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Indian Journal of Community Medicine

Letter to Editor
District Public Health Services: Cost-Benefit Analysis

Author(s): C Kannan

Vol. 32, No. 4 (2007-10 - 2007-12)

ISSN No. 0970-0218

Sir,
District public health services – cost-benefit analysis: “The basic needs concept is a reminder that the objective of the development effort is to provide all human beings with the opportunity for a full life” – Paul Streeton. Development assures the fulfilment of the needs of man and the society, individual and the economy, and citizen and the nation. Development warrants a high level of gross national product (GNP) and the attainment of the “highest standard of living”. Rapid economic growth has been shown to be dependent on human resources – health and education programmes that will boost the GNP. The hierarchy of goals of development may be shown in the form of a pyramid wherein at the base are basic minimum needs followed by economic and social necessities for bare subsistence. The fulfilment of these needs leads to a higher set of socio-political needs and ultimately to the goal of the full owering of human personality or “total development” and the release of the creative energies of every individual.

Cost Particulars

The data relate to the financial year 1995-1996 (01.04.05 to 31.03.06) for the public health services carried out by 32 primary health centres and 267 health sub-centres for the 13.4-lakh rural population of Kanyakumari district of Tamil Nadu.

The total expenditure on salary for 830 public health staff and non-salary items for the district was 4.48 crore. Rs. 25 lakh was the cost of drugs for the 32 primary health centres. The cost of vaccines supplied by the government was not readily available and I considered the value of vaccines at 8 lakh. The expense for doing 7601 tubectomy operations was put at Rs. 15.2 lakh at the rate of Rs. 200 per sterilization. The other expenses, which might have been left out were put at 50 lakh. Thus, the total cost was nearly 5.5 crore.

Benefit Particulars

Various programmes in curative, preventive and promotive sides are carried out through the primary health centres. For easy compilation, the following benefits were considered.

The number of mothers who got antenatal care including tetanus toxoid administration, natal care (only a few mothers, as most of them delivered in hospitals or nursing homes) and post-natal care was just above 30,000. The benefit for the above services for each mother was put at Rs. 100 and thus the total benefit was put at Rs. 30 lakh.

A total of 29,000 children got full immunization. The benefit for each child was put at Rs. 100 and thus the total benefit was put at Rs. 29 lakh consequently benefit under maternity and child health programme was put at Rs. 59 lakh.

Family Welfare Programme

It was presumed that by each equivalent sterilization, two children were avoided in the lifetime of each woman, who benefited from the family welfare programme.

A child should be given food, shelter, clothes, education and health care by their parents at least up to the age of 15 years. On an average, the monthly expense per child was put at Rs. 300 and yearly at Rs. 3600 and for 15 years at Rs. 54,000. By acceptance of sterilization and copper “T” the savings to every eligible couple was put at Rs. 108,000. The benefit to 9077 eligible couples was put at Rs. 98 crore. The savings to the nation by preventing 18,154 births was put at Rs. 20 crore, approximately Rs. 10,000 per child. Therefore, the total benefit under the family welfare programme was put at Rs. 116 crore

Table 1: Benefit details

Health programme/ intervention Number of beneficiaries Benefit (in rupees)
1. Benefit under family
welfare programme
7601 116 crore
a. Sterilizations done 4428
b. Copper T insertions
(equivalent sterilizations)
9077
2. Benefit for maternity and
child health programme
  0.59 crore
3. Benefit on curative side   0.72 crore
a. New cases 444,869
b. Old cases 561,332
c. Inpatients 2208
Total benefits from above
three programmes
  117.31 crore

For every new case, the benefit was put at Rs. 10 and for every old case, the benefit was put at Rs. 5. The benefit for the inpatients treated was excluded being small in number. Hence, the total benefit under curative side was put at Rs. 72 lakh.

Benefit-Cost Ratio

Benefit-Cost Ratio

For every rupee spent by the Government of Tamil Nadu, the benefit was Rs. 21 to the people of that district. Thus, Tamil Nadu health programme seems to be cost beneficial at the assumptions made in this study. The benefit will increase further when other preventive, promotive and curative services will be taken into consideration as expenditures on salary will remain the same.

C Kannan
Community Medicine Department, V.M.K.V. Medical College, Salem – 636 308, Tamil Nadu, India.
E-mail: ckannandr(at)yahoo.co.in
Received: 29.11.06
Accepted: 31.10.07

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