The issue of recurrent costs: implementing PHC in Zambia
Harnmeijer, J.W.
Implementing primary health care experiences since Alma Ata: 101-112
1990
Document Number: 377272
It is the level of recurrent costs that ultimately determines the affordability and sustainability of primary health care programmes. This paper attempts to analyse the theoretical recurrent costs of a PHC programme implemented in Western Province, Zambia, in order to estimate what the recurrent costs would be at different levels of coverage. Local data and information based on personal experience and observations are used for the analysis, and issues such as resource distribution, equity, ability and willingness to pay, as well as the financing of PHC are discussed. Specifically, the calculation presented concerns annual recurrent costs at community health worker, traditional birth attendant and rural health centre levels, and allows unit costs, including supervision costs, to be determined. Based on these calculations, an indication is given of overall recurrent costs for rural areas in three situations: rural area coverage of 55.5%, 66.6% and 100%. It is concluded that it is the extent to which recurrent expenditures can be met in the long term that determines whether a PHC project is sustainable or not. Whether these expenditures are met is in turn determined by the ability and willingness to pay.