[health menu] XI International Conference on AIDS
July 7-12, 1996

Forsythe S.
AIDSCAP/Family Health International, Arlington, VA, USA

Mangkalopakorn, Chatpimol, Chitwarakorn A.
V.D. Division, Ministry of Public Health
Bangkok, Thailand

Masvichian N.
Disease Control Division
Bangkok Metropolitan Administration
Bangkok, Thailand


Opportunities for Sustainability in Bankok's STD Clinics


Bangkok's STD clinics are reviewing outreach services to commercial sex workers (CSWs) and the expansion of operating hours to determine whether providing such services is cost-effective and sustainable.


An economic analysis (full economic, recurrent, and marginal costs) was performed at 5 public and private facilities for clinic-based STD services, outreach work to CSWs, and evening STD services.


The average recurrent cost per patient treated at these clinics was $US21. The clinics' costs included: 82% labor, 7% transport and operations/maintenance, 7% medications, and 4% other materials. The additional cost of evening services at two clinics (US$31 per patient) raised their recurrent costs by 40-60%, while increasing the total client population by 30-40%. The clinics must determine whether the cost of $US62,000/year is worth the benefits of providing access to an additional 2,000 patients/year. The marginal cost/year of providing outreach services to CSWs was found to be inexpensive. Approximately 14,000 CSWs are reached at a cost of US$3,000/year. Thus the cost of providing outreach services to the CSWs is US$0.20 per woman reached (outreach activities include education and condoms, exclude exams or on-site lab analysis).

This study revealed that 85-92% of the recurrent costs for STD treatment at public clinics are paid by the government, with the remaining being recovered through patient fees. This heavy reliance on government sources for continued funding suggests more options for improving the financial sustainability of public clinics should be reviewed.


  1. Review a policy of charging patients a small fee (US$2 to US$4) for STD checkups.

  2. Do not introduce charges for condoms.

  3. Encourage STD clinics to expand their outreach services.

  4. Perform further research regarding the evening clinics to determine whether this is the most cost-effective use of limited resources.

  5. If the evening clinics are reopened, consider a premium user charge for patients attending the clinic.

  6. Permit government laboratories to implement a cost-recovery scheme.

  7. Review the quality of care at each facility.

Chatpimol Mangkalopakorn
c/o Alfred Nimocks
AIDSCAP, 2101 Wilson Blvd.
Arlington, VA 22201 USA
Tel: 703.516.9779; Fax: 703.516.9781

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Created: July 16, 1996
Last modified: July 17, 1996

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