Cost Projections for the Complementary Package of Activities - basics

$175,231 in that year, whereas according to the norms it should have had 59 staff and a budgetof around $258,000.As another example, Prey Chhor Hospital, a 70-bed CPA 1 hospital in Kampong ChamProvince, had a BOR of 61% and an ALOS of 6.3 days in 2007. It had 28 staff and spent$170,160 in that year, whereas for the number of services that it provided it should have had 54staff and a budget of around $227,000. However, if it operated at optimal capacity and reducedits ALOS to 4.6 days it would treat twice as many inpatients but would require 65 staff and abudget of around $290,000.The funding for the sample of contracting hospitals used for this study came from a variety ofsources. Between 67% and 83% of the funds came from the Government, most of which was indrugs and supplies. User fees, health equity funds and health insurance made up between 12%and 24% of total funding. Direct donor assistance made up between 5% and 9% of totalfunding. A portion of the Government funding and the health equity funds are also donorfunded. Depending on the ability of the Government to finance the increased costs it is likelythat a significant portion of the increased funds needed would have to come from user fees andinsurance and from donors, at least in the short term.Both the actual 2007 costs and the normative costs estimated in this study are significantlyhigher than the costs used in the second child survival costing study and in HSP 2, and may behigher than figures used in estimating the cost of the reproductive health, HIV/AIDS and TBstrategic plans. The strategic plan costs need to be reviewed and, if necessary, adjusted.The costing model can be used to estimate a budget for any referral hospital. However, it isimportant to note that these costs are rough estimates. The following recommendations aremade regarding improving the quality of this information.• For this study the staffing norms were developed from ranges shown in CPA Guidelinesand drug and supply costs were based on actual amounts provided to the hospitals.They may not reflect accurately the needs of the hospitals and they do not take intoaccount differences in patient mix. These figures should be reviewed by the MOH andan analysis and determination of standard clinical practices should also be carried out todevelop more accurate staffing norms and standard drug and clinical supply needs.• The figures used for staff remuneration were based on averages of actual payments atthe sample of hospitals. These figures should be reviewed and, if necessary, adjusted.• A more detailed analysis of the operating costs would also be advisable, since it ispossible that some aspects, such as maintenance, are underfunded and that this maynot have been fully taken into account by the hospital directors when they estimated theadditional funds needed.We also recommend that the HSP2 targets be translated into specific service delivery targets.This will assist the health centers and hospitals to set targets that will result in the achievementof HSP2 goals.27