Cost-effectiveness analysis of antenatal care under MCH program at Thana Health Complex and Health and Family Welfare Center in Bangladesh : a case study of Fultala Thana

The objective of this study was to compare and analyze the cost-effectiveness of antenatal care under maternal and child health care program at Thana Health Complex (THC) and Health and Family Welfare Center (H&FWC). Providers costs were calculated and effectiveness were measured for THC and H&FWC through a descriptive and cross sectional study in 1998. Fultala thana was selected as a case study from provider's perspective. 381 pregnant mothers were made 901 antenatal visits in ThC and 424 pregnant women received 1,345 antenatal visits in H&FWC. Costs were classified by inputs i.e. capital cost and recurrent cost. Effectiveness of antenatal care were measured by percentage of pregnant women covered, percentage of pregnant women who received at least three ANC visits and percentage of normal delivery of pregnant mothers. It was found that cost per antenatal visit at THC was Tk 46.30 and in H&FWC was only Tk 33.95 in 1998. As effectiveness is considered it is found that H&FWC covered a higher percentage (88.33%) of targeted pregnant mothers than that covered by THC (79.38%). As regard to 3 visits more than about two-thirds of the pregnant mothers were covered by the H&FWC, but the coverage was below fifty percent (42.52%) in THC. Pregnant mothers had higher normal delivery at H&FWC (99%) than at THC (93.37%). The cost-effectiveness results showed that cost requird to cover each pregnant mother at THC was Tk 109.50 snf in H&FWC was Tk 107.68. But in THC per pregnant mother got average 3.17 antenatal visits where as in THC 2.36 visits. The cost required providing each pregnant mother with at least three visits was higher in THC (Tk 257.53) than that incurred at H&FWC (Tk 154.77). The antenatal cost in terms of having normal delivery shows the same trend Cost of having normal delivery at H&FWC is lower (Tk.114.43) in comparison to that of THC (Tk 123.43). Comparing three indicators, it is evident that providing antenatal care service is more cost-effective at H&FWC than that at THC.