Cost Effectiveness of Primary Health Care

A Review of Evidence You do not have access to this content

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Michael F. Drummond, Anne Mills
01 Jan 1987
9781848594234 (PDF)
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  • Executive Summary

    Given that health care budgets in all countries are increasingly stretched in the face of competing demands, there is a pressing need for evidence on the cost and benefits of health care programmes. The objective of this project was to review the evidence on the costs, effects and benefits of key primary health care (PHC) projects, to analyse and to interpret the results of such projects, to report on the policy implications for ministries of health and to suggest further work that the Commonwealth Secretariat could undertake in this area.

  • Introduction

    All countries, no matter what their stage of economic development, face tough choices in how they allocate their scarce resources between competing activities. Public expenditure decisions, be they within or between Ministries, are made (and will continue to be made) as a result of a complex interplay of social, cultural, economic and political factors. However, given that budgets are increasingly stretched in the face of competing demands, there is a pressing need for evidence on the costs and benefits of public sector investments.

  • Review of Literature Relating to Economics of PHC Activities in Commonwealth Countries

    In this section the existing literature is reviewed and several general analytical points discussed. Studies are classified according to the eight essential elements of primary health care discussed in Section 1.2 above.

  • Case Studies of Major PHC Projects

    The debate over whether various health programmes should be delivered separately, as vertical programmes, or integrated through a general health service delivery system has continued for at least the last 30 years (Mills, 1983). It continues to be in the forefront of policy debates, with arguments over the integration within PHC of programmes such as malaria control, family planning, nutrition and immunization. In the late 1960s, the Narangwal project was set up to examine this and other issues.

  • Policy Issues

    The number of economic evaluations carried out in any one country is usually too small for outside observers to draw detailed conclusions on the value of investment in PHC as against investment in other areas of the health sector, though countries themselves can usually go some way towards assessing this issue by examining the relative costs of different interventions, even if they have little data on effects or benefits. Because international and national health policy makers over the last few years have been requiring evidence on the value of investment in PHC programmes and particular PHC activities, a number of reviews have been undertaken which attempt to synthesize the results of studies performed in a number of countries (Gwatkin et al, 1980; Grosse and Plessas, 1979; Phillips et al, 1985, Barlow and Grobar, 1986; Cochrane and Zachariah, 1983; Applied Communication Technology, 1985).

  • Recommendations

    Given the diverse nature of the countries in the Commonwealth it would be wrong to propose hard-and-fast rules for all. However, several general points have emerged from this review which could be considered to constitute guidance for health ministries. Obviously, such guidance may be ignored, either because it is inappropriate given local circumstances, or because it is already implicit in current policy.

  • References and Acknowledgements
  • Appendices
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