Background: Cost studies are paramount for demonstrating how resources have been spent and identifying
opportunities for more efficient use of resources. The main objective of this study was to assess the actual
dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural
primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision
efficiency in order to inform health policy and planning.
Methods: This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries
in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs
reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in
service provision between the study facilities was conducted. Reported personnel workload was also described.
Results: The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for
service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total
costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service
provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth.
The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results
showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and
perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly
influenced childbirth efficiency.
Conclusions: Differences in the efficiency of service provision present an opportunity for efficiency improvement.
Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate
utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple
techniques such as measurement of unit costs should be made standard in health care provision, health managers can
then use the performance results to gauge progress and reward efficiency through performance based incentives.