Marseille 2007
| Abstract #427 - Home Community-Based Care (HCBC) Cost and Content of Services in Selected Districts of South Africa | ||||
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Session: 11.1: Cost (Parallel) on Monday @ 11.00-12.30 in HC Chaired by Eileen Stillwaggon, Didier Fassin Authors: Presenting Author: Dr Veni Naidu - Health Economist, South Africa |
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| Additional Authors: Mr Peter Fumulani Netshipale, Mrs Connie Kganakga, Mrs Johanna De Beer, Dr Jean-Francois Aguilera, | ||||
| Aim: In the context of the HIV/AIDS epidemic, reliance on HCBC in South Africa is greater to reduce the strain on the public health care system. Evaluation of cost and quality is essential to establishing efficiency of funded NPOs and for funding and planning purposes. We developed a protocol to monitor cost and quality of HCBC service delivery. | ||||
| Method / Issue: We conducted a literature review on cost analysis methods in HCBC programs. We censored HCBC programs in four districts and selected a random sample for cost analysis. Retrospective data were collected for a 12-month period via financial records, program documents and in-depth interviews. Financial and economic costs were considered from the provider perspective. The step-down costing methodology was used to apportion costs to individual services. | ||||
| Results / Comments: Costs per beneficiary, visit and hour of service were commonly used measures to account for efficiency. We identified 359 HCBC programs and selected 13 either funded or non-funded. Financial and economic findings included (1) clients/carer ratio ranged from 3 to 153 (mean=32), (2) time spent per visit depended on the type of visit and ranged from 20 minutes to 3 hours (mode=1 hour), (3) average annual number of visits per client ranged 3 to 118 (mean=39), and (4) yearly average cost of home visits per client ranged ZAR86 to 3,681 (mean=ZAR805). Due to large variances in cost and for comparison purpose, we estimated a standard yearly home visit service to cost ZAR500 per client. Similar variances in costs were found for other services such as the provision of meals, food parcels or day care. | ||||
| Discussion: The types, levels and cost of services provided by HCBC programs varied widely making comparisons between HCBC programs difficult. We plan to perform additional cost analysis using cost-quality index in selected funded NPOs to facilitate scale-up of HCBC services, improve fund allocation and identify NPOs support needs. | ||||
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