Schnippel Kathryn, Lince-Deroche Naomi, van den Handel Theo, Molefi Seithati, Bruce Suann, Firnhaber Cynthia
Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Right to Care, Johannesburg, South Africa.
PLoS One. 2015 Mar 9;10(3):e0119236. doi: 10.1371/journal.pone.0119236. eCollection 2015.
Cervical cancer screening is a critical health service that is often unavailable to women in under-resourced settings. In order to expand access to this and other reproductive and primary health care services, a South African non-governmental organization established a van-based mobile clinic in two rural districts in South Africa. To inform policy and budgeting, we conducted a cost evaluation of this service delivery model.
The evaluation was retrospective (October 2012-September 2013 for one district and April-September 2013 for the second district) and conducted from a provider cost perspective. Services evaluated included cervical cancer screening, HIV counselling and testing, syndromic management of sexually transmitted infections (STIs), breast exams, provision of condoms, contraceptives, and general health education. Fixed costs, including vehicle purchase and conversion, equipment, operating costs and mobile clinic staffing, were collected from program records and public sector pricing information. The number of women accessing different services was multiplied by ingredients-based variable costs, reflecting the consumables required. All costs are reported in 2013 USD.
Fixed costs accounted for most of the total annual costs of the mobile clinics (85% and 94% for the two districts); the largest contributor to annual fixed costs was staff salaries. Average costs per patient were driven by the total number of patients seen, at $46.09 and $76.03 for the two districts. Variable costs for Pap smears were higher than for other services provided, and some services, such as breast exams and STI and tuberculosis symptoms screening, had no marginal cost.
Staffing costs are the largest component of providing mobile health services to rural communities. Yet, in remote areas where patient volumes do not exceed nursing staff capacity, incorporating multiple services within a cervical cancer screening program is an approach to potentially expand access to health care without added costs.
宫颈癌筛查是一项关键的医疗服务，但资源匮乏地区的女性往往无法获得。为了扩大获得这项及其他生殖和初级医疗服务的机会，南非的一个非政府组织在南非的两个农村地区设立了一辆基于货车的流动诊所。为了为政策制定和预算编制提供参考，我们对这种服务提供模式进行了成本评估。
评估是回顾性的（一个地区为2012年10月至2013年9月，第二个地区为2013年4月至9月），并从提供者成本的角度进行。评估的服务包括宫颈癌筛查、艾滋病毒咨询和检测、性传播感染（STIs）的症状管理、乳房检查、提供避孕套、避孕药具以及一般健康教育。固定成本，包括车辆购置和改装、设备、运营成本和流动诊所人员配备，从项目记录和公共部门定价信息中收集。获得不同服务的女性人数乘以基于成分的可变成本，反映所需消耗品。所有成本均以2013年美元报告。
固定成本占流动诊所年度总成本的大部分（两个地区分别为85%和94%）；年度固定成本的最大贡献者是员工工资。每个患者的平均成本由就诊患者总数驱动，两个地区分别为46.09美元和76.03美元。巴氏涂片检查的可变成本高于提供的其他服务，一些服务，如乳房检查以及性传播感染和结核病症状筛查，没有边际成本。
人员成本是向农村社区提供流动医疗服务的最大组成部分。然而，在患者数量不超过护理人员能力的偏远地区，在宫颈癌筛查项目中纳入多种服务是一种在不增加成本的情况下潜在扩大医疗服务可及性的方法。
