An assessment of the costs of basic package of health services (BPHS) in Afghanistan

Objectives: To explore the costs of the BPHS at the health facility level to guide planning and coverage of the package in the coming years, particularly to: 1) understand major cost drivers; 2) compare cost variations; 3) inform decision making process about resource allocation.

Methodology: Using data compiled from July 1, 2010 – June 30, 2011, this study samples 11 provinces and costs service provision in 484 health facilities. The sample represents approximately 27 percent of all BPHS health facilities in Afghanistan and covers 29 percent of the total population.

Results: The total BPHS operating costs across the 11 provinces were USD 30,110,549. This represented an average per capita cost of USD 4.17, ranging from USD 2.43 (Ghazni) to USD 5.93 (Bamyan). The differences in BPHS costs across the provinces were significant (p< 0.001). Salaries and wages comprise the largest share of BPHS costs (40 percent) followed by other operational expenses (21 percent) and drugs and disposables (21 percent).

Conclusions: Findings from this study reveal several interesting trends across geographic clusters, rural and urban locations, and BPHS facilities. The results point to the importance of capturing major cost-drivers within BPHS facilities across Afghanistan. This information could help decision-makers understand how much is being spent on BPHS and how much more will be required in the future as health priorities change. Moreover, this study could support the preparation of county-level service delivery plans and budgets planning as well as assisting the coordination and harmonization of external assistance.