@phdthesis{Kone2011,
  author    = {Insa Kon{\´e}},
  title     = {Costing of hospital services in rural sub-Saharan Africa - The case of Nouna district hospital, Burkina Faso},
  journal    = {Kostenanalyse von Krankenhausleistungen im l{\"a}ndlichen Afrika s{\"u}dlich der Sahara - Das Beispiel des Distriktkrankenhauses Nouna, Burkina Faso},
  url       = {https://nbn-resolving.org/urn:nbn:de:gbv:9-000967-1},
  year      = {2011},
  abstract  = {District hospitals are the only solution to guarantee basic health care including life-saving surgeries and hospitalisations in rural SSA areas. Neither regional nor national hospitals, financially and geographically out of reach for the majority of the population, nor rural health care centres, mostly staffed with a nurse only, can cover these tasks adequately. However, only little research exists on care giving processes, cost and efficiency of district hospitals in SSA. The general problem in health economics is that limited resources should be used in order to maximise health effects. This dissertation evaluates the actual treatment pathways and their average provider’s cost per patient for four different diagnoses at Nouna district hospital in Burkina Faso. A total of 95 patient records was analysed in detail and discussed with the health personnel in charge. Cost information for the year 2005 was taken from the well-established provider cost information system. Cost were broken down to the different sequences of the treatment pathway and summed up at the end. Average provider’s cost for paediatric Malaria were U\$ 6.71 for outpatients, US\$ 60.59 for inpatients with anaemia and US\$ 75.11 for inpatients with neurological affection. Average provider’s cost for treating hypertension were US\$ 67.94 per year. Average cost for hernia cure were US\$ 146.85 under local anaesthesia, US\$ 153.08 under spinal anaesthesia and US\$ 169.78 under general anaesthesia. Average provider’s cost for Caesarean sections were US\$ 140.15 under spinal anaesthesia and US\$ 180.41 under general anaesthesia. This means that cost per patient are comparable to or even lower than provider’s cost found for other SSA setting in the literature. Cost would decrease between 20\% (a hypertensive outpatient) and 46\% for Malaria with neurological affection as complication, if utilisation rates rose from actually 20 to 80\%. Patients paid between 35 and 94\% of total provider’s cost in form of user fees. If fees would not change and the utilisation rate increased to 80\%, cost-recovery for the considered diseases would then be between 63 and 117\%. Although this would not allow the hospital to break even in its current configuration, the cost-recovery rate would be considerably higher, especially when taking into account that a full cost analysis was done including all investment cost. The introduction of clinical pathways based on the actual treatment pathways is suggested to improve process structure and documentation and to standardise the treatment according to national and international guidelines.},
  language  = {en}
}