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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

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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

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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
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

the mdg needs assessment approach3
The MDG Needs Assessment Approach

1.Identify interventions

2.Specify targets for each intervention

3.Estimate resource needs

4.Check results

3

1 choosing interventions
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

1 choosing interventions5
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

2 defining and setting targets outcome targets
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

3 estimating resource needs
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

3 estimating resource needs a direct intervention costs

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

3 estimating resource needs b human resources
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

3 estimating resource needs b human resources10
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

3 estimating resource needs b human resources11
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

3 estimating resource needs c infrastructure
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

3 estimating resource needs d health systems strengthening
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

3 estimating resource needs d health systems strengthening14
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

3 estimating resource needs adding it all up
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

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

16

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