Social Return of Investment of Health Promotion by Dr. Poranee Laoitthi


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The presentation was shown during the Healthy People, Wealthy Nation Forum last January 29, 2014.

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Social Return of Investment of Health Promotion by Dr. Poranee Laoitthi

  1. 1. Poranee Laoitthi Piya Hanvoravongchai Faculty of Medicine, Chulalongkorn University Bangkok Thailand. 29 Jan 2014
  2. 2. •  Social Return On Investment (SROI) Evaluation Concept •  SROI for tobacco control by ThaiHealth •  Results •  Discussion and Limitations
  3. 3. What is Social Return on Investment (SROI)? SROI is “a way of understanding how effectively money is spent.” • SROI = Value of Benefits Investment Example: SROI = 10 Every Source: NEF Consulting Group $1 investment equals to social return of $10
  4. 4. SROI & Value for Money Concept have been used: “VfM is defined as the optimum combination of whole-of-life costs and quality (or fitness for purpose) of the good or service to meet the user’s requirement. VfM is not the choice of goods and services based on the lowest cost bid.” UK HM Treasury (2006) Value for money guidance
  5. 5. Triple Bottom Line Measurement of values across the ‘triple bottom line’ The economy The environment People Source: NEF Consulting Group
  6. 6. SROI Principles 1. Involve Stakeholders 2. Understand what changes 3. Value the things that matter 4. Only include what is material 5. Do not over claim 6. Be transparent 7. Verify the result Source: NEF Consulting Group
  7. 7. Stages of an SROI analysis 1.  Engage stakeholders to identify outcomes •  Theory of Changes •  inputs > activities > outputs > outcomes 2.  Data collection •  Outcomes •  Impacts: Deadweight, Attribution, Displacement •  Benefit period and drop off 3.  Model and calculate: Valuation of outcomes 4.  Report
  8. 8. Measuring & Valuing Outcomes Outcomes Indicators Monetary Value Outcome incidence (Monetary Unit)
  9. 9. Assessing Impacts outcome incidence Minus deadweight incidence what would have happened anyway Multiply by attribution rate Minus displacement The proportion an organization can take credit for social benefit value moved from elsewhere
  10. 10. SROI of ThaiHealth: Tobacco Control ตัวอย่างการประเมินการลงทุน ของ สสส. โดยใช้ SROI
  11. 11. SROI  evalua+on  using  macro   perspec+ve •  SROI  Assessment  can  be  done  at  the  project  or   aggregate  level.     •  ThaiHealth  supported  1,000++  projects   •  Several  projects  address  small  specific  acBviBes   that  may  not  be  directly  linked  to  key  outputs/ outcomes     •  Assessing  each  project  may  not  be  appropriate:   –  Do  not  cover  the  whole  spectrum  of  desired  outputs/ outcomes     –  May  double  count  some  of  the  expected  outputs  
  12. 12. Outcome measurement Economy Environment Social and Health •  Household spending on cigarettes and tobacco Cancelled out •  Economic returns to producers and sellers • Health and well being of smokers averted: Avoidable health spending & productivity gained from avoided illnesses • Family mental health: willingness to pay • Societal benefit: willingness to pay
  13. 13. Modeling changes in outcome indicators •  Use data on Tobacco consumption from National representative surveys done by National Statistics Office (10 x-sectional datasets from 1986- 2009) •  Estimate cohort specific pattern of smoking prevalence across datasets (sex & year-of-birth cohorts) based on pre-ThaiHealth patterns •  Estimate smoker prevalence of each cohort if ThaiHealth does not exist •  Calculate averted smokers from actual vs estimated smokers in each cohort for 2001-2010
  14. 14. Prevalence in Male by age cohorts
  15. 15. Monetary value of averted smokers Physical health = Avoidable health expenditure & productivity gained = (no. of smokers averted by age-sex)* (estimated health spending and productivity lost for one smoker by age-sex) Note: value of health spending and productivity lost per smoker from Montarat Thaworncharoensup et al 2011
  16. 16. Valuing Outcomes Family mental health •  Willingness to pay of family with smokers* numbers of households with averted smokers Societal benefit =willingness to pay of general pop to have one fewer smoker
  17. 17. Valuing Outcomes Physical Health Family Mental Health Societal benefit Total = 29,257,469,937.0 + 29 Bil Baht (-405,467,511.0) = 3,546.39 baht *268,576 households 952 Mil Baht = 898 baht * 324,074 averted smokers 291 Mil Baht 30 Bil Baht
  19. 19. Investments by ThaiHealth 1.4 Bil baht Indirect  cost Office  1 program 1 Admini stratio n cost Program 2 Program 3 Office 5 Program 10 program program Program 1.36 Bil baht Direct cost23 mil baht Indirect 43.7 mil baht Financial support to program Public communi cation Source: HITAP
  21. 21. Calculation SROI SROI ratio is 18.3:1. (12.5-19.8) For the equivalent of 1 baht invested in tobacco control program, 18.3 baht return on social value.
  22. 22. Limitations and suggestion •  Does not include all results that can not be easily valued e.g. changes in social norms •  Financial proxies may be difficult to measure e.g. WTP for social benefits •  There might be biases from the involvement of stakeholders in determining attribution level •  Activities may effect future preventable smokers; these were not taken into account in this study. •  Did not consider displacement into other negative behavior e.g. drug use. •  Equity blinded (no assessment of equity dimension)