Search

Household sanitation in developing countries, especially in the rural areas, is poor. An evaluation of what was achieved in this regard during the 1980-90 decade of safe water supply for all was carried out in the present study. It was observed that even where a safe water supply and sanitary latrines were provided, people did not always use them. While 23% of the studied households had sanitary latrines, children in about 11.5% of these households did not use them and women in about 6% of households did not use them for micturition at night. Not a single house in the study area could fulfil all the criteria of sanitary housing in a strict sense; for example, although 34.5% of the households had tubewells, only 11.5% of them had a satisfactory level of water usage. Since socioeconomic conditions and education influence the level of sanitation, improvements in both are required.

This report describes the first-ever cost analysis of a primary health care centre in Bangladesh. The aim was to provide information on costs incurred on various health care activities available in a thana health complex, in relation to the number of patients and the intensity of use of services.Overall costs were estimated by examining records and papers and by interviewing staff. Cost apportionment was carried out in three stages. In the first stage, all direct expenditure was calculated for each activity, e.g., wards, outpatient department, tuberculosis services, etc. In the second stage, general service costs, covering water, sanitation, security, and administration were divided among the various services. In the third stage, the costs of laboratory services were distributed according to the number of examinations carried out for each service.The capital costs for 1979 were US$ 36 382, of which 84.6% were incurred on the buildings. Recurrent costs for 1979 were US$ 59 556, i.e., 62% of overall costs, reflecting the labour intensiveness of the health complex. The distribution of the costs among the various health care activities was detailed. It was found that, in general, the cost per unit of activity depended mainly on the intensity of use of the resources, e.g., unit costs incurred in the outpatient department, maternal and child health services, and subcentres were relatively low because of the high rate of utilization of services.This study has demonstrated that it is possible to estimate unit costs in a thana health complex. It is hoped that the methods used here will provide a basis for further work of a similar nature.