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Measuring Costs of Pilot Interventions

Measuring Costs of Pilot Interventions. John H. Bratt September 29, 2009. Outline. How costing pilot interventions differs from costing services Phases of pilot interventions From phases to resources Converting resources into costs Data sources Example: Introducing CBD of DMPA.

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Measuring Costs of Pilot Interventions

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  1. Measuring Costs of Pilot Interventions John H. Bratt September 29, 2009

  2. Outline How costing pilot interventions differs from costing services Phases of pilot interventions From phases to resources Converting resources into costs Data sources Example: Introducing CBD of DMPA

  3. Average Costs of Health Services Health facility represents a production process (inputs-processes-outputs) Defined outputs produced Measured and costed all resources used to produce these outputs Result: average cost per service Other PMTCT CT Program Costs ART

  4. Incremental Costs Associated with Interventions Many health interventions begin as small pilot projects Pilot projects often carried out within an existing program Which costs should we consider? Incremental Costs Program Costs

  5. Costs of a Pilot Project Outputs Processes (activities) Outcomes Inputs • Planning the intervention • Implementing the plan • Carrying out new service delivery • Labor • Supplies • Capital Increased or improved provision of services • Higher use of ARVs • Improved Adherence • Higher PMTCT coverage

  6. Economic Taxonomy of a Pilot Project Pilot Project Phase

  7. Phases of a Pilot Project Planning Implementing the Plan Initial service delivery

  8. Economic Taxonomy of a Pilot Project Pilot Project Phase Activity

  9. Phase 1: Planning Examples of objectives/activities in the planning phase: Design Intervention Work sessions to decide on intervention size and scope Build stakeholder support Meetings with MoH, community leaders, service providers, etc. Design training materials Work sessions to create curricula and job aids

  10. Phase 2: Implementing the Plan Examples of objectives/activities in the “implementing the plan” phase: Train ToTs Workshops to form cadres of trainers Train providers Workshops to introduce the intervention to providers Improve supervision system Consultations with supervisors to explain changes in system

  11. Phase 3: Initial service delivery Examples of objective/activities in the “service delivery” phase: New / improved service provision Additional time spent with clients Increased use of supplies and commodities Additional time spent by supervisors

  12. Economic Taxonomy of a Pilot Project Pilot Project Phase Activity Resource Cost

  13. Approach to Costing Identify resources used for each activity Labor Supplies Capital

  14. Approach to Costing, cont’ Measure resources in natural units hours, items, days of per-diem Assign Unit Value to each resource wage rate, unit cost Cost calculation for activity Σ (quantity of resource x unit cost)

  15. Costing a planning activity: MoH stakeholder meeting

  16. Costing an implementation activity: workshop for clinic staff

  17. Costing a service delivery activity: increased supervision visits

  18. How and where do we obtain data to cost out a pilot project?

  19. Retrospective vs. Prospective Retrospective data collection is the only option if the intervention has already been carried out Quality of data highly variable; depends on financial systems and reporting requirements of implementing agency Best case – worst case

  20. Prospective is Preferred The Ideal: build economic component into pilot project from beginning Assess routine financial reporting of implementing agency Build on existing systems for financial reporting Introduce forms to intervention staff Monitor. Monitor. Monitor.

  21. Example: CBD of DMPA What is DMPA? Progestin-only injectable contraceptive Highly effective (99%) when timely injections given over the first year Administered as an intramuscular Injection (IM) Fertility resumes after 4 months

  22. Facilitating Factors Government support is essential An active, strong CBD program Existing demand for injectables State-of–the art service guidelines Effective commodity logistics system

  23. Planning Phase for CBD of DMPA: Building Stakeholder Consensus Gauge support among national health authorities Create advocacy strategy Establish national core team Conduct sensitization meetings with various stakeholder groups

  24. Costing a planning activity: MoH stakeholder meeting

  25. Total Costs of Building Stakeholder Consensus

  26. Planning Phase for CBD of DMPA: Designing the Intervention Develop training curriculum Design supervision system Develop messaging strategy

  27. Total Costs of Designing the Intervention

  28. Planning Phase: Total Costs Stakeholder consensus $1,524 + Intervention Design $5,500 = Total Planning Cost $7,024

  29. Implementation of Plan:CBD of DMPA Intervention staff conduct TOT Trainers train CBAs in central location Improve supervision system Improve logistics system for commodities

  30. Costing an implementation activity: workshop for CBAs

  31. Total Costs of Implementing the Plan

  32. Initial Service Delivery Phase for CBD of DMPA More DMPA provided (maybe fewer OCs?) Increased supervision visits/content CBAs spend more time with clients

  33. Total Costs of Initial Service Delivery (6 months)

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