Costing of Malaria treatment in a rural district hospital

Objective: It is the aim of this paper to estimate the provider’s cost of treating paediatric cases of Malaria in a rural African hospital. Furthermore, we intend to give some insights into the possibilities of improving the efficiency of treating children with this disease in order to support policy makers in the resource allocation process. Methods: The cost analysis was done in the district hospital of Nouna, Burkina Faso. Based on a comprehensive cost-of-illness information system, the cost of treating paediatric Malaria in the district hospital in the year 2005 were estimated using a combination of topdown and activity-based costing. It divides the entire treatment process into a set of activities along the clinical pathway and allocates monetary values for the resource consumption to each activity. Results: The average actual provider’s cost were 6.74 US$ for a paediatric outpatient with Malaria, 61.08 US$ for a paediatric Malaria inpatient with anaemia and, respectively 74.29 US$ for a case of paediatric Malaria with neurological affection. 54% of the cost was due to laboratory work. This high unit cost was mainly due to a severe underutilisation of the hospital capacity. The current cost recovery rate per case was between 18% and 43%. It would be between 32% and 73% if the occupancy increased to 80%. Conclusion: The paper demonstrates that detailed costing is possible in a district hospital in rural Africa. The unit cost seems to be extra-ordinary high and the share of laboratory cost is tremendous. However, this is mainly due to a very strong underutilisation of the existing capacities. This fact calls for intensive efforts of the management of the institution to attract more patients by improving the quality of services and in particular the satisfaction of the patients.