1. Contextualizing Case
Management Costs
in OVC Programs
Results Presentation
Stacie Gobin, MPH, Senior Health Economist
Shaylen Foley, MPH, MEL Specialist
MEASURE Evaluation
Palladium
May 2018
© 2017 Uganda, Shaylen Foley

2. Global, five-year, $232M cooperative agreement
6 partners, led by the University of North Carolina at Chapel Hill
Strategic objective:
Strengthen capacity in developing countries to gather,
interpret, and use data to improve health

3. • Prime: UNC-CH and partners:
• ICF
• John Snow, Inc.
• Management Sciences for Health
• Palladium
• Tulane University
• MEASURE Evaluation works with more than
72 smaller sub-awardees in over 27
countries
• Over 26 percent of project funding goes
back to minor sub-awardees
Local partners and capacity
building are key

4. Global Footprint (more than 40 countries)

5. Outline of the Webinar
1. Overview
2. Program Features
3. Case Worker Context
4. Case Management Costs
5. Conclusions
© 2016 Riccardo Gangale/VectorWorks , Photoshare

6. Overview

7. Objective
To provide cost estimates of OVC case management,
as defined by 4Children
To explore the context of case worker costs
Purpose
To improve understanding of OVC expenditures going
towards case management and its relative
components, supported by contextual data on case
worker experiences
To assist Missions with utilizing OVC cost data for
planning and resource allocation
Study Overview

8. Methodology
Mixed-methods cost analysis
• Selected programs in six
countries: Nigeria, Rwanda,
South Africa, Tanzania,
Uganda, and Zambia
• Collected financial data
• Conducted 184 qualitative
interviews
• Qualitative content analysis
• Determination of cost elements
and allocation of costs
© 2006 Babafunke Fagbemi, Photoshare

9. OVC Case Management
Cross-Cutting Case
Management Program Features
Supervision cascades
Government involvement
Case worker (CW) context:
CW education / qualification
CW training
Caseload
CW compensation

10. Program Features

11. Program Features
Rwanda Tanzania Uganda South
Africa
Zambia Nigeria
Program
Name
Turengere
Abana
Kizazi Kipya Better
Outcomes
GCBS Zamfam STEER
Implementing
Mechanism
Program
Structure
FXB Rwanda
No partners /
CSOs
Pact
5 Partners &
48 CSOs
World
Education
4 Partners &
7 CSOs
Pact
Support Dep.
of Social
Devel.
ECR
3 Partners &
73 CBOs
Save the
Children
2 Partners &
58 CSOs
Beneficiaries
(OVC & CG)
16,401 493,743 110,484 215,000 111,569 328,045
Setting Rural Both Rural Both Both Both

12. Big-Picture
Differences
• Supervision cascade
• Government
involvement
• Case worker attributes
© 2016 Simi Vijay, Photoshare

13. Supervision Cascade
Rwanda: Turengere Abana
National
Office
•Administrative/Leadership positions
•M&E support
Regional
Offices
•Regional managers: Supportive supervision,
training cascade support
Field
•Field facilitators: direct supervision of PSW (case
workers), cascade training, case file and
document management
•PSW: home visits, ISLG leadership
Program Structure

14. Supervision Cascade
Uganda: Better Outcomes
National
Level
• Case management oversight
• Administrative support
Regional
Level
• Regional support roles
District
Level
• Indirect CW
supervisors
County
level
• Direct CW
supervisors
Subcounty
• Case workers
• CW counterparts
District:
DCDO
County:
Probation
Officer
Subcounty:
CDO
Government CounterpartsProgram Structure

15. Government Involvement
• Much variation in role and degree of
government involvement
• All had some kind of engagement at
the local or regional/national level
• Identification of beneficiaries
• Selection of case workers
• Referrals to government resources
• Training support
• Case worker supervision

16. Case Worker Context

17. Contextual Findings
Case Worker Education
0
2
4
6
8
10
12
14
16
18
20
Grade 1-7 Grade 8-9 Grade 10-12 Certificate Bachelors
NumberofCaseWorkers
Education Level by Country/Program
Rwanda Tanzania Uganda South Africa Zambia Nigeria

18. Contextual Findings
Case Worker Qualifications
Rwanda Tanzania Uganda South Africa Zambia Nigeria
CW
Requirements
Read/write
Selected by
peers in
savings
group
Read/write
Less than 55
Primary
education
Pass
interview
Read/write
Chosen by
local council
Read/write None
(most can
read and
write)
Assessment/
interview
Identified by
peers
Read/write
Pass written
exam &
interview

19. Rwanda Tanzania Uganda South Africa Zambia Nigeria
Monetary and
non-monetary
compensation
(monthly)
Unpaid
Intangible
benefits (and
receive
beneficiary
services)
Stipend
($21 USD)
Materials
(not yet
received)
Stipend
($5.50 USD)
Materials
Stipend
($120 USD*)
*paid by
government
Unpaid
Materials
Training
certification
Salary
($55 USD)
Contextual Findings
CW Compensation
CW Perception of Compensation:
• Payment or increased pay would provide motivation
• Help cover costs of the role (communication,
transport, beneficiary needs)
• Enable case workers to spend more time (and less
time on other work)

20. Contextual Findings
CW Training
Various training approaches were observed:
• In-service/supervision (Rwanda)
• Cascaded ToT trainings (Tanzania, Zambia)
• Mixture of formal trainings and in-service trainings
(Uganda, Nigeria, South Africa)

21. Contextual Findings
CW Tools
• All programs used paper tools
• Number of case worker tools ranged from
three forms (Uganda) to seven forms
(Tanzania and Zambia)
• Challenges were not frequently reported
with using the tools but refresher trainings
commonly requested

22. Contextual Findings
CW Caseloads
Rwanda Tanzania Uganda South Africa Zambia Nigeria
Avg. # of HH
Range
21.7 HH
10-30 HH
18.1 HH
5-40 HH
12.2 HH
8-16 HH
32.6 HH
10 – 53 HH
9.8 HH
4-25 HH
30.9 HH
26-42 HH
Avg. # of
beneficiaries
49.2
(est.)
39.2
(est.)
72.2
(est.)
71.3 (report) 22.2 (report) 117.2
(report)
CW Perception of Caseload:
• Reporting/defining caseload was challenging; found large
regional variation
• Caseload burden is related to time spent at households, travel
time, and visit frequency
• Severe cases added to perceived burden when reported

23. Contextual Findings
CW Supervision
Rwanda Tanzania Uganda South Africa Zambia Nigeria
Supervision
Ratio
17.8 88.7 36.0 Not reported Not reported 4.3
Frequency of
Contact
Monthly
(formal)
Weekly
(informal)
Monthly
(formal)
Monthly
(formal)
Weekly
(informal, with
government
supervisor)
Weekly
(formal)
Monthly
(formal)
Monthly
(formal)
Biweekly or
weekly
(informal)

24. Case Management Costs

25. Case Management Costs
Cost Categories
Supervision
Direct supervisor salaries
Indirect supervisor salaries (supervision cascade)
Training
Case worker case management training costs
Staff training case management costs
Transport
Travel costs for supportive supervision
Vehicle or motorbike expenses
CW Support
CW stipends and materials/supplies
Monthly meeting costs
Mobile phone/communication costs
Printing of CM tools/forms
General Personnel Administrative staff costs
Office Costs
Recurrent office expenses
Office supply costs
M&E M&E costs related to case management

26. Rwanda Tanzania Uganda Zambia South Africa Nigeria
Study time
period
Oct 2015 to
May 2017
4.7 YEARS
Oct 2016 to
Sept 2017
1 YEAR
April 2015 to
Sept 2017
2.5 YEARS
Jan 2015 to
Dec 2017
2 YEARS
Oct 2016 -
Sept 2017
1 YEAR
Sept 2013 to
Sept 2017
4 YEARS
Financial
data
Expenditure
data
Expenditure
& budgetary
data
Budgetary
data
Budgetary
data
Expenditure
data
Expenditure
data
Outcome
measure
Total served
count
OVC_SERV*
Total served
count
Total served
count
OVC-SERV*
Sum of newly
enrolled
beneficiaries
Case Management Costs
Data Characteristics
*per MER 2.0 Guidance, only Q4 counts were used for OVC_SERV

27. Case Management Costs
Rwanda, Turengere Abana
Supervision,
44.7%
Training,
8.9%
Transport
ation,
22.4%
CW
Support,
1.2%
General
Personnel,
21.2%
Office
Support,
1.1%
M&E,
0.5%Annualized
Cost of Case
Management
% of Total
Program Cost
Cost per
Beneficiary
$76,621
22%
$21.96

28. Supervision,
5.1%
Training,
56.8%Transport
ation,
5.5%
CW
Support,
14.0%
General
Personnel,
9.0%
Office
Support,
9.2%
M&E,
0.4%
Case Management Costs
Tanzania, Kizazi Kipya
Annualized
Cost of Case
Management
% of Total
Program Cost
Cost per
Beneficiary
$8,061,375
42%
$15.98

29. Supervision,
10.4%
Training,
8.4%
Transportation,
5.4%
CW
Support,
35.6%
General
Personnel,
25.2%
Office
Support,
10.2%
M&E, 4.8%
Case Management Costs
Uganda, Better Outcomes
Annualized
Cost of Case
Management
% of Total
Program Cost
Cost per
Beneficiary
$2,093,697
55%
$47.38

30. Case Management Costs
South Africa, GCBS
Annualized
Cost of Case
Management
% of Total
Program Cost
Cost per
Beneficiary
$1,796,006
5%
$8.35
Supervision,
27.7%
Training,
6.8%
Transportation,
3.0%CW
Support,
2.2%
General
Personnel,
52.8%
Office
Support,
4.1%
M&E,
1.6%

31. Supervisi
on, 16.5%
Training,
32.9%
Transportation,
4.9%
CW
Support,
14.2%
General
Personnel
, 22.3%
Office
Support,
3.0%
M&E,
6.3%
Case Management Costs
Zambia, ZamFam
Annualized
Cost of Case
Management
% of Total
Program Cost
Cost per
Beneficiary
$2,784,349
%22%
$50.41

32. Case Management Costs
Nigeria, STEER
Annualized
Cost of Case
Management
% of Total
Program Cost
Cost per
Beneficiary
$1,782,441
%33%
$21.73
Supervision,
34.6%
Training,
5.5%
Transport
ation,
4.0%
CW
Support,
19.4%
General
Personnel,
27.7%
Office
Support,
6.5%
M&E,
2.3%

33. Rwanda Turengere Abana
Expenditure Category Costs from FXB Total %
Supervision $ 160,948 44.7%
Direct Supervision $ 100,504
Supervision Cascade $ 60,4424
Training $ 32,092 8.9%
CW Training $ 28,907
Staff Training $ 3,185
Training Support
Travel/Transportation $ 80,682 22.4%
Field Staff and CW $ 19,851
Other Travel/Supervision Cascade $ 47,642
M&E Travel $ 13,189
CW Support $ 4,144 1.2%
CW Stipends and Materials
Printing of Tools $ 4,148
Monthly Meeting costs
Communication Costs
Other Costs $ 80,479 22.3%
M&E Support $ 1,776
Labor and Personnel General $ 76,366
Non-CM Specific Office Support $ 4,112
Total Cost of Case Management $ 360,120 22%
Annualized Cost (4.75 years) $ 76,621
Cost per Beneficiary $ 21.96

34. Tanzania Kizazi Kipya
Expenditure Category Pact HQ JSI Pact CBOs Total %
Supervision $ 401,097 5.1%
Direct Supervision $ 123,596
Supervision Cascade $ 131,270 $ 146,231
CM & Related Training $ 4,482,213 56.8%
CW Training $ 3,608,149 $ 212,786
Staff Training $ 49,773 $ 154,528 $ 319,178
Training Support $ 116,138 $ 21,661
Travel/Transportation $ 432,646 5.5%
Field Staff and CW $ 94,952
Other Travel/Supervision Cascade $ 229,824 $ 107,871
CM and CW Support $ 1,103,369 14.0%
CW Stipends and Materials $ 782,850
Printing of Tools $ 25,082 $ 104,968 $ 67,296
Monthly Meeting costs $ 3,134
CW Identification Costs $ 73,872
Beneficiary Identification Costs $ 8,631
Communication Costs $ 37,537
Other Costs $ 1,468,364 18.6%
M&E Support $ 33,942
Labor and Personnel General $ 465,901 $ 243,719
Non-CM Specific Office Support $ 195,030 $ 529,773
Total Cost of Case Management $ 7,887,689 41.1%
Annualized Cost (1 year) NA
Cost per Beneficiary $ 15.98

35. Uganda Better Outcomes
Expenditure Category Cost from WEI
Costs from
Partners
Costs from
CSOs
Total %
Supervision $ 545,848 10.4%
Direct Supervision $ 14,621 $ 80,303 $ 88,934
Supervision Cascade $ 210,054 $ 86,063 $ 65,873
CM & Related Training $ 437,834 8%
CW Training $ 101,707 $ 274,928 $ 3,012
Staff Training $ 20,296 $ 1,289
Training Support $ 7,868 $ 22,641 $ 6,092
Travel/Transportation $ 284,448 5.4%
Field Staff and CW $ 95,449 $ 51,305
Other Travel/Supervision Cascade $ 137,694
CM and CW Support $ 1,863,816 35.6%
CW Stipends and Materials $ 124,182 $ 120,558 $ 191,578
Printing of Tools $ 15,922 $ 6,610 $ 19,822
Monthly Meeting costs $ 121,600 $ 3,904 $ 4,529
Identification Costs $ 671,598 $ 3,612
Referral Costs $ 49,175 $ 124,232 $ 302,332
Communication Costs $ 79,557 $ 17,127 $ 7,478
Other Costs $ 2,102,297 40.2%
M&E Support $ 135,363 $ 45,783 $ 67,833
Labor and Personnel General $ 606,708 $ 553,321 $ 157,477
Non-CM Specific Office Support $ 412,264 $ 66,314 $ 57,234
Total Cost of Case Management $ 5,234,244 55%
Annualized Cost (2.5 years) $ 2,093,697
Cost per Beneficiary $ 47.38

36. Case Management Costs
• Cost per beneficiary range from $9 to $50
• Large portion of program expenses contribute
to case management (except in SA GCBS)
• Distribution of expenditures reflect program
structure and approach
Summary

37. 4Children Definition
Costing the CM process
RWANDA
Identification Assessment/
Enrollment/
Case Plan
Development
Implementation/
Monitoring
Graduation
21% 25% 35% 19%

38. Conclusions

39. Findings Summary
• Case management viewed as integral to
program delivery, but challenging to define
costs and activities attributable to CM
• High staff reported LOE estimates contributing
towards CM, even at above-field level
• 22% - 55% of total expenditures on CM
• Supervision and training structure reflected in
cost distribution, ie. Rwanda & Tanzania
• High CW demand for in-service training, especially
in programs with pre-service training focus
• Supervision marked by informal communication
not reflected in expenses

40. Findings Summary
• Direct case worker expenditures mostly cover
printing of tools, meeting costs, &
compensation
• Case worker pay is low relative to other
staffing costs
• Stipends used to cover out-of-pocket expenses on travel,
emergency cases, direct beneficiary assistance, &
communication
• When tangible material benefits are provided, they are
often perceived as poor quality (i.e. bags) or poor fit for case
worker needs (i.e. oversized record books)
• Challenges with balancing caseload and
supervisor ratios

41. Implications
• Case management approach reflected in
costs – highlighting need for activity based
budgeting
• Clarification of the definition of case
management as an intervention is needed,
using 4Children process definition as
foundation
• Case worker costs should be reviewed to
assess adequacy of compensation for
covering CW expenses, particularly for
transportation and emergency cases

42. Conclusions
• Investment in OVC programs requires high
quality and accessible case management
• Engagement with national and international
stakeholders to:
Support OVC strategic objectives
Prioritize cost-effective services
• Focus on domestic resource mobilization in
light of the PEPFAR shift to epidemic control

43. Questions?
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Please submit all
questions to the Q&A
box on your screen.

44. This presentation was produced with the support of the United States
Agency for International Development (USAID) under the terms of MEASURE
Evaluation cooperative agreement AID-OAA-L-14-00004. MEASURE
Evaluation is implemented by the Carolina Population Center, University of
North Carolina at Chapel Hill in partnershipwith ICF International; John
Snow, Inc.; Management Sciences for Health; Palladium; and Tulane
University. Views expressed are not necessarily those of USAID or the United
States government.
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