Hospital costs of high-burden diseases: malaria and pulmonary tuberculosis in a high HIV prevalence context in Zimbabwe


  • 1

    Micro-costing is a concept based on principles of industrial engineering science, which use input-based methods of measuring resource use. The approach involves direct enumeration and costing of inputs consumed in the treatment of a particular patient. Input costs are then summed to obtain a total cost, which can be converted, to desired units of interest—for example, cost per case or cost per day.

  • 2

    Eisenberg et al. (1984) define time and motion analysis as involving the observation of workers carrying out their usual activities and recording the time consumed during each step of the process.

  • 3

    The panel consisted of three public health physicians and two senior nursing officers with considerable experience in the health care delivery system in Zimbabwe, the Provincial Medical Director for Mashonaland East province, the Medical Officer of Health (Maternal and Child Health), the Medical Officer of Health (Disease Control and Epidemiology), the Provincial Nursing Officer, and the Provincial Community Nursing Officer.

  • 4

    Government Medical Stores (GMS) is the central procurement and distribution unit for drugs and medical supplies for public facilities. Private sector suppliers are only used for products out of stock at GMS. In fact, GMS approves private procurement.

  • 5

    The only possible source of differences between hospitals was in staff costs. In other words, the same test conducted by a laboratory technologist cost more compared to one carried out by a junior technician.

  • 6

    At this level of analysis (pooled), malaria severity was not independent of referral status (F test, P = 0.02).

  • 7

    Questions about the efficacy of malaria microscopy tests, and whether the patients actually had malaria or just parasitaemia are not relevant in this study. All cases that were clinically categorised by health staff as having malaria were considered as such and treated accordingly.

  • 8

    According to an Independent Samples t-test.

  • 9

    Hospital 2 had generally the least staff-to-patient day ratios: 37:1 for doctors, 2.7:1 for nurses and 55:1 for pharmacy technicians compared to the respect average of 43:1 for doctors, 3:1 for nurses and 186:1 for pharmacy technicians.

  • 10

    Chi-square text.

  • 11

    To reduce congestion in hospitals, and to contain hospital costs, TB patients are kept in hospital for a shorter period of time (1–2 weeks) during the intensive phase of treatment rather than the conventional 2 months in hospital. Once patients are stabilised, they are discharged for continued home treatment. What is important is that someone close to the patient (relative or Village Health Worker) is trained to directly observe the patient taking medication at prescribed times. Direct observation improves treatment compliance and treatment success rate (MOH 1998).

  • 12

    Such patients are classified as Category 1 patients according to the National TB Treatment Guideline. These are cases with pulmonary TB, admitted for the first time with TB and with no evidence of resistance to TB drugs (MoH 1994).

  • 13

    Principal reason for admission.


This paper explores the measurement of hospital costs and efficiency in a context where data is scarce, incomplete or of poor quality. It argues that there is scope for using tracers to examine and compare hospital cost structures and relative efficiency in such contexts. Two high-burden diseases, malaria and pulmonary tuberculosis, are used as tracers to calculate the average costs of inpatient care at selected tertiary hospitals. This study shows that it is feasible to prospectively collect cost data for specific diseases and explore in detail both patient cost distribution and susceptible areas for efficiency improvement. The present study found that the critical source of efficiency variation in public hospitals in Zimbabwe lies in the way hospital beds are used.