Ameli Omid, Newbrander William
Tech-Serve Program, Management Sciences for Health, Kabul, Afghanistan.
Bull World Health Organ. 2008 Dec;86(12):920-8. doi: 10.2471/blt.08.053108.
To research the effects of changes in health service utilization and quality on the costs of the Basic Package of Health Services (BPHS) in 13 provinces of Afghanistan.
The study grouped data from 355 health facilities and more than 4000 health posts into 21 data points that represented 21 different nongovernmental organization contracts for service delivery between April 2006 and March 2007. Data were pooled from five data sets on expenditure, service utilization, quality (i.e. client satisfaction and the availability of essential medicines and female health-care providers), pharmaceuticals, and security and remoteness scores. Pearson's partial correlation and multiple linear regression models were used to examine correlations between expenditure and other study variables.
Fixed costs were found to comprise most of the cost of BPHS contracts. There was no correlation between cost and utilization rate or security. The distance to the health facility was negatively correlated with costs (R(2) = 0.855, F-significance < 0.001). The presence of female health workers, indicative of good quality in this cultural context, was negatively correlated with security (r = -0.70; P < 0.001). There was a significant correlation between the use of curative services and client satisfaction but not between the use of preventive services and client satisfaction (R(2) = 0.389 and 0.272 for two types of health facilities studied).
Access to health services can be extended through contracting mechanisms in a post-conflict state even in the presence of security problems. Service characteristics, geographical distance and the security situation failed to consistently explain, alone or in combination, the observed variations in per capita costs or visits. Therefore, using these parameters as the basis for planning does not necessarily lead to better resource allocation.
研究阿富汗13个省份卫生服务利用和质量的变化对基本卫生服务包（BPHS）成本的影响。
该研究将来自355个卫生机构和4000多个卫生站的数据分组为21个数据点，这些数据点代表了2006年4月至2007年3月期间21份不同的非政府组织服务提供合同。数据来自五个数据集，涉及支出、服务利用、质量（即客户满意度、基本药品供应和女性医疗服务提供者的可用性）、药品以及安全和偏远程度得分。使用皮尔逊偏相关和多元线性回归模型来检验支出与其他研究变量之间的相关性。
发现固定成本占BPHS合同成本的大部分。成本与利用率或安全性之间没有相关性。到卫生机构的距离与成本呈负相关（R² = 0.855，F显著性 < 0.001）。在这种文化背景下，女性卫生工作者的存在表明质量良好，但与安全性呈负相关（r = -0.70；P < 0.001）。治疗服务的使用与客户满意度之间存在显著相关性，但预防服务的使用与客户满意度之间不存在显著相关性（对于所研究的两种类型的卫生机构，R²分别为0.389和0.272）。
即使在存在安全问题的冲突后国家，也可以通过承包机制扩大卫生服务的可及性。服务特征、地理距离和安全状况单独或综合起来都未能始终如一地解释观察到的人均成本或就诊次数的变化。因此，以这些参数为规划基础不一定会导致更好的资源分配。
