outline how costing pilot interventions differs from costing services phases of pilot interventions...
TRANSCRIPT
Measuring Costs of Pilot Interventions Measuring Costs of Pilot Interventions
John H. BrattJohn H. BrattSeptember 29, 2009September 29, 2009
Outline
How costing pilot interventions differs from costing services Phases of pilot interventions From phases to resources Converting resources into costs Data sources Example: Introducing CBD of DMPA
Average Costs of Health Services
•Health facility represents a production process (inputs-processes-outputs)•Defined outputs produced•Measured and costed all resources used to produce these outputs•Result: average cost per service
ART
CT
PMTCTOther
Program Costs
Incremental Costs Associated with Interventions
•Many health interventions begin as small pilot projects•Pilot projects often carried out within an existing program•Which costs should we consider?
Program Costs
Incremental Costs
Costs of a Pilot Project
Inputs OutputsProcesses (activities)
•Labor•Supplies•Capital
•Planning the intervention•Implementing the plan•Carrying out new service delivery
Increased or improved provision of services
Outcomes
•Higher use of ARVs•Improved Adherence •Higher PMTCT coverage
Economic Taxonomy of a Pilot Project
• Pilot Project– Phase
Phases of a Pilot Project
• Planning• Implementing the Plan• Initial service delivery
Economic Taxonomy of a Pilot Project
Pilot ProjectPhase
• Activity
Phase 1: Planning
Examples of objectives/activities in the planning phase:
Work sessions to create curricula and job aids
Design training materials
Meetings with MoH, community leaders, service providers, etc.
Build stakeholder support
Work sessions to decide on intervention size and scope
Design Intervention
Phase 2: Implementing the Plan
Examples of objectives/activities in the “implementing the plan” phase:
Consultations with supervisors to explain changes in system
Improve supervision system
Workshops to introduce the intervention to providers
Train providers
Workshops to form cadres of trainers Train ToTs
Phase 3: Initial service delivery
Additional time spent by supervisors
Increased use of supplies and commodities
Additional time spent with clients
New / improved service provision
Examples of objective/activities in the “service delivery” phase:
Economic Taxonomy of a Pilot Project
Pilot ProjectPhase
• Activity– Resource
» Cost
Approach to Costing
Identify resources used for each activity– Labor– Supplies– Capital
Approach to Costing, cont’
Measure resources in natural units– hours, items, days of per-diem
Assign Unit Value to each resource– wage rate, unit cost
Cost calculation for activity– Σ (quantity of resource x unit cost)
Costing a planning activity: MoH stakeholder meeting
Resource Quantity Unit Cost Total
Facilitator time 3 person-hours $18/hr $54
Facilitator travel 1 RT taxi $6/RT $6
Tea/snack 8 portions $2/portion $16
Grand Total $76
Costing an implementation activity: workshop for clinic staff
Resource Quantity Unit Cost Total
Trainer time 5 person-days $120/day $600
Lodging/food 24 person-days $80/day $1,920
Venue fee 3 days $60/day $180
Trainee time 21 person-days $8/day $168
Grand Total $2,868
Costing a service delivery activity: increased supervision visits
Resource Quantity Unit Cost Total
Supervisor time 3 person-days $80/day $240
Lodging 2 nights $50/night $100
Per-diem 3 days $60/day $180
Transport 3 days $100/day $300
Grand Total $820
How and where do we obtain data to cost out a pilot project?
Retrospective vs. Prospective
• Retrospective data collection is the only option if the intervention has already been carried out
• Quality of data highly variable; depends on financial systems and reporting requirements of implementing agency
• Best case – worst case
Prospective is Preferred
• The Ideal: build economic component into pilot project from beginning
• Assess routine financial reporting of implementing agency• Build on existing systems for financial reporting • Introduce forms to intervention staff • Monitor. Monitor. Monitor.
Example: CBD of DMPA
What is DMPA?• Progestin-only injectable contraceptive• Highly effective (99%) when timely injections given over the first
year• Administered as an intramuscular Injection (IM) • Fertility resumes after 4 months
Facilitating Factors
• Government support is essential• An active, strong CBD program• Existing demand for injectables • State-of–the art service guidelines• Effective commodity logistics system
Planning Phase for CBD of DMPA: Building Stakeholder Consensus
• Gauge support among national health authorities• Create advocacy strategy• Establish national core team• Conduct sensitization meetings with various stakeholder
groups
Costing a planning activity: MoH stakeholder meeting
Resource Quantity Unit Cost Total
Facilitator time 3 person-hours $18/hr $54
Facilitator travel 1 RT taxi $6/RT $6
Tea/snack 8 portions $2/portion $16
Grand Total $76
Total Costs of Building Stakeholder Consensus
Activity Quantity Unit Cost Total
MOH Meetings 4 meetings $76 $304
Sensitization meetings
8 meetings $140 $1,120
Advocacy Strategy 2 meetings $50 $100
Subtotal $1,524
Planning Phase for CBD of DMPA: Designing the Intervention
• Develop training curriculum• Design supervision system• Develop messaging strategy
Total Costs of Designing the Intervention
Activity Quantity Unit Cost Total
Training Curriculum 15 consultantdays
$200/day $3,000
Supervision System 5 consultant days $180/day $900
Messaging Strategy 1 package $1,600 $1,600
Subtotal $5,500
Planning Phase: Total Costs
Stakeholder consensus $1,524
+ Intervention Design $5,500
= Total Planning Cost $7,024
Implementation of Plan:CBD of DMPA• Intervention staff conduct TOT• Trainers train CBAs in central location • Improve supervision system• Improve logistics system for commodities
Costing an implementation activity: workshop for CBAs
Resource Quantity Unit Cost Total
Trainer time 5 person-days $120/day $600
Food/Lodging 24 person-days $80/day $1,920
Venue fee 3 days $60/day $180
Trainee time 21 person-days $8/day $168
Grand Total $2,868
Total Costs of Implementing the Plan
Activity Quantity Unit Cost Total
ToT workshop 1 $1,880 $1,880
CBA workshop 3 $2,868 $8,604
Supervisor training 3 $200 $600
Logistics upgrade 3 $85 $255
Total cost of “implementing the plan” $11,339
Initial Service Delivery Phase for CBD of DMPA• More DMPA provided (maybe fewer OCs?)• Increased supervision visits/content• CBAs spend more time with clients
Total Costs of Initial Service Delivery (6 months)
Activity Quantity Unit Cost Total
DMPA commodity 420 units $0.92 $386
Supervisor visits 3 visits $250 $750
Additional CBA time with clients
4200 minutes $0 $0
Total cost of initial service delivery $1,136