Costing a national health plan

Enhancing capacity for budget analysis and advocacy 27 – 30 August 2013, Ole Sereni Hotel

Nairobi, Kenya

Dr. Dheepa Rajan Health Systems Governance, Policy, and Aid Effectiveness Unit,

World Health Organization, Geneva

STRATEGIC PLANNING AND COSTING ARE 2 SIDES OF THE SAME COIN

1. Priorities Even strong governments are faced with pushes and pulls

from all sides – external aid, vested interests, etc. need to be adequately managed.

Complex challenges mean making investment choices. 2. Process A country-led participatory policy dialogue is fundamental 3. Investments Building a health system requires sustained, balanced

investment across the health system building blocks and national programmes

NEW HEALTH INITIATIVES SINCE 2000.. .

ECC

MOH (15 Staff)

Damian Foundation

Memisa

Cordaid

Oxfam GB

Cemubac

Int and Nat NGO's (Development and church related)

INGO's (Emergency)

Multilateral agencies

MSF Belgium

BASICS

Caritas

CRS

Louvain development

Bilateral Funding / Technical agencies

Fometro World Vision

BDOM

Salvation army

Asrames

World bank

More than 200 health partners

State and Parastatal organisations

Fonds Social de la République

BCECO

13 MoH Departments

53 specialised programs

11 provincial management team

11 Provincial Ministries of Health

Ministry of Finance

Ministry of Education

Faculties of Medicine

Schools of Public Health

Novib

Merlin

Sanru

Gavi

ECHO

UNFPA

UNAIDS

UNICEF EU UNHCR

WHO

IMF

Global Fund

WFP

13 Donor Government program coordination committees

Apefe

PSF-CI

GTZ

SIDA

ACDI BTC CTB

USAID

DFID

BAD

VVOB

[Source: Porignon, WHO, 2008]

IHP+

INEFFICIENT AID Procurement systems - Kenya

Source: Kinzett, 2007.

1.1 Family Health Services 1.2 HIV 1.2 malaria1.2 others 1.3 hygiene and environment 1.4 curative1.service delivery and quality of care 2.physical access, transportation 3.human resources deve4.strengthening pharmaceuticals sector 5.IEC BCC 6.HMIS/management7. Health care financing 8.crosscutting

HIV

HIV

MCH

Malaria

MCH

Health System

HRH: Human resources for health I&E: Infrastructure and equipment L&M: Logistics and medicine (L&M)

HIS: Health information systems L&G: Leadership and governance HFA: Health financing activities

Findings from a review of national health plans

(25 LI countries) ONE COUNTRY

CHALLENGES

Increasing expectations on the health system ……

Increased spending (in some areas) in health …

Changing epidemiology & population structure (e.g. NCD/aging) ...

Calls to scale up …

Rise of the private sector …

Recognition of multi-sectoral nature of health (SDH) …

... but increasing dissatisfaction with health services

… but is there value for money? … but MDGs 4 and 5 at risk

… but capacity lacking, especially across the system

… but clear rules of engagement often lacking

… but coordination is problematic

GOVERNMENTS NEED TO...

... Set priorities (costing…)

... Make choices

... Balance different interests

But the process is not simple, not linear

PROCESS

HEALTH POLICY AND PLANNING

More than the sum of programme plans such as MCH, TB, NCDs …

Blueprints won't work It is not only the "plan“-

the process is more important!

… but the process is usually messy…

Priority setting and costing

This is why inclusive and procedural policy dialogue is key

Idealized

Bottom-up participatory planning cycle

CSO

CSO

CSONGO

NGO

GHI partners

5 year plan

Annual Review

Annual Review

Annual Review

Annual Review

Political priorities

partners

Lobbies

Elections

Programmes

Private sector 5 year plan

Government plan

Operational plan disease x

Civil service reform

dea sed p a g p ocesses

Real-life planning processesReal life

MATERNAL AND CHILD HEALTH – A KEY OUTCOME IN NATIONAL HEALTH PLANS

National health plan

Maternal & child health

MDG 4 & 5

Regional maternal & child health strategies in all WHO regions

The Global Strategy for Women's and Children's Health

Source: Thierry Lambrechts, 2013

PLANNING AND MANAGEMENT CYCLES

Develop

implementation plan (1-2 yearly)

Prepare for review of implementation

status (1–2 yearly)

Evaluate programme

coverage and health impact (5-

10 yearly)

E.g. DHS, MICS

Develop strategic plan (5-10 yearly)

Manage

implementation (Ongoing)

National Health Plan

Source: Thierry Lambrechts, 2013

NHPSP and performance monitoring

Malaria

Inputs Outputs Outcome Impact

RMNCH

HIV/AIDS

Tuberculosis

NCD & injuries

HSS

Nutrition

- aligning efforts with the systems countries use to plan, monitor, and evaluate their national health strategies and specific health programmes;

Principle of accountability

A good costing process helps aligning programme specific plans with national health plans

Source: Thierry Lambrechts, 2013

Steps for strategic planning

COSTING

A good (RMNCAH) program strategic plan is a pre-requisite for sound inputs to a National plan…and a good national plan should reflect key (RMNCAH) program issues The (RMNCAH) program strategic planning

cycle should be synchronized with the national health planning cycle

SITUATION ANALYSIS

Scale up: • Rota virus and pneumococcal vaccines 0-90 %

SUMMARY OUTPUTS: COMPARING SCENARIOS

Scenario Cost of Plan Capacity utilization of nurses

U5MR end year 2020

Burkina 50 712 million 56% 90

Burkina 70 777 million 110% 79

Burkina 90 848 million 131% 71

WILL OUR HEALTH SYSTEM COPE? WHAT ARE THE BOTTLENECKS?

Is it linked to strategic planning? Is RMNCH planning and costing aligned with the national planning cycle? Do the cost categories reflect national health

priorities? Is there a clear explanation re. data sources and

data collection methods? Intervention lists? Did a multi-disciplinary team undertake the

costing work? Was this team part of the planning team? Were

planning and costing done together?

EVALUATE THE COSTING PROCESS

Are the costs disaggregated? (by national priorities, levels of service delivery, programmes, etc)? Do the numbers appear feasible? Cost drivers? Explanation of cost categories? Coverage targets? Catchment areas? Utilization

rates? Different costing scenarios? Link to available resources? Link to national health budget?

EVALUATE THE NUMBERS