Costing essential services package in Bangladesh

Globally, unit cost of health services provides important infor- mation for policy making, and thus many costing studies have been conducted in the last decades in developing countries. Using a stratified sampling approach to select 18 static clinics, a study in Bangladesh estimate the unit costs for 13 primary care services from 1115 observations (clients) in the country.

The estimated 2015 average costs for immunization services were $2.23 per visit, compared to other services: antenatal care ($7.03), postnatal care ($4.57), control of diarrheal diseases ($1.32), acute respiratory infection ($1.53), integrated management of child illness ($2.02), sexually transmitted infections ($4.70), reproductive tract infections ($3.56), tuberculosis ($41.65), limited curative care ($4.30), family planning ($0.72), births by normal de- livery ($29.45) and C-section ($114.83). 

Although cost per outpatient visit is also widely used for costing studies, the unit cost measured in this way could be substantially confounded by the mix of patients and thus, cannot be readily used to compare performance among health facilities. As the unit cost in this study is measured as the cost per visit of a particular service, it eliminates the confounding of patient mix in health facilities. Thus, the unit cost is more comparable across health facilities, regions and countries. 

This study provides rich information on unit costs for various essential services in Bangladesh. However, obtaining and deriving the unit cost is often just the first step for policy analysis. The unit cost information, if supplemented with data from other sources, such as epidemiological and demographical data, could be used for generating more evidence for programme planning, policy designing, evaluation and decision-making  .

As Bangladesh strives to scale up services to meet the goal of universal health coverage, this cost information would be useful for designing future health insurance schemes, such as setting up health insurance premiums and establishing the reimbursement rate for a particular service. As an example, the study found variations of unit cost between ultra and vital clinics and rural and urban clinics. When reimbursing health facilities for providing services, different rates should be considered by the location and type of clinics. .

The study suggests that inefficiency and quality concerns exist in health service delivery in some facilities. Increasing the volume of clients through demand-side mechanisms and standardization of services would help address those concerns.

For further details and to access the abstact, see link below.


For more information, contact:


Wu Zeng,

Assistant Research Professor

Brandeis University