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Title: Value for money in the health sector: the contribution of primary health care. Author: Mills A, Drummond M. Journal: Health Policy Plan; 1987 Jun; 2(2):107-28. PubMed ID: 10312103. Abstract: Since the Alma-Ata Declaration in 1978, primary health care (PHC) has been seen in most countries as a vital part of any strategy to improve the health of the population. Economic evaluations of PHC delivery and PHC activities are therefore needed to assist in decision-making on resource use in the health sector. A report was prepared on such economic evaluations in the Commonwealth and this paper summarizes those findings which relate to developing Commonwealth countries. After a brief explanation of the main methods of economic evaluation, existing evaluations, classified according to the eight essential elements of PHC, are reviewed. The literature review throws up a number of methodological issues of which policy-makers need to be aware when interpreting evaluations. These are pointed out before moving on to a consideration of what lessons the literature may hold about the value and affordability of PHC and the most efficient ways of delivering PHC activities. The final section suggests that, although economic evaluation techniques have an important role to play in decision-making, they have not so far been used to best advantage. A number of ways in which health ministries could increase the usefulness of the evaluations they commission are considered. This is a literature review of the cost effectiveness and cost benefit analysis of key primary health care (PHC) projects in Commonwealth countries, part of a larger work including surveys and suggestions for Commonwealth health ministers. First, terms used in cost evaluation are defined and methods explained. Then the 8 elements in PHC (immunization, sanitation, nutrition, etc.) are reviewed as applied in Commonwealth countries. Key methodological issues that policymakers should keep in mind when they consult the literature are noted: whether health or societal needs are the main perspective; whether the medical evidence is adequate (determined by a sensitivity analysis); what type of economic benefits will derive from the health program (resource savings, increased productivity, or quality of life). One must realize in estimating costs that PHC programs usually are added to existing programs, so costs are added, not averaged. Evaluations have to take into account the fact that benefits are usually long-term, while cost outlays are current. Since policymakers must estimate costs and benefits to justify PHC activities, there are a number of comparative international reviews presenting evidence of program effectiveness. The report discusses whether PHC costs can be afforded. Some countries spend as little as 2% of GNP, or 5% including water and sanitation projects. Two topics which have good data are immunization and oral rehydration. Costs of immunization, with its standardized technology, range about 4-fold in different programs. Oral rehydration costs range 80-fold. Various options in PHC program design are enumerated. Vital evaluation studies will useful if standard methods are employed and well documented.[Abstract] [Full Text] [Related] [New Search]