ESTIMATING THE RETURNS OF INVESTING IN RMNCH

Malcolm Bryant and Susan Foster

Overview

Why calculate ROI Overall approach Developing a framework for policy-

makers How it will work Challenges

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Why calculate returns on investment for RMNCH?

Economic benefits of investing in health have been calculated for a range of populations and diseases

Identification of the economic benefits of investing in HIV, TB, malaria—presented persuasive cases

Financing agencies understood these arguments, and as a result, increased funding

RMNCH have not benefitted from the same form of detailed analysis

Country-level decision-makers require tools to understand and support RMNCH

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Overall approach

Review and list the RMNCH challenges faced by women and their children in low-income environments

Identify the major health, social, and other impacts of each challenge

Identify the economic impact of each challenge

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Creating a framework

Identify the most important costs associated with each impact Use an expanded cost-of-illness approach; Capture direct and indirect costs; Individuals Households Healthcare systems Societies

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Populate the framework

What data is required to estimate each cost at the national level?

What are the possible sources of such data in typical country settings? Current burden of morbidity and mortality Unit costs to estimate the cost of illness Estimate current costs of providing RMNCH

interventions and services Identify data needed to calculate

productivity losses

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How will it work?

1. What are the RMNCH challenges?

All common maternal, neonatal, and childhood illnesses and conditions!

How to make sense of them? The Continuum of Care

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Adolescence and before pregnancyStage/Event

Challenges Outcomes Impacts

Menarche and before

Rituals – e.g. FGM

Pain, shame, fear, psychological and mental illness, dyspareunia, perineal tears during labor

Burden on health systemMarital discord+/- divorceNeonatal deaths and asphyxia, postpartum hemorrhage and death

Menstruation

Pain, inconvenienceEarly marriage

Lost days at school, lost days at work,

Decreased female literacy; increased child mortality;Lost productivity

Early Sexual Activity

Unwanted pregnancy, STI, HIV/AIDS

Social rejection, dystocia in young girls, Infertility, divorce, early end of schooling

Burden on health systemNeonatal death and asphyxia, decreased female literacy, increased child mortality

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Selecting priorities

RMNCH is infinitely complex (it makes HIV, TB, and Malaria seem simple). We have to make rational choices about which impacts to address

Proposed Criteria: Must be proven interventions to address impact Feasibility Political visibility

Attractive to politicians and can be understood by them

Evidence of cost-effectiveness

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Possible criteria that could be used Health services costs averted Lives saved – RMNCH is unique in being able to

save more than one life with one treatment episode, e.g. a mother and the baby

Long term sequelae of birth injuries, e.g. asphyxia - need for lifetime of care, low or no income earning, etc.

Long term sequelae of maternal injuries e.g. fistula – divorce, stigma

Indirectly, loss of a mother often means poor survival of remaining children

Increasing under five survival has a disproportionate effect on national life-expectancy

Societal costs – low morale, fatalism, orphans, widowers

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Who is our target audience

International funding agencies? Politicians and policymakers at national

level Ministry of Finance Ministry of Health

National medical and nursing staff and thought leaders

Local politicians and funding groups in decentralized settings

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How closely to link with health and non-health solutions

Where does female education fit in with this?

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Next Steps

Link RMNCH challenges to health, social, economic and other impacts

Estimate the costs to the individual, household, community, health system, and country of each impact

Create a simple tool that can be used to estimate the costs Simple is key. Methodological soundness is

required, but a balance must be maintained between the perfect and the practical

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