MBB Costing of the Ghana 5Yr POW 2007 – 2011 MBB Team

1. MBB Costing of the Ghana 5Yr POW 2007 – 2011 MBB Team Tuesday 17 APRIL 2007

2. Costing tool: Marginal Budgeting For Bottlenecks An analytical costing, planning and budgeting toolkit for evidence-based result-oriented health service management in developing countries

3. Marginal Budgeting for Bottlenecks (MBB) – a three questions tool • What are major health system bottlenecks hampering delivery of health services? • How much money (additional) is needed for expected results? • How much can be achieved in health outcomes by removing the bottlenecks?

4. Integration of Horizontal approaches Malaria Diarrhea HIV TB Pneumonia etc. Family oriented community based services Population oriented schedulable services Individual oriented clinical services

5. Service delivery mode & service package Environmental care Family neonatal care Infant and child feeding C-Integrated Management of Newborn & Childhood Illnesses Preventive care for adolescent girls & women Preventive pregnancy care HIV/AIDS prevention and care Preventive infant & child care Clinical primary level skilled maternal & neonatal care Clinical Integrated Management of Childhood Illnesses Clinical first referral illness management Clinical second referral illness management Family Oriented Community Based Services Population Oriented Schedulable Services Individual Oriented Clinical Services

6. Identifying bottlenecks Effective quality Timely continuous utilization Initial utilization Accessibility – physical access Availability – human resources Availability – essential commodities

7. Overview of the MBB Inputs Bottlenecks Health Output MDGs Outcome Essential drugs, commodities, safe water system, human resources. .. Availability ∆Cof health interventions delivered by Family/Community Support for community meeting, inputs for a mobile team, construction of health post etc. Impact on MDG health indicators: Reduction in U5MR and MMR Accessibility ∆Cof health interventionsdelivered by Outreach team Drugs and supplies, subsidies for insurance for referral care per user etc. Utilization Demand side subsidy, performance-based incentives for health workers, doctors, and IEC inputs etc. ∆Cof health interventionsdelivered by Clinics/Hospitals Continuity Cost of removing bottlenecks to achieve certain MDG target Training, supervision and monitoring of community mobilizers, primary and referral clinical care etc. Quality Aggregate cost of inputs

9. Potential causes and solutions to bottlenecks Potential causes: • Insufficient skills of TBA’s • Insufficient funds for TBA’s to purchase delivery kits Potential solutions: • Re-training of TBA’s • Policy to phase out TBA’s and phase-in midwives

12. Potential causes and solutions of bottlenecks Potential causes: • High staff attrition rate • Myths, rumours, misconceptions and communication problems Potential solutions: • Revise the implementation of present incentives policy • In-service training of existing staff • Train of mid-level cadres • Intensive IEC / BCC

15. Potential causes and solutions to bottlenecks Potential causes: • Inadequate recognition of pneumonia • Inadequate resources for training nurses • Long length of the IMCI training • Potential solutions: • Intensify IEC for care givers • Expand training institutions and strengthen existing training institutions • Update the curricula of training institutions

17. Investment and impact on MDGS $31.73 $17.95 $11.81 $1.97

18. Cont. $50.7 $40.04 56.22 $4.01

19. Investment & impact on MDGs $62.7 $50.24 58.67 $3.78

20. MDGs Impact

21. MDGs Impact

22. Thank You