The cost of clinical procedures performed in the maternity ward of Thebe District Hospital

[摘要] Background: Maternity services in South Africa like in many developing countriesremains a challenge. The high mortality and morbidity rates recorded in theconfidential enquiries to maternal death (CEMD) reports in South Africa support aneed for more studies to be done to improve maternal health services. Althoughclinical procedures are an integral part of the maternal health services, little is knownabout the current-status of clinical procedures performed in the maternity units ofdistrict hospitals and related resource utilisation. The apparently 'free” maternityservices at government hospitals involve substantial hidden and unpredicted costs,which is not quantified.Aims of the study: To describe the cost of the specific clinical proceduresperformed at the maternity unit of Thebe District Hospital.Methodology: This was a cross-sectional study design involving a retrospectiverecord review of all maternity patient records for a one-month period in 2009. Themonth of September is mid-month for the financial year and was chosen as it isreflected a stable month in terms of financial performance. The costing aspect of thisstudy was based on the National Health Reference Price List and UPFS. Data wasanalysed with NCSS software.Results: The study found that NVD was the main clinical procedures, which is in linewith the district hospital package. The CS rate was within acceptable norm but asignificant number of BBA is of concern and would require further exploration. Themajority of the patients who delivered at this unit are black, unemployed and had nomedical aid. Most of them arrived by ambulance although it was not clear whetherthese patients were coming directly from home or were referred by PHC clinics andCHCs. There were no maternal and perinatal mortality and morbidity during thestudy period.This study documented the direct cost of clinical procedures performed at a districthospital. The Human resources was the main cost driver. The calculated cost forthis study was far lower than the costs prescribed in NHRPL for NVD and CS buthigher than UPFS. This study highlighted the need for revising the UPFS. Conclusion: The research findings will inform the resource needs for performingspecified clinical procedures in maternity section at the Thebe District Hospital andwill hopefully be used as a benchmark for maternity sections at all district hospitals inThabo Mofutsanyana District and elsewhere. It has provided reasonable indicationsabout the costs of each procedure and evidence can be used to determine the costsof each procedure in various district hospitals in the country and worldwide. It canfurther be utilised to do proper planning for our district hospitals in the province anddevelop the scientific criteria for resource allocation.

[发布机构] University of the Witwatersrand