Financing and Sustainability

Postabortion Care Services

March 2002

Financial Sustainability

What does it take? Not about numbers only But numbers do count Not “business as usual”

Not About Numbers Only

Sustainability plan included in strategic plan Business plans also for NGOs?

Change of attitude

Efficiency in service delivery

Awareness of cost implications of quality Costs of high vs. poor quality

Numbers Do Count

How much does it cost to provide services: current level and at scale?

What price to charge for PAC services If no cost recovery, who pays for any

subsidies offered? Budgetary recognition and allocation

by ministries of health

Not Business As Usual

Organizational sustainability Need business-like approach Leadership Strategic partnerships/collaboration External relations – creatively managed

Business-like Approach

“Not-For-Profit is not a management style, but a tax status” (P. Drucker)

Relevant business-type principles: Use of financial management information Cost analysis Synergy through integration Customer/patient/client focus

Leadership

Born or taught?

Need for champions to promote

Political will creates enabling environment

Partnerships

Training – who has comparative advantage?

Logistics for MVA and other supplies Procurement of supplies

External Relations

These need to be managed well Costs/burden of donor support

Weaning out of donor dependence – is this in the sustainability plan?

Cost of PAC Services

Availability of information on cost Some studies on cost effectiveness of

MVA vs. D&C Little information on the costs involved in

scaling up of PAC services What cost information is relevant?

Scaling Up: What Costs Are Relevant?

Incremental costs only: MVA or D&C supplies

Additional staff time costs

Other supplies and equipment required

Relevant Costs (cont)

Opportunity costs of scaling up PAC services What happens to funding for other RH

services

Scaling up FP reduces need for PAC; Unwanted pregnancy implies failure in FP

Cost Estimation

Step 1: Strategic mapping to identify what exists and service delivery gaps

Step 2: Estimation of demand. Step 3: Incremental resources needed

over time. Step 4: Cost of additional resources

Costing Tools CORE

(Cost and Revenue analysis tool developed by MSH)

Cost Estimate Strategy (developed by MSH)

Cost Analysis Tool (developed by EngenderHealth)

A Guide to Assessing Resource Use for the Treatment of Incomplete Abortion (Developed by Ipas)

Scaling Up: Cost Determinants

Capital costs – Buildings, equipment, initial training Takes into account existing infrastructure

Projected demand for services Treatment protocols Ease of replication of pilot

Cost Drivers

The key cost drivers include: Treatment protocols, e.g.

The re-use of canulla Length of stay/Discharge from hospital

Drugs and medical supplies and staff time are the most significant costs

Need to control the key cost drivers.

Financing PAC Services User fees Community health funds Health insurance Cost savings through:

Lower hospital stay Use of MVA where possible as this has

been proven to be more cost effective than D&C

Public funds (taxation) External assistance

Policy Considerations

Financing issues Service sustainability

Staff capacity Continued availability of supplies

Support for PAC at policy level Budgetary support Clarity on legal issues to enhance use

Classification of PAC services as “emergency” care?

Conclusions

Importance of financing and sustainability in PAC

Complex subject Cost effectiveness of MVA vs. D&C Need to do more research on issues of

financing and sustainability in scaling up PAC