Cost comparison between the existing package and an integrated core package of HIV/AIDS activities : a case study of Tambon Lor Health Center in Phayao Province

Abstract

This cross sectional study analyzes the cost of HIV/AIDS activities at the health center level that is nearest to people in the service area. The objective of this study is to identify the component costs, estimate cost of the existing package and then compare an improved integrated core package of HIV/AIDS activities to the existing package of HIV/AIDS activities. Integrated core package or essential health package can be defined as health care services that are considered important and that society decides should be provided to everyone. An integrated core package is modified from the existing package of HIV/AIDS activities by considering expert opinion, stakeholder or action groups authority, state of the art, national policy and guidelines. Values such as equity, quality, cost-effectiveness, or transparency underlie these concepts. The research was conducted to analyze cost to the provider including: 1) capital cost that clarified to cost of building, equipment, vehicle, and human capital, and 2) recurrent cost that clarified to labor cost and supply cost. Provider cost of the existing package and an integrated core package of HIV/AIDS activities are derived into five categories as follow; 1) palliative care, 2) MCH, 3) HHC or home visitation, 4) MIS and paperwork, and 5) health education and health promotion. In this study, the proportion of health personnel time, medical supply for HIV/AIDS is the real proportion. The proportion for other components such as building, equipment, vehicle, non-medical supply is a rough proportion obtained from number of HIV visits over number of total visits. The study shows that the total cost of the new package, total cost of all activities including improved HIV/AIDS activities is 10% higher than the existing health package. The total cost of an integrated core package for HIV/AIDS activities is 3.4 times higher than the existing package of HIV/AIDS activities. The cost of the HIV/AIDS package is 5% of the health package for an existing package and 16% for the new integrated core package. Some costs could be switched from the hospital to the health center. They are still financed by government. The real additional cost over the cost of an integrated health package is 1:10. The real additional cost of an integrated core package of HIV/AIDS activities is 1,093 Baht per PWA or 33 Baht per capita. The cost of the new health package is 358 Baht per capita. The proportion cost of HIV/AIDS activities over health package is 5% for an existing package rising to 10% for an integrated core package with real additional cost. The cost of the new package IS affordable and could be financed by the government.