Appropriateness of laboratory expenditure for primary health care facilities across South Africa

BACKGROUND: Primary health care (PHC) services have been prioritised from a cost-containment perspective. To manage expenditure, facility managers use the Laboratory Handbook that indicates the Essential Laboratory List (ELL) tests. AIM: The aim of this study was to analyse PHC laboratory expenditure to assess the impact of the ELL in South Africa. SETTING: We reported ELL compliance at the national, provincial and health district levels. METHODS: A retrospective cross-sectional study was used to analyse data for the 2019 calendar year. The unique tariff code descriptions were used to develop a lookup table to identify ELL compliant testing. Researchers analysed data for the human immunodeficiency virus (HIV) conditional grant tests and by facility for the bottom two districts. RESULTS: There were 356 497 tests (1.3%) that were not ELL compliant that equated to an expenditure of $2.4 million. Essential Laboratory List compliance ranged from 97.9% to 99.2% for clinics, community healthcare centres and community day centres. The provincial ELL compliance ranged from 97.6% for the Western Cape to 99.9% for the Mpumalanga province. The average cost per ELL test was $7.92. At the district level, ELL compliance ranged from 93.4% for Central Karoo to 100% for Ehlanzeni. CONCLUSIONS: High levels of ELL compliance have been demonstrated from the national to the health district level, demonstrating the value of the ELL. CONTRIBUTION: This study provides data for quality improvement initiatives at primary care facilities.