units that provided services for only 6 hours per day for 6 days, the annual standard cost was US$ 22 800. Medicines, supplies and laboratory tests accounted for the highest proportion of the total costs, followed by staff salaries and operating costs. Staffing requirements increased for multiple roles.

Integrating services and analysing service costs regularly to align resources with care needs can help improve the cost-effectiveness of services at primary health centres.