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MBB Application Update. Dept. of Planning and Finance. Content. To update the Health Partnership Group on the main developments with respect to the application of the Marginal Budgeting for Bottlenecks (MBB) approach to 6 National Targeted Programs in Viet Nam Background Main features

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mbb application update

MBB Application Update

Dept. of Planning and Finance


To update the Health Partnership Group on the main developments with respect to the application of the Marginal Budgeting for Bottlenecks (MBB) approach to 6 National Targeted Programs in Viet Nam

  • Background
  • Main features
  • Developments
  • Preliminary results - Discussions
  • Recommendations
mbb application overall view
MBB application – overall view
  • Though rapid and sustained progress on a number of the health related Millennium Development Goals, Viet Nam still faces many challenges. Under nutrition, old (TB) and new (H1N1) infectious diseases under the constraints of national budgets and issues of equity of access, outcomes, and financing
  • Current system of planning, budgeting, and allocating scarce resources is not well suited to meeting the health challenges in Viet Nam
  • The Consultation on Equity in the Access to Quality Health Care of Women and Children, which was held in April 2008 in Quang Ninh led to a series of decisions by Government
mbb application overall view cont
MBB application – overall view (cont.)
  • MBB as a trial towards a more evidenced and results based approach to achieving important national health targets,
  • The first phase was designed to focus on 6 NTPs, namely: (1) Tuberculosis; (2) Nutrition; (3) Expanded Program of Immunization; (4) Malaria; (5) HIV/AIDS; and (6) Maternal Health
  • A substantial work/workload has been accomplished by a Government led team with technical support from UNICEF
mbb some main features
MBB- Some main features
  • An Excel based software package initially developed by UNICEF and the World Bank and later on adopted by the UN system
  • MBB is a results-based planning and budgeting tool using an Excel based software package
    • (i) focuses attention on the most important gaps and barriers
    • (ii) provides a menu of interventions with a strong, scientific evidence base that can be used on the demand side, or supply side, of health care; and
    • (iii) estimates the total extra ("marginal") investment cost to achieve increased progress
recent developments
Recent developments
  • Further refinement in discussion with WHO and other technical experts at the international level --- a wider choice of evidenced base interventions to choose from.
  • Intense data cleansing and testing of the model.
  • Preliminary results were generated (and were informally presented to several development partners, including ADB, WHO, and World Bank)
discussions preliminary outcomes
Discussions – preliminary outcomes
  • The analysis finds potentials to reduce under-five mortality, and maternal mortality, and accelerate achievement of the MDGs rapidly over time, and at relatively little per capita cost.
  • The analysis indicates significant gains in health and equity are available for relatively little additional cost by addressing "missed opportunities"
  • The analysis suggests to invest more in first and second level curative care, including Comprehensive Emergency Obstetric Care (CEOC)
discussion advantages
Discussion - Advantages

MBB- a tool with a relatively comprehensive and systematic approach - can support innovative changes in planning and marginal budgeting in Viet Nam. The MBB application promotes use of evidence for policy making, planning and budgeting

direct attention on good quality data for decision making.

ask right question to navigate key gaps and barriers in the health system in order to facilitate right investment of limited resources on addressing key bottlenecks/ issues with strategic focus and rational allocation of priorities



Discussion – Advantages (cont.)

2. MBB can contribute significantly to joint/united efforts for substantial move towards result-based policy making

discussion limitations
Discussion - Limitations
  • Recommendations are dependent on the extent and quality of data though intensive cleansing of data has been undertaken.
  • As the approach is focused on MDG targets, non communicable diseases and accidents are not captured.
  • The potentials that private sector could offer to the system have yet to be taken into account.
  • The efficacy of recommended interventions is assumed on basis of international evidence while actual implementation may be at variance.
next steps recommendations
Next steps - Recommendations

1. The results are sufficiently advanced that they can serve as a basis for consideration by the Ministry of Health and the Government of Viet Nam:

--- It will be important to decide exactly how any decisions arising from this analysis are linked into the Government's Medium Term Expenditure Framework. It is also important that initiatives and interventions based on the MBB exercise could be implemented in a pilot scale, and with careful M&E of the costs, and consequences

2. As the results are preliminary, ongoing refinement and improvement are needed.

3. The views of Development Partners, and other stakeholders, will be an important part of the entire process.