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Table 6 Breakdown of costs by facility utilization

From: A cost function analysis of child health services in four districts in Malawi

Item Facility utilization level
  Low utilization (Fewer than 7,000 outpatient visits) Middle utilization (7,000 to 14,999 outpatient visits) High utilization (Over 15,000 outpatient visits)
Number of health centres 6 13 5
of which CHAM 4 2 2
Population served (average) 18,345 24,372 36,071
Estimated Children U5 (average) 3,385 4,597 6,561
Outputs (Children U5)    
Inpatient admissions (average) 71 82 338
Outpatient visits (average) 4,446 10,507 18,961
FIC (average) 495 1,013 1,165
Child outpatient utilization rate 1.31 2.29 2.89
Proportion of caretakers reporting over 1 hour travel time to facility (95% CI)* 67% 60% 56%
(52 – 81%) (47 – 73%) (41 – 71%)
Inputs (Children U5)    
Variable    
Staff remuneration 47% 23% 29%
Average number of clinical staff 3.7 3.8 5.8
Outpatient visits per clinical staff 1213 2732 3269
Average number of staff (all) 37.2 29.8 45.6
Outpatient visits per staff (all) 120 352 416
Training 5% 8% 6%
Vehicle operation & Field visits 6% 7% 20%
Non-medical supplies 1% 2% 3%
Medical Supplies 8% 7% 5%
Pharmaceuticals 18% 42% 22%
Average pharmaceutical spending per visit ($) 1.4 2.6 1.3
Proportion of drugs out of stock 0.19 0.32 0.28
Proportion of children correctly medicated 0.59 0.82 0.81
Subtotal: Variable costs 87% 94% 92%
Fixed    
Building & Equipment (incl. lab/x-ray) 8% 5% 5%
Vehicles 5% 1% 3%
Subtotal: Fixed costs 13% 6% 8%
  1. *Based on 229 exit interviews of caretakers at facilities; 60 respondents for low utilization facilities, 128 respondents for middle utilization facilities, and 41 respondents for high utilization facilities. Difference between low utilization and high utilization facilities is statistically significant (p<0.05) in logit regression when controlling for district (data not shown).