Evaluating the costs, work patterns and efficiency (CORE) of comprehensive primary healthcare (CPHC) in India (The CPHC CORE study): a top-down micro-costing study protocol.

INTRODUCTION

Primary healthcare is broadly acknowledged as the cornerstone of any strategy aimed at achieving Universal Health Coverage (UHC). This study aims to evaluate the costs, work patterns and efficiency of comprehensive primary healthcare (CPHC) in India.

METHODS AND ANALYSIS

We will use a top-down microcosting approach to estimate the economic cost of services delivered at the primary healthcare facilities in India. A multistage stratified random sampling approach will be applied to select the primary healthcare facilities (AAMs), formerly Health and Wellness Centres (HWCs). First, states will be selected based on key supply-side and demand-side healthcare indicators. Second, two districts will be chosen in each state based on advanced functionality criteria of AAMs. Finally, AAM-subhealth centres (SHCs) and AAM-primary health centres (PHCs) will be randomly selected within each district, implying a total of 48 SHCs and 24 PHCs. Data on both quantity and prices of capital (such as space, building, equipment and furniture) and recurrent resources (including salaries, medicines, consumables, stationery and overheads) used for delivering primary healthcare services during the period from April 2022 to March 2023 will be collected. All costs will be reported in current India Rupees (₹) and US Dollar (USD) ($) at an exchange rate of $1 = ₹86. A time and motion study will be undertaken to collect data from a total of 48 Community Health Officers (CHOs) and 48 auxiliary nurse midwives (ANMs) over a period of 6 days. This will be complemented by interviews to ascertain time spent on various services and activities. The data will be analysed to derive the annual cost of delivering CPHC services at an AAM, unit cost of individual services as a part of the 12 CPHC packages, as well as time spent by the healthcare workers (CHO and ANM) on various activities and services. Finally, a data envelopment analysis will be used to assess the level of technical efficiency in delivering primary healthcare services. The evidence on cost generated through the study will be useful for decisions related to better planning of healthcare services by aligning the work pattern to desired goals, efficient resource allocation, as well as future research on cost-effectiveness and benefit incidence over health accounts of primary healthcare services.

ETHICS AND DISSEMINATION

The study has been approved by the Institute Ethics Committee of the Post Graduate Institute of Medical Education and Research, Chandigarh, India vide IEC no: PGI/IEC/2023/EIC000588. The study results will be published in peer-reviewed journals and presented to the policymakers at the national level. Furthermore, the cost estimates generated by the study will be integrated into the National Health System Cost Database for India, providing information to policymakers and researchers.