UNDP RBA Workshop on MDG-Based National Development Strategies Module 4: Health Strategies UN...

UNDP RBA Workshop onMDG-Based

National Development Strategies

Module 4:Health Strategies

UN Millennium ProjectFebruary 27-March 3, 2006

2 www.unmillenniumproject.org

• Reaching the MDGs will require investing in an outcome focused health system that can deliver an integrated set of quality essential health services to all of the population

• Such a strengthened system of health care delivery includes prevention and treatment activities carried out in the community, the clinic and up to the district, referral hospital

The MDG Needs Assessment Approach


The MDG Needs Assessment Approach

1.Identify interventions

2.Specify targets for each

intervention

3.Estimate resource needs

4.Check results


1. Choosing Interventions

Infectious Diseases

Child Health, Maternal Health, and Reproductive Health

• IMCI package• Immunization• Neonatal package• Antenatal care• Skilled attendance and clean delivery • Emergency obstetric care (EmOC)• Contraception and family planning services• Safe abortions and care of complications of abortion

• Antiretroviral therapy • UNAIDS HIV prevention and care package• Artemisinin combination treatment for malaria (as

appropriate)• Insecticide treated nets and IRS as appropriate (other

vector control as appropriate)• DOTS and DOTS Plus (as required)


1. Choosing Interventions

• New infrastructure and O&M of existing infrastructure at district level• Adequate health personnel salaries• Pre- and in-service training• Community demand interventions• Management systems and monitoring & evaluation• Research and development

Health System

•Interventions to ensure availability, e.g.:

•Incentives to direct research and development

•Establishment of national essential medicines lists, including preventive, curative, and reproductive health commodities, equipment, and supplies

•Ensuring reliable procurement and distribution systems

•Interventions to ensure affordability, e.g.:

•Equity pricing

•Reduction of tariffs and duties

•Reduction of mark-ups

•Interventions to ensure appropriate use, e.g.:

•Programs to improve the way drugs are prescribed, dispensed, and used

•Public media campaigns and education of providers

Access to Essential Medicines


• Some health MDGs have quantified targets, such as the goal on child mortality

• Others allow for interpretation of targets, such as HIV/AIDS

• Each country will need to adopt specific numeric outcome targets to guide its MDG health strategy.

• Health MDGs offer no specific guidance on coverage levels for health services. Overall aim should be to achieve universal coverage of essential health services (or “essential health package”).

2. Defining and Setting Targets: Outcome Targets


3. Estimating Resource Needs

To assist countries in undertaking a Needs Assessment, the Millennium Project suggests the following four-point approach:

A. Direct intervention costs (drugs, supplies, hospital beds, diagnostic tests)

B. Human resources

C. Infrastructure

D. Health systems strengthening


NO. OF CASES

COST PER CASE

Country epidemiological data

Country demographic data

Target coverage rates

Intervention components and quantities

Unit costs of components• Drugs• Hospital bed and food• Laboratory costs• Other supplies

TOTAL COSTS

3. Estimating Resource Needs:A. Direct Intervention Costs


3. Estimating Resource Needs:B. Human Resources

Countries need to calculate the number and cost of health workers at all levels of the health system needed to deliver the interventions at scale. Health workers include (among others):

• doctors

• nurses and midwives

• clinical officers

• lab technicians and technologists

• pharmacists and pharmacy technicians

• community health workers

• health managers



Human resource cost categories include

• salary and benefits

• in-service training

• pre-service training

• retention and distribution incentives

Human resource needs should be carefully estimated by each country for the desired level of service coverage



Suggested costing methods

• Health workers per facilities

• Doctor or nurse to population ratio

• Conducting a comprehensive human resources needs survey

Country example: Yemen Human Resources Needs, 2015


3. Estimating Resource Needs:C. Infrastructure

Number and cost of building or refurbishing health facilities from health posts to first level referral hospitals (including capital costs, maintenance, and overhead).

Country example: Ethiopia Infrastructure Needs, 2015


3. Estimating Resource Needs:D. Health Systems Strengthening

Two methods:

1. Bottom-up costing of health system components

• Costs of managers at all levels (training and salaries)

• Quality control and audit systems

• Basic financial and accounting systems

• Health information systems (and required ICT)

• Public health functions (such as epidemiologic surveillance)

• Enhancing community demand for services (health education and community mobilization)


3. Estimating Resource Needs:D. Health Systems Strengthening

2. Overhead mark-up to direct cost of services

• Estimate a percentage of direct cost of services as follows:

Strengthening management systems (including financial management)

20% of direct health costs including salaries

Improving monitoring, evaluation, and quality assurance


Building capacity for basic research and development



3. Estimating Resource Needs:Adding it All Up

Direct costs of all

interventions +

Infrastructure and HRH costs

Costs ofhealth systemstrengthening+

Total health costs


4. Checking Results

Review all results to ensure that numbers are robust. Here are some sample health costs from Tanzania:

Per capita total cost estimates in 2000 US$ 2005 2010 2015% of total

in 2015 Average 2005-15

% of total over

period

HIV/AIDS Prevention 1.93 2.75 3.25 7% 2.7$ 8%HIV/AIDS Care 1.06 1.38 1.46 3% 1.4$ 4%HIV/AIDS Treatment 0.70 6.00 9.59 22% 5.8$ 17%TB 0.33 0.33 0.33 1% 0.3$ 1%Malaria Prevention 0.28 0.51 0.73 2% 0.5$ 1%Malaria Treatment 1.98 2.03 1.58 4% 1.9$ 6%Maternal Heath 1.04 1.56 2.05 5% 1.6$ 5%Child Health 4.40 4.51 4.50 10% 4.5$ 13%Management 2.34 3.82 4.70 11% 3.7$ 11%Quality improvement 1.76 2.86 3.52 8% 2.8$ 8%Human resources (salary incr.) 4.69 7.64 9.40 22% 7.5$ 22%Community demand 0.40 0.86 1.31 3% 0.9$ 3%R&D capacity 0.23 0.38 0.47 1% 0.4$ 1%Infrastructure recurrent costs 0.78 0.72 0.66 2% 0.7$ 2%

Total cost per capita ($) 22 35 44 100% 35 100%

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