The cost of sustaining the Ghana's "Cash and Carry" system of health care financing at a rural health centre.

This paper investigates the sudden fall in clinic attendance at a rural health centre. The pressure to sustain the cash and carry system of procuring drugs is being blamed for over prescription, inconsistent pricing of prescriptions and subsequent fall in clinic attendance. The clinic attendance which was dropping since the introduction of fee-for-service (1985) has now dropped sharply to about 25% after the implementation of the Cash and Carry system (1990). Yet, the average revenue generated per patient has jumped from 201 cedis in 1990 to 348 cedis in 1992. Analysis of the prescription pattern for malaria infection showed that 56% and 89% of patients received injections or were given three or more drugs in the free health service period and in the fee-for-service period respectively. Prescriptions which contained injections or more than three items yielded between 120% and 200% profit to the Health Centre compared to a profit of 60% if only chloroquine and analgesics were prescribed. Consumptions of drugs by staff and non paying patients amounted to about 10% of the revenue generated from the paying patients. It is suggested that, at the health centre level, mechanism for pricing of prescriptions to patients must be reviewed, since motivation for profit could influence the management of diseases and also the use of health facilities. Secondly, refund for drugs consumed by staff and non-paying patients must be recovered in order to remove undue pressure to make profit.