Understanding cost variation in medical and health sciences education: An institutional perspective.

Strengthening the health workforce is a central policy challenge in fragile and low-income settings, yet governments often lack basic information on what it costs to train health professionals. This study provides the first institutional level evidence on the structure and magnitude of medical education costs in Afghanistan using detailed administrative and financial records from Kabul Medical University. A retrospective costing approach combined with a step-down cost accounting framework is used to allocate all direct and shared expenditures across faculties and across years of study. The results reveal large differences in per student costs across programs, with Curative Medicine requiring substantially more resources than Stomatology, Nursing, and Public Health. Support services account for a large share of total expenditure, and resource use rises sharply in clinically intensive years. A sensitivity analysis that varies personnel costs, allocation rules, and price adjustments shows that these patterns remain stable. The findings indicate that fiscal pressures, gender imbalances in enrollment, and inefficient allocation of support costs limit the effectiveness of current training investments. The study provides a quantitative foundation for policies that seek to improve the financial sustainability of medical universities, align training capacity with national health needs, and strengthen resource tracking systems in fragile and low-income contexts.