Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
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