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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


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


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


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)


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


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”).


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


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




Intervention components

and quantities



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


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


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


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


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)


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:


3 estimating resource needs adding it all up
3. Estimating Resource Needs:Adding it All Up

Costs of

health system


Direct costs

of all


Infrastructure and HRH costs



Total health costs


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