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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 PowerPoint PPT Presentation

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

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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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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

    • 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

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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:

  • Direct intervention costs (drugs, supplies, hospital beds, diagnostic tests)

  • Human resources

  • Infrastructure

  • Health systems strengthening

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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

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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:

  • 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

  • Overhead mark-up to direct cost of services

    • Estimate a percentage of direct cost of services as follows:

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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

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4. Checking Results

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

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