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					UNDP RBA Workshop on MDG-Based National Development Strategies

Module 4: Health Strategies

UN Millennium Project February 27-March 3, 2006

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

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The MDG Needs Assessment Approach

1.Identify interventions

2.Specify targets for each intervention 3.Estimate resource needs 4.Check results

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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)

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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

Access to Essential Medicines

• 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 5 www.unmillenniumproject.org

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”).

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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
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3. Estimating Resource Needs: A. Direct Intervention Costs

Country epidemiological data Country demographic data Target coverage rates

NO. OF CASES TOTAL COSTS

Intervention components and quantities Unit costs of components

COST PER CASE

• Drugs • Hospital bed and food • Laboratory costs • Other supplies

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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
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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

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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

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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

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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)
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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

15% of direct health costs including salaries
2% of direct health costs including salaries

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3. Estimating Resource Needs: Adding it All Up

Direct costs of all interventions

+

Infrastructure and HRH costs

+

Costs of health system strengthening

Total health costs

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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$ HIV/AIDS Prevention HIV/AIDS Care HIV/AIDS Treatment TB Malaria Prevention Malaria Treatment Maternal Heath Child Health Management Quality improvement Human resources (salary incr.) Community demand R&D capacity Infrastructure recurrent costs Total cost per capita ($)

2005 1.93 1.06 0.70 0.33 0.28 1.98 1.04 4.40 2.34 1.76 4.69 0.40 0.23 0.78 22

2010 2.75 1.38 6.00 0.33 0.51 2.03 1.56 4.51 3.82 2.86 7.64 0.86 0.38 0.72 35

2015 3.25 1.46 9.59 0.33 0.73 1.58 2.05 4.50 4.70 3.52 9.40 1.31 0.47 0.66 44

% of total in 2015 7% 3% 22% 1% 2% 4% 5% 10% 11% 8% 22% 3% 1% 2% 100%

Average 2005-15 $ 2.7 $ 1.4 $ 5.8 $ 0.3 $ 0.5 $ 1.9 $ 1.6 $ 4.5 $ 3.7 $ 2.8 $ 7.5 $ 0.9 $ 0.4 $ 0.7 35

% of total over period 8% 4% 17% 1% 1% 6% 5% 13% 11% 8% 22% 3% 1% 2% 100%

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