UNDP RBA Workshop on MDG-Based National Development Strategies Module 4: Health Strategies UN Millennium Project Februa

1. UNDP RBA Workshop on MDG-Based National Development Strategies Module 4: Health Strategies UN Millennium Project February 27-March 3, 2006

2. The MDG Needs Assessment Approach • 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 2

3. The MDG Needs Assessment Approach 1.Identify interventions 2.Specify targets for each intervention 3.Estimate resource needs 4.Check results 3

4. 1. Choosing Interventions 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 Infectious Diseases • 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) 4

5. 1. Choosing Interventions Health System • 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 • 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 5

6. 2. Defining and Setting Targets: Outcome Targets • 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”). 6

7. 3. Estimating Resource Needs To assist countries in undertaking a Needs Assessment, the Millennium Project suggests the following four-point approach: • Direct intervention costs (drugs, supplies, hospital beds, diagnostic tests) • Human resources • Infrastructure • Health systems strengthening 7

8. Country epidemiological data Country demographic data • Unit costs of components • Drugs • Hospital bed and food • Laboratory costs • Other supplies Target coverage rates 3. Estimating Resource Needs:A. Direct Intervention Costs NO. OF CASES TOTAL COSTS Intervention components and quantities COST PER CASE 8

9. 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 9

10. 3. Estimating Resource Needs:B. Human Resources • 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 10

11. 3. Estimating Resource Needs:B. Human Resources • 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 11

12. 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 12

13. 3. Estimating Resource Needs:D. Health Systems Strengthening • Two methods: • 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) 13

14. 3. Estimating Resource Needs:D. Health Systems Strengthening • Overhead mark-up to direct cost of services • Estimate a percentage of direct cost of services as follows: 14

15. 3. Estimating Resource Needs:Adding it All Up Costs of health system strengthening Direct costs of all interventions Infrastructure and HRH costs + + Total health costs 15

16. 4. Checking Results • Review all results to ensure that numbers are robust. Here are some sample health costs from Tanzania: 16