estimating the returns of investing in RMNCH

1. estimating the returns of investing in RMNCH Malcolm Bryant and Susan Foster

2. Overview • Why calculate ROI • Overall approach • Developing a framework for policy-makers • How it will work • Challenges

3. Why calculate returns on investment for RMNCH? • Economic benefits of investing in health have been calculated for a range of populations and diseases • Identification of the economic benefits of investing in HIV, TB, malaria—presented persuasive cases • Financing agencies understood these arguments, and as a result, increased funding • RMNCH have not benefitted from the same form of detailed analysis • Country-level decision-makers require tools to understand and support RMNCH

4. Overall approach • Review and list the RMNCH challenges faced by women and their children in low-income environments • Identify the major health, social, and other impacts of each challenge • Identify the economic impact of each challenge

5. Creating a framework • Identify the most important costs associated with each impact • Use an expanded cost-of-illness approach; • Capture direct and indirect costs; • Individuals • Households • Healthcare systems • Societies

6. Populate the framework • What data is required to estimate each cost at the national level? • What are the possible sources of such data in typical country settings? • Current burden of morbidity and mortality • Unit costs to estimate the cost of illness • Estimate current costs of providing RMNCH interventions and services • Identify data needed to calculate productivity losses

7. How will it work? 1. What are the RMNCH challenges? • All common maternal, neonatal, and childhood illnesses and conditions! • How to make sense of them? • The Continuum of Care

9. Adolescence and before pregnancy

10. Selecting priorities • RMNCH is infinitely complex (it makes HIV, TB, and Malaria seem simple). We have to make rational choices about which impacts to address • Proposed Criteria: • Must be proven interventions to address impact • Feasibility • Political visibility • Attractive to politicians and can be understood by them • Evidence of cost-effectiveness

11. Possible criteria that could be used • Health services costs averted • Lives saved – RMNCH is unique in being able to save more than one life with one treatment episode, e.g. a mother and the baby • Long term sequelae of birth injuries, e.g. asphyxia - need for lifetime of care, low or no income earning, etc. • Long term sequelae of maternal injuries e.g. fistula – divorce, stigma • Indirectly, loss of a mother often means poor survival of remaining children • Increasing under five survival has a disproportionate effect on national life-expectancy • Societal costs – low morale, fatalism, orphans, widowers

12. Who is our target audience • International funding agencies? • Politicians and policymakers at national level • Ministry of Finance • Ministry of Health • National medical and nursing staff and thought leaders • Local politicians and funding groups in decentralized settings

13. How closely to link with health and non-health solutions Where does female education fit in with this?

14. Next Steps • Link RMNCH challenges to health, social, economic and other impacts • Estimate the costs to the individual, household, community, health system, and country of each impact • Create a simple tool that can be used to estimate the costs • Simple is key. Methodological soundness is required, but a balance must be maintained between the perfect and the practical