A methodology for optimal allocation of government budget to maximize health coverage : the case of antenatal care in Egypt

The performance of these systems is often disappointing. People seek alternatives to government provision even when it is available to them at little or no direct cost or they do not receive the priority services at all. Governments often respond to this situation by trying to do more of what they have done already, increasing the investments in the public sector health care delivery system. This strategy can be found even in countries where government services are clearly underused (i.e., have excess capacity) and where there is also a large and possible growing set of alternative non-government providers that many people may prefer to use. This paper extends the authors" earlier work that developed an analytical model to analyze government choices to expand coverage with priority services. It develops and tests the operational capability of the model with data for antenatal care in Egypt in 1995, augmented by additional estimations as needed. The objective of this analysis was not to develop policy recommendations for Egypt, however, but rather to test and demonstrate the approach. The paper shows that more resources should be allocated at the margin to subsidize transportation, educate women, and finance the use of nongovernment providers rather than to expand the quantity of public provision. Sensitivity analysis with the model highlights the importance of better measurement of some key variables like quality of care, cost of educating the population, and operating subsidies. The authors conclude that where public services are underused and there are significant non-government alternatives, governments should consider both demand- and supply-side factors in designing investment programs. They propose applying this approach in other countries where there is available data and the possibility of collecting additional information as needed. (Author abstract)