How much does it cost to complete medical school? : evidence from cost analysis of Kabul Medical School

Background: Efficient and effective investments in developing human resources for health are essential. Kabul Medical University, a public institution, plays a pivotal role in producing and supporting high quality health workforce for Afghanistan’s health system. This report describes the first ever costing exercise of Kabul Medical University (KMU). The results intend to assist university managers and government to improve the efficiency of their programs by understanding the various costs associated with specific activities and faculties within the university. Methodology: Step-down Cost Accounting approach was used for generating costs and unit costs. Two cost centers were identified for apportioning costs: 1) Support Cost Center and 2) Service Cost Center. A Microsoft Excel spreadsheet was used to enter cost data and obtain estimations. Data were collected by HEFD over a period of 1.5 months in collaboration with KMU management. Findings: In 1390 (March 2011 – March 2012), the total cost of all faculties at KMU is $3,436,995 USD. The cost per student for each faculty include: $18,476 USD for Curative; $5,534 USD for Nursing; $1,199 USD for Public Health; and $16,543 USD for Stomatology. The largest proportion of costs for supporting cost center activities are attributed to administrative and supportive staff (26.1%), trainings (31.2%), and teaching hospitals (21.6%). The distribution of costs among teaching staff is highest among the latter classes. Conclusions: Based on this study, the majority of costs for 1390 (2012) went to the Curative faculty for services. Additionally, the majority of support costs went to training 19 teaching staff (donor supported) and salaries for administration and supportive staff. The Nursing and Stomatology faculties are largely skewed towards female students. At the same time, the proportion of women in Curative faculty is very low given the needs of female health workers, especially doctors, in the health sector. As the government moves towards a model of self-sustained financing, stronger financial accounting mechanisms are needed to ensure the appropriate use of public funds. This report serves as a baseline for KMU costs, which can now be monitored in the future in light of limited resources.