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Issues in costing cross cutting hss interventions in


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Issues in costing cross cutting hss interventions in

  1. 1. Issues in costing cross cutting HSS interventions in GFATM proposals Afghanistan experience Najibullah Safi, MD, MSc. HPM
  2. 2. Health system building blocks <ul><li>Health services </li></ul><ul><li>Health workforce </li></ul><ul><li>Health information system </li></ul><ul><li>Medical products, vaccines and technologies </li></ul><ul><li>Health financing </li></ul><ul><li>Leadership and governance </li></ul>
  3. 3. Areas covered under HSS <ul><li>Globally * : </li></ul><ul><ul><li>Human resources </li></ul></ul><ul><ul><li>Infrastructure and equipments </li></ul></ul><ul><ul><li>Communication </li></ul></ul><ul><ul><li>Training </li></ul></ul><ul><ul><li>Health product </li></ul></ul><ul><ul><li>Procurement </li></ul></ul><ul><ul><li>Monitoring and evaluation </li></ul></ul><ul><ul><li>Management </li></ul></ul><ul><ul><li>* Activities supported under GFATM R8 </li></ul></ul>
  4. 4. Areas covered under HSS cont. <ul><li>Afghanistan: </li></ul><ul><ul><li>Expansion of lab network (R8 &R10) </li></ul></ul><ul><ul><li>Training </li></ul></ul><ul><ul><ul><li>Long term programs (community nursing program (R8 &R10), FETP (R8), female community health supervisor (R10 )) </li></ul></ul></ul><ul><ul><ul><li>Short term programs </li></ul></ul></ul><ul><ul><li>Revision of HMIS (R8) </li></ul></ul><ul><ul><li>Technical support </li></ul></ul><ul><ul><li>Research </li></ul></ul><ul><ul><li>Salary support </li></ul></ul>
  5. 5. Measuring unit costs <ul><li>Unit cost: </li></ul><ul><ul><li>Relationship between financial investments and outcomes </li></ul></ul><ul><li>Required development of tools for standardized unit costing e.g. </li></ul><ul><ul><li>Cost per person-year of ART (variations) </li></ul></ul><ul><ul><li>Cost per DOTS patient treated (variations) </li></ul></ul><ul><ul><li>Cost per LLIN distributed (is this practical?) </li></ul></ul><ul><li>Routine unit costing is expected to: </li></ul><ul><ul><li>Improve budgeting, planning, and target setting </li></ul></ul><ul><ul><li>Optimize resource allocation </li></ul></ul><ul><li>Is this practical to calculate unit cost for HSS interventions? </li></ul>
  6. 6. Issues in costing, Afghanistan experience <ul><li>Lack of local expertise </li></ul><ul><li>HSS cover wide range of services (make it difficult to use standardized procedures/tools for costing) </li></ul><ul><li>Unavailability of costed national strategies and standard procedures for costing </li></ul><ul><li>Difficult to properly link inputs (investment) with outcome/impact </li></ul><ul><li>Inadequate preparation for proposal writing/costing </li></ul><ul><li>Significant proportion of budget goes to salaries (less structured) </li></ul>
  7. 7. Issues in costing, Afghanistan experience cont. <ul><li>Lack of required data for planning </li></ul><ul><ul><li>Estimation of the required quantities/number </li></ul></ul><ul><ul><li>Geographical distribution (cost varies) </li></ul></ul><ul><ul><li>Estimation of the unit cost (e.g. FETP, BHC labs) </li></ul></ul><ul><li>Too much assumptions </li></ul><ul><li>Duplication with the supported programs by other donors </li></ul><ul><li>Inflated budget </li></ul>