Estimating the Cost of Primary Healthcare Delivery in Ghana: Evidence from a Three-year Study of Seven Districts in Northern Ghana

Abstract

Background: Over the past two decades, Ghana has developed a comprehensive community-based primary healthcare services program as its flagship strategy for achieving universal access to healthcare. However, there is paucity of knowledge on the cost burden of delivering these services so as to enhance efficient allocation of resources, planning, budgeting and forecasting. This paper provides a cost analysis of primary healthcare services in seven rural districts of northern Ghana. Methods: Cost data form public primary healthcare facilities from seven districts in the Upper East region of Ghana were systematically collected over a three-year period. Adapting five health system building blocks as analytical cost components, we computed the unit cost, total cost and per capita cost of primary healthcare service delivery. Results of both financial and economic cost are presented. Internally generated funds and the quantum of cost recovered over the study period were also examined. Results: The financial cost of primary healthcare delivery was ~$11 per capita and that of economic cost was ~$10 per capita per year. There was not much difference in per capita cost over the three-year study period. Human resource was the highest cost component accounting for about 77% of cost, followed by medicines (13.4%), service delivery (8.0%), leadership (0.9%) and health information cost (0.6%). Only 23% of cost was recovered through internally generated funds. Conclusion: The per capita cost of delivering community-based primary healthcare services in Ghana is substantially low. Human resource is the highest cost component of primary healthcare delivery in Ghana. Internally generated funds amounted to only a small fraction relative to cost incurred. This raises issues of self-sustainability and depicts the continuous huge dependence on government and external donor support.