System Costs of Producing a Nurse: Evidence from PIMS Nursing College Hidayat Ullah

1. System Costs of Producing a Nurse: Evidence from PIMS Nursing College • HidayatUllah • Department of Health Economics & Management • Health Services Academy INSERTLOGO HERE • Supervisor: Prof. Dr. ShafqatShehzad Introduction Data Expenses Related to Repair and Maintenance (TVC5) Data Sources The study has been collected data related to variable cost per student per year from the Administration, Accounts and Finance Offices of the PIMS College of Nursing, Islamabad, Pakistan. • The health workforce is one of the most important pillars of the health system. Qualified health professionals, especially the nurses available in adequate numbers to deliver the services, are very important for improving health outcomes. More recently, there is growing awareness from local and international health community on the relatively ignored aspect of human resources of health. In absence of qualified health care personnel, it becomes very difficult to achieve the desired health care objectives, particularly, the ones that are internationally agreed through the charter of the United Nations in terms of the Millennium Development Goals (MDGs). • At present in Pakistan, little data is available to identify what the educational investment in nursing actually is or what it should be. There is need for conversation of information about costs and establishment of a more or less standard method of cost determination applicable to the institutions and organizations associated with it. Inquiry in this domain is utmost important. • The study intends to explore what is the system cost (provider’s cost) of producing a Post RN BSc Nurse at PIMS College of Nursing, Islamabad? Data generated by the study will be helpful in priority setting, planning, budgeting and management of nursing education programs by the government and the private sector. • Data Collection • A detailed data collection form has been developed to extract cost information under different heads from the accounts and finance offices of the PIMS College of Nursing. Existing record of recurrent and developmental expenditures for the fiscal year 2009-10 and 2010-11 has been analyzed. Retrospective record reviews were used to gather information on expenditures made specifically for the program under study. • Study Variables • The following are variables of cost used in our study: • Employees Pay Related Expenses: • b) Operating Expenses: It includes basic pay and all the allowances paid to the gazettedofficers, non gazettedofficers and other support staff.They are divided in to five broad categories e.g. communication related expenses, utilities, occupancy costs for residential accommodation of employees, travel and transportation of employees and goods and other general expenses. The general expenses includes expenses related to stationary, printing and publication, books and periodicals, uniforms, protective clothing and others for services rendered. • c) Transfers related Expenses: It includes Entertainment and Gifts which are presented to employees who are transferred in the form of welcome and farewell parties. The expenses for other extra-curricular activities are also come under this head. • d) Purchase of Physical Assets: It comprised of two broad categories e.g. plant and machinery, furniture and fixture. Plant and machinery include transport, generators, computers, hard ware and other related equipment used specially for the program under study. Furniture and fixture used for office and classroom. • e) Repair and Maintenance:Repair and Maintenance expenditures include repair and maintenance of transport, machinery and equipment, furniture and fixture, office building and classroom, computer equipment, telecommunication works and general maintenance of gardens. Total Variable Cost (TVC) 2009-10 Total Variable Cost (TVC) 2010-11 Average Cost per Student per Year 2009-10 • Methodology • Study ModelCosts have been calculated based on seven steps for computing unit costs, a framework built on the procedures of the UNICEF Manual for Analysis of District Health Service Costs and Financing (Hanson and Gilson, 1996). However the steps adopted and modified according to requirement of the study. The first step of the model is to define the final product. With reference to the present study, Post RN BSc Nurse has been taken as an output. • The second step is to determine the number of participants (Students) per program. The third step determines the average length of participation (duration of the Nursing program). The fourth step defines cost categories. The major cost categories for most departments include employees pay related expenses, operating expenses, expenses related to transfers, special purchases made for the program’s use, repair and maintenance and other general expenses. • The fifth step identifies the full cost for each input. It is an important step for calculating the unit cost. Availability of complete cost data is an essential aspect of this step. The sixth step assigns inputs to cost categories. In the seventh step, all costs are allocated to the final cost. • Equations • The Total Variable Cost, Average Cost and Total Program Cost is calculated by the following equations; • Total Variable Cost (TVC) • Total Variable Cost (TVC) = TVC1+ TVC2 + TVC3 + TVC4 + TVC5……….1 • Where TVC1, TVC2, TVC3, TVC4 and TVC5 represents Employees Expenditures, Operating Expenses, Transfers related Expenses, Purchase of Physical Assets and Repair and Maintenance Expenditures respectively. • Average Cost • Average Cost (AC) = Total Variable Cost/Total number of Post RN BSc N Graduates…..2 • Total Program Cost • It is the sum of the Total Variable Cost for the fiscal Year 2009-10 and 2010-11 Average Cost per Student per Year 2010-11 Results Employees Pay Related Expenses (TVC1) Total Program Cost The Total Program Cost for the two years’ Post RN BSc N program has been calculated by adding the Total Variable Cost for both the fiscal years 2009-10 and 2010-11. The Total Program Cost for the Post RN BSc N Program has been calculated 31.17 million rupees or 31,170,000 rupees. Operating Expenses (TVC2) Policy Implications As nursing has lack of information about costs of educating students in Pakistan, if we are to increase educational capability to address the nation’s need for nurses, we need to have cost analysis data. Once reliable and valid data available on the cost of nursing education, prospects for obtaining funds whether government other public or private, should be identified and pursued. Pakistan Nursing Council (PNC) which is the regulatory body for nurses in Pakistan should have full cost information to inform the government for the resources required to overcome nursing shortage and to promote the educational level of existing nursing workforce to improve the health outcome. We suggest similar studies in other nursing schools, colleges, medical colleges and universities and allied health professions in Pakistan enabling effective comparisons. Comparable data once obtained can then be utilized by the policy makers at all levels for the enrollment expansion and scaling up of nursing workforce in the context of Pakistan. If the government wants to privatize the nursing education, cost analysis permits policy makers to know the full cost of educating the nurses. Studies of this type can provide quantitative basis for human resource for and health policy considerations. Transfer Related Expenses (TVC3) Purchase of Physical Assets (TVC4)