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The Cost of Providing District-Level Surgery in Malawi..pdf (268.82 kB)

The Cost of Providing District-Level Surgery in Malawi.

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Version 2 2022-05-19, 08:46
Version 1 2019-11-22, 15:45
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posted on 2022-05-19, 08:46 authored by Dennis Cornelissen, Gerald Mwapasa, Jakub GajewskiJakub Gajewski, Tracey McCauley, Eric Borgstein, Ruairi BrughaRuairi Brugha, Leon Bijlmakers

BACKGROUND: Three district hospitals in Malawi that provide essential surgery, which for many patients can be lifesaving or prevent disability, formed the setting of this costing study.

METHODS: All resources used at district hospitals for the delivery of surgery were identified and quantified. The hospital departments were divided into three categories of cost centres-the final cost centre, intermediate and ancillary cost centres. All costs of human resources, buildings, equipment, medical and non-medical supplies and utilities were quantified and allocated to surgery through step-down accounting.

RESULTS: The total cost of surgery, including post-operative care, ranged from US$ 329,000 per year to more than twice that amount at one of the hospitals. At two hospitals, it represented 16-17% of the total cost of running the hospital. The main cost drivers of surgery were transport and inpatient services, including catering. The cost of a C-section ranged from $ 164 to 638 that of a hernia repair from $ 137 to 598. Evacuations from uterus were cheapest mainly because of the shorter duration of patient stay.

CONCLUSION: Low bed occupancy rates and utilisation rates of the operating theatres suggest overcapacity but may also indicate a potential to scale up surgery. This may be achieved by adding surgical staff, although there may be rate-limiting steps, such as demand for surgery in the community or capacity to provide anaesthesia. If a scale-up of surgery cannot be realised, hospital managers may be forced to reduce the number of beds, reorganise wards and/or reallocate staff to achieve better economies of scale.


European Union—7th Framework Programme for Research and Technological Development Grant, Ref: FP7-AFRICA-2010, grant agreement number 266417.



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Published Citation

Cornelissen D, Mwapasa G, Gajewski J, McCauley T, Borgstein E, Brugha R, Bijlmakers L. The Cost of Providing District-Level Surgery in Malawi. World Journal of Surgery. 2018;42(1):46-53

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  • Public Health and Epidemiology
  • Surgical Affairs

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