The health system costs of post abortion care in Tanzania.
Cost
Health system
Post abortion care
Tanzania
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
22 Jul 2021
22 Jul 2021
Historique:
received:
19
12
2020
accepted:
23
06
2021
entrez:
23
7
2021
pubmed:
24
7
2021
medline:
27
7
2021
Statut:
epublish
Résumé
Unsafe abortion is common in Tanzania. Currently, postabortion care (PAC) is legally provided, but there is little information on the national cost. We estimated the health system costs of offering PAC in Tanzania in 2018, at existing levels of care and when hypothetically expanded to meet all need. We employed a bottom-up costing methodology. Between October 2018 and February 2019, face-to-face interviews were conducted with facility administrators and PAC providers in a sample of 40 health facilities located across seven mainland regions and Zanzibar. We collected data on the direct and indirect cost of care, fees charged to patients, and costs incurred by patients for PAC supplies. Sensitivity analysis was used to explore the impact of uncertainty in the analysis. Overall, 3850 women received PAC at the study facilities in 2018. At the national level, 77,814 women received PAC, and the cost per patient was $58. The national health system cost for PAC provision at current levels totaled nearly $4.5 million. Meeting all need for PAC would increase costs to over $11 million. Public facilities bore the majority of PAC costs, and facilities recovered just 1% of costs through charges to patients. On average PAC patients incurred $7 in costs ($6.17 for fees plus $1.35 in supplies). Resources for health care are limited. While working to scale up access to PAC services to meet women's needs, Tanzanian policymakers should consider increasing access to contraception to prevent unintended pregnancies.
Sections du résumé
BACKGROUND
BACKGROUND
Unsafe abortion is common in Tanzania. Currently, postabortion care (PAC) is legally provided, but there is little information on the national cost. We estimated the health system costs of offering PAC in Tanzania in 2018, at existing levels of care and when hypothetically expanded to meet all need.
METHODS
METHODS
We employed a bottom-up costing methodology. Between October 2018 and February 2019, face-to-face interviews were conducted with facility administrators and PAC providers in a sample of 40 health facilities located across seven mainland regions and Zanzibar. We collected data on the direct and indirect cost of care, fees charged to patients, and costs incurred by patients for PAC supplies. Sensitivity analysis was used to explore the impact of uncertainty in the analysis.
RESULTS
RESULTS
Overall, 3850 women received PAC at the study facilities in 2018. At the national level, 77,814 women received PAC, and the cost per patient was $58. The national health system cost for PAC provision at current levels totaled nearly $4.5 million. Meeting all need for PAC would increase costs to over $11 million. Public facilities bore the majority of PAC costs, and facilities recovered just 1% of costs through charges to patients. On average PAC patients incurred $7 in costs ($6.17 for fees plus $1.35 in supplies).
CONCLUSIONS
CONCLUSIONS
Resources for health care are limited. While working to scale up access to PAC services to meet women's needs, Tanzanian policymakers should consider increasing access to contraception to prevent unintended pregnancies.
Identifiants
pubmed: 34294104
doi: 10.1186/s12913-021-06688-7
pii: 10.1186/s12913-021-06688-7
pmc: PMC8296742
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
720Informations de copyright
© 2021. The Author(s).
Références
Int Perspect Sex Reprod Health. 2013 Sep;39(3):114-23
pubmed: 24135043
Trop Med Int Health. 2008 Dec;13(12):1442-51
pubmed: 18983268
Sex Reprod Health Matters. 2020 Dec;28(2):1779631
pubmed: 32515666
Int Perspect Sex Reprod Health. 2013 Dec;39(4):174-84
pubmed: 24393723
Health Policy Plan. 2014 Jan;29(1):56-66
pubmed: 23274438
Health Policy Plan. 2015 Mar;30(2):223-33
pubmed: 24548846
Health Policy Plan. 2012 Mar;27 Suppl 1:i23-34
pubmed: 22388497
PLoS One. 2018 Aug 6;13(8):e0201833
pubmed: 30080875
Lancet Glob Health. 2014 Jun;2(6):e323-33
pubmed: 25103301
PLoS One. 2019 Apr 9;14(4):e0214807
pubmed: 30964909
Int Perspect Sex Reprod Health. 2020 Jun 24;46:99-112
pubmed: 32584778
PLoS One. 2015 Sep 11;10(9):e0133933
pubmed: 26361246
Int J Gynaecol Obstet. 2012 Sep;118 Suppl 2:S127-33
pubmed: 22920616
Glob Health Sci Pract. 2019 Aug 27;7(Suppl 2):S327-S341
pubmed: 31455628