State-sponsored primary health care in Africa: The recurrent cost of performing miracles

In this paper the author suggests that the design and execution of ongoing and future primary health care (PHC) interventions in Africa could be improved by more comprehensive and realistic assessments of the recurrent costs of alternative approaches to providing given levels of health care benefits. He develops the distinction between development and recurrent cost elements; distinguishes between marginal and average costs of interventions; identifies elements of social opportunity cost that are frequently overlooked in assessing project costs and shows how their inclusion magnifies the aggregate social cost of interventions featuring recurrent involvement of state agents; suggests that the perception of benefits conveyed by state-sponsored PHC programs to rural populations is limited, especially in relation to the true social costs; and discusses the implications of the above analysis for future PHC strategy.