A feasibility study using time-driven activity-based costing as a management tool for provider cost estimation: lessons from the national TB control program in Zimbabwe in 2018

Abstract Background Insufficient cost data and limited capacity constrains the understanding of actual resources required for effective TB control. This study used process maps time-driven activity-based costing to document service delivery processes. The analysis identified sustain services in Zimbabwe, as well several opportunities more efficient use available resources. Methods A multi-disciplinary team applied (TDABC) develop measure clinical pathways Drug Susceptible (DS-TB) at urban polyclinics, rural district provincial hospitals, community based targeted screening (Tas4TB). performed interviews observations collect on time taken by health care worker-patient pairs every stage treatment pathway. personnel’s practical rates were calculated five domains. An MS Excel model diagnostic costs. Findings Twenty-five stages pathway across all facilities except TB. Considerable variations observed among how professionals client registration, taking vital signs, follow-up, dispensing medicines processing samples. average per patient entire DS-TB was USD324 with diagnosis USD69 USD255. higher clinics than hospitals (USD392 versus USD256). Nurses 1.6 expensive hospitals. main components personnel (USD130) laboratory (USD119). Diagnostic Tas4TB twice that facility setting (USD153 vs USD69), major drivers being demand creation (USD89) sputum specimen transportation (USD5 USD3). Conclusion TDABC is a feasible management tool low-resource settings. costs revealed innovative improvements NTP under public programme Re-engineering testing processes synchronising follow-up antiretroviral treatments could produce better uniform significantly lower Zimbabwe.