Evaluating the financial sustainability of SGHPs.
The SGHPs operated as a public–private partnership. The facilities were owned by the Rwanda Ministry of Health, but were run by a private operator, usually a nurse, similar to a private clinic. The operator delivered medical services, dispensed drugs, hired and supervised up to three additional staff (e.g., a laboratory technician, additional nurses, and a medical assistant), paid salaries and other operating expenses, received revenues from patients and insurers, and provided financial and use data. The SFH provided training and compiled use and financial data for monitoring and informing the Ministry of Health.We used these facility-based financial data to estimate the annual financial cost of providing care in an average SGHP during the first year (October 2019–September 2020) and 1 year after the establishment of the SGHPs (October 2020–September 2021). The financial cost consisted of the operations cost, including personnel and supplies, and an estimated 10% for administration. Totaling SGHPs’ monthly reports to SFH, we computed the annual revenues from services provided at the SGHPs and paid by private patients, In addition, we estimated the economic nonfinancial cost, which adds the annualized capital expenditures on buildings (30 years), equipment (7 years), and training (2 years) to the financial cost, and estimated the economic profit or loss as the difference between the revenues and economic cost. The capital cost was estimated for a typical SGHP and excluded the cost of a dental clinic and maternity services, which had been installed in only a few SGHPs. The buildings for each of the four SGHPs without maternity areas cost $43,000; buildings with maternity areas cost $64,000 each. Equipment (including laboratory equipment and furnishings) averaged $13,000 per SGHP. Second-generation health posts also benefited from use of the land on which the buildings were constructed, and ongoing monitoring and support from the SFH. Because of data limitations, we did not value these two inputs, but their annual value is likely small.