India has announced the program to transform the current primary care health facilities (sub-health centres, SHCs and primary health centres, PHCs) to Health and Wellness Centres (HWC) for provision of comprehensive primary health care. We undertook this study to assess the cost of this scale-up to inform decisions on budgetary allocation, as well as to set the norms for capitation-based payments.

The scale-up cost was assessed from financial and an economic perspective. Primary data on resources used to provide services in 93 SHCs and 38 PHCs was obtained from the National Health System Cost Database. Incremental fixed cost inputs were assessed using the normative guidelines of Indian Public Health Standards and the HWC guidelines. The cost of variable inputs was determined by undertaking a need estimation based on disease burden or program guidelines, standard treatment guidelines and care utilization patterns from nationally representative sample surveys. The financial cost is reported in terms of the annual incremental cost at facility level, as well as its implications at national level, given the planned scale-up path. Secondly, economic cost is assessed as the total annual as well as annual per capita cost of services at HWC level. Monte Carlo simulation was undertaken to perform sensitivity analysis and estimate 95% confidence intervals for cost estimations.

Scaling to comprehensive primary health care through HWC would require an additional INR 721,509 (US$ 10,178) million allocation of funds for primary health care over 5 years from 2019 to 2023. The scale-up would imply an addition to Government of India’s health budget of 2.5% in 2019 to 12.1% in 2023. If a capitation based payment system was used to pay providers, provision of comprehensive primary health care would need to be paid at between INR 332 (US$ 4.68) and INR 246 (US$ 3.47)/person covered for SHC PHC, respectively.