Issues in costing cross cutting HSS interventions in GFATM proposals

Afghanistan experience

Najibullah Safi, MD, MSc. HPM

Health system building blocks

• Health services • Health workforce• Health information system• Medical products, vaccines and technologies• Health financing• Leadership and governance

Areas covered under HSS

• Globally*:– Human resources– Infrastructure and equipments– Communication – Training– Health product– Procurement– Monitoring and evaluation– Management

* Activities supported under GFATM R8

Areas covered under HSS cont.

• Afghanistan:– Expansion of lab network (R8 &R10)– Training– Long term programs (community nursing program

(R8 &R10), FETP (R8), female community health supervisor (R10))

– Short term programs– Revision of HMIS (R8)– Technical support – Research – Salary support

Measuring unit costs• Unit cost: – Relationship between financial investments and outcomes

• Required development of tools for standardized unit costing e.g. – Cost per person-year of ART (variations)– Cost per DOTS patient treated (variations)– Cost per LLIN distributed (is this practical?)

• Routine unit costing is expected to:– Improve budgeting, planning, and target setting– Optimize resource allocation

• Is this practical to calculate unit cost for HSS interventions?

Issues in costing, Afghanistan experience

• Lack of local expertise• HSS cover wide range of services (make it difficult to

use standardized procedures/tools for costing)• Unavailability of costed national strategies and

standard procedures for costing • Difficult to properly link inputs (investment) with

outcome/impact • Inadequate preparation for proposal writing/costing• Significant proportion of budget goes to salaries (less

structured)

Issues in costing, Afghanistan experience cont.

• Lack of required data for planning – Estimation of the required quantities/number– Geographical distribution (cost varies) – Estimation of the unit cost (e.g. FETP, BHC labs)

• Too much assumptions• Duplication with the supported programs by other

donors • Inflated budget