This document summarizes a costing study of community-based health units (UCOS) in Honduras. The average cost to implement one UCOS unit was $5,530, with recurrent costs making up 98.6% of expenses. The study found that maternal and newborn delivery services were lowest cost at the community level, 38 times lower than private hospitals. Home deliveries were 85% less expensive for households than services at maternal-child clinics. The study also found that households using UCOS services saved an average of $7.81-$9.86 per child compared to government health centers.

1. UCOS Costing
Study, Honduras
Alfonso Rosales MD, MPH-TM
arosales@americas.childfund.org
CORE Group Spring Meeting, Washington DC,
May 2012

2. Background: Innovations
– define and standardize the role of communities in
order to increase institutional deliveries and
strengthen CB obstetric and neonatal care within a
national decentralization strategy;
– create self-sustaining CB health units (UCOS) which
integrate vertical Ministry of Health (MOH) programs
and various cadres of volunteers; and
– adapt and implement CB continuous quality
improvement (CQI) systems for UCOS.

3. UCOS Costing Study
Overall objective: to determine overall service
implementation costs
Additional objectives:
– comparison of costing of health service delivery
for children under 5 between services delivered
at community level (health volunteer) and
health facility (nurse or doctor);
– and determine out-of-pocket expenses for
families receiving health-related services at
various delivery points.

4. Methods
– Cost Analysis study
• Key informant interviews to health and volunteer
personnel of all service distribution points,
• survey of mothers of children under- 5 years of age
• triangulation with other sources of information such
as health facility and UCOS (community health units)
registers of patients and their estimated service
delivery costs according to market values.
Category of cost Recurrent cost Capital cost
DIRECT Personnel, drugs and lab, Land, building, equipment
transportation, communications,
material
INDIRECT (user) Transportation, food, drugs,
consult fee, time, diagnosis-cost

5. Results
The average cost for implementing one UCOS in the department of
Francisco Morazán, Honduras is US $5,530; where 98.6% are
recurrent costs and 1.4% are capital costs
Average cost per
beneficiary is US $
8.02 and $ 1,843
per community.

6. Results: Maternal and newborn
delivery services
the lowest cost was found at the community level, which is
38 times lower that the most costly service-private hospital
service, and almost 11 times lower than the next provider
level-maternal and child clinic.

7. Results: Maternal and newborn delivery
services

8. Results: Maternal and newborn delivery
services
In terms of cost-saving to household expenditure on normal deliveries, home
delivery is 85% less expensive to the household when compared to the next
level of service (maternal-child clinic), and almost three-time lower when delivery
occurs at a hospital ($31, $58, and $87 respectively).

9. Figure 1. Maternal and newborn delivery services
Normal delivery cost by
point of delivery:
Honduras GNI $1,880
Home delivery: $31 (WB, 2010)
Health Expenditure per
Maternal-Child Clinic:$58 capita: $177
(WHO, 2008)
Hospital: $87
Lepaterique GNI $1,470
(UNDP, 2006)
6 per cent of GNI

10. Results: Under-5 delivery services
Households covered by UCOS services had on average savings of US
$7.81 per child-case when having services rendered by UCOS in
comparison to services rendered by a government health post (CESAR),
and US $9.86 when compared to services rendered by a MOH health
center (CESAMO).

11. Under-5 delivery services: out-of-pocket
expenses by component
Food Other
1% 2%
Other
12%
Transport
25% Time
Food
31%
19%
drugs
66%
Time
Drugs 24% UCOS
20%
MOH Services