In Search of a New Model for Rationalizing Primary Health Care System in Sri Lanka : Cost-Analysis of a Primary Health Care Unit

The Ministry of Health in Sri Lanka is currently examining the evidence for rationalizing primary level health care system in order to better address the socio-demographic and epidemiological transition challenges. The policy documents, Health Master Plan (2007-2016) and the Hospital Re-Categorization (2005) are important milestones and the policy implications are important in identifying a rational model. The “Samadigama” Primary Health Care (PHC) centre which was initiated as a post tsunami intervention providing care to a resettled community was used as a pilot intervention supporting the evidence for developing a comprehensive primary health care model for the country. This centre established in 2007 in the southern part of Sri Lanka, namely Hambantota district, and it is based on the classical Primary Care Concept in Taiwan. The study aimed to analyze the total cost and unit cost of “Samadigama” PHC Centre, considering a provider’s perspective. This centre is an integrated model providing both curative and preventive care services through one center at a primary level facility. The step-down technique was used to calculate the unit cost of each service department. The data was collected using secondary sources and observation method. Unit costs for out patient care, medical clinic, antenatal clinic, family planning clinic, dental clinic and traditional medicine clinic were calculated. The unit costs were relatively high due to relative underutilization of services which is attributed to lack of full-time staff. Extending the number of full-time staff and number of service hours is recommended as the projections show the unit costs will be reduced by 35% for out patient care, 75% for medical clinic, 9% for dental clinic, 9% for traditional medicine clinic and 1% for antenatal clinic and family planning clinic. This study could be a benchmark for future cost evaluation studies, and the costing information on unit costs could be used for future planning and budgeting exercises