“‘Cost’ is the most important component in many of evaluations used for decision making in health care”
Taniya Tembo CIDRZ Costing Research Associate said this during the CIDRZ weekly research meeting when she presented results from a study on Time and Motion Study: Results from the CommART Baseline Assessment
The study was conducted in 10 control and intervention sites selected on the basis of epidemiologic,
economic, and operational characteristics to assess the importance of good costing during the costing of activities for the Community ART for Retention (CommART) project.
The CommART project was developed to find alternatives to problems in the scale-up of providing ART on an already over-stretched health care system and limited health infrastructure and decentralized ART models were found to potentially reduce cost of HIV care due to the reduced use of providers’ time and improve patient outcomes due to increased retention.
Cost-assessment under the CommART project was based on societal perspective using micro-costing method (both bottom up and top-down), quantification of different types of resources used for the HIV, treatment and care through identification of unit costs and multiplied quantities of resource used by respective unit costs.
Further components of the cost assessment included, patient costs such as opportunity costs (including waiting time), transportation to and from clinic, provider costs( cost of ARVs, labs, personnel, equipment, supplies & administrative costs), programme costs i.e. costs to set up the monitoring and evaluation framework, technical advice, staff meetings and trainings, and facility-level costs (calculation of amounts allocated to HIV care).
Data from the study was based on ART services such as counseling, pharmacy, laboratory and clinical visits.
The key cost parameters were analysed from two dimensions: Patients and healthy systems Parameters:
From a patient’s perspective, it included issues to do with lost productivity, lost wages due to illness and seeking care, out of pocket costs for each clinic visit, including repeat visits (drugs, tests, hospitalization among others). From a health system perspective, the study looked at costs of providing clinical services per patient visit and cost of evaluation, diagnosis, treatment and hospitalization.
The results revealed that on average patient waiting time to receive all the above services were 254 minutes in urban and 215 minutes in rural clinics per day respectively. The study also found that in terms of direct patient activities, Counselors spent 978 minutes, Pharmacy Technicians 298 minutes, Clinical Officers 302 minutes and Nurses 593 minutes on average per day.
The study concluded that good costing was important in standard treatment and introduction of new health interventions.
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