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 ß 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
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
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 ß 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
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