Costing health plans in countries:Costing health plans in countries:the role of OneHealth the role of OneHealth

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Topics in this presentationTopics in this presentation

• What is OneHealth?• What is the purpose of OneHealth?• Who will use it?• Why and how was it developed?• How will it strengthen strategic planning? • What is new?• What are the challenges?

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What is OneHealth?What is OneHealth?

• A tool for medium term strategic health planning (3-10 yrs) at national level

• A software that incorporates UN epidemiology impact models to demonstrate the achievable health gains

• A unified tool in 3 ways:– For joint planning, costing, budgeting, impact analysis,

and financial space analysis– Disease programme + health systems– One UN

• Aligned with Joint Assessment of National Strategies (JANS) principles

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What is the purpose of OneHealth?What is the purpose of OneHealth?

Challenges: OneHealth Role:Too many toolsDe-linked planning cycles

Enabling integrated planning

Bringing partners togetherLittle consideration of health systems

Linking programmes to HSS platform

"First plan… then costing" Costing as part of the Planning process!

Budget should consider the country fiscal space

Strategic Planning for Better Health Outcomes4

Who should use OneHealth? Who should use OneHealth?

• A multi-disciplinary team

•Health Sector planners ( MoH Department of planning)

•Disease-specific programme planners (e.g. EPI, Malaria) , Health System component (e.g., Human Resource Department in MoH)

•NGOs and other agencies in countries

•Donors, academics and UN agencies5

How was OneHealth developed?How was OneHealth developed?

• Agreement to develop a joint UN model.• Inter-Agency Working Group on Costing (IAWG-COSTING) established in

2008 (WHO, UNICEF, WB, UNAIDS, UNFPA, UNDP).• Partner support:

– The Global Fund to fight Aids, TB and Malaria, The Global Health Workforce Alliance, The Health Metrics Network, Bilateral agencies, IHP+, have provided funding and technical support.

– Other partners: UNIFEM and projects like USAID deliver, Optimize provide technical inputs.

• Health Planners in Country Reference Group provide technical and user related inputs into model development (Burkina Faso, Cap Verde, Ghana, Mali, Mauritania).

2008: a meeting in Senegal reviewed 13 commonly used tools

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Pre-existing tools incorporated into OneHealthPre-existing tools incorporated into OneHealth

Tool Specific areas incorporatedMBB Bottleneck analysis, Fiscal space analysis;

Budget mappingWHO (stop TB) TB planningWHO (iHTP) Detailed intervention planning for

RMNCH (staff time minutes; drugs commodities)

LiST (Lives Saves Tool) Impact for child and maternal health

Resource Needs Model Costs for HIV/AIDS interventionsAIM, GOALS Impact for HIV/AIDS interventions

WHO ( Child Health Cost Estimation tool)

Intervention costing for child health; Overall Framework for Programme Activity Costing

FamPlan Impact for Family Planning interventions

UNFPA RH costing tool Costing reproductive health interventions

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Inputs Process Outputs Outcomes Impact

OneHealth supports a planning process from inputs and OneHealth supports a planning process from inputs and activities activities to outcomes and impact to outcomes and impact

Interventions & services, Inpatient days, outpatient visitsHealth Systems outputs (access, quality, availability, etc)

Coverage of interventions;

Risk behaviours, effective behaviours

Under 5 mortality

Maternal mortality

Nutrition outcomes

HIV/TB/malaria incidence, prevalence, mortality

Total fertility rate 8

Type of outputs (results) producedType of outputs (results) produced

1. Health impact: what will be my U5MR in 2020? Do I expect to reach my MDG targets by 2015?

2. Health Systems investments and service outputs: – Required investments in the Supply Chain – Total & additional bed days and outpatient visits; requirements

for hospitals, facilities and community services3. Costs: Costs by year, by programme, by inputs, etc.4. Financial projections, fiscal space and expected shortfall5. Scenarios: how is cost and impact different for

alternative scenarios of packages, targets and activities?

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Type of outputs: nutrition specificType of outputs: nutrition specific

1. Health impact: a. how many deaths are averted by nutrition interventionsb. Reductions in stunting, wasting, IUGRc. Breast feeding prevalence

2. Costs: a. Commodities, drugs and supplies, b. Programme costs: training, supervision, M&E, administration, etc.

3. Health Systems:a. proportion of health worker time used by nutrition interventions

4. Scenarios: comparison of service delivery mechanisms10

National

Hospital

Health Centre

Outreach

Community

HS4. Health Information

HS5. Governance and Leadership

HS6. FinancingPolicies

HS3. LogisticsHS1. Infrastructure and Equipment

HS2. Human Resources

Malaria

Disease Programmes

TB

HIV

Reproductive H

ealth

WA

SH

Imm

unization

Child H

ealth

Nutrition

NC

D

Health System

Envelope

Fiscal Space envelope

Service delivery planning O

thers

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What's new? What's new?

• User-friendly interface

• Modular format adaptable to different country contexts

• Flexible structure corresponds to the ways in which real-world health care system planning is performed

• User can choose the level of detail for planning

• Regularly updated software

• Direct links and checks built in between different modules

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How does OneHealth support How does OneHealth support programme planning to be programme planning to be

aligned with Health Systems aligned with Health Systems planning?planning?

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"Check" (calculated)

Nutrition Programme Minutes of staff time

required for patient care

Nutrition Programme #of staff that need

in-servicetraining

Link between programme MNCH-related activities and HSS investments (1/2)

HRHStaff requirements

Staff Costs

HRH planner decides on HRH plan

PROGRAMME

SYSTEM

Programme Planning & Health Systems implications:Programme Planning & Health Systems implications: #1 - Health Worker time#1 - Health Worker time

Potential adjustment of coverage targets

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Available health worker time

Estimated time required for programme scale-up

Programme Planning & Health Systems implications:Programme Planning & Health Systems implications: #1 - Health Worker time: example a#1 - Health Worker time: example a

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Direct input (calculated)

LogisticsTotal volume of commodities

>-Supply Chain Requirements >-Supply Chain Costs

Nutrition ProgrammeSpecific requirements

for drugs /commodities

PROGRAMME

SYSTEM

Programme Planning & Health Systems implications:Programme Planning & Health Systems implications: #2 - Demands on the Supply Chain#2 - Demands on the Supply Chain

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Programme Planning & Health Systems implications:Programme Planning & Health Systems implications: #2 - Demands on the Supply Chain: example#2 - Demands on the Supply Chain: example

Volume of commodities transported in Logistics system,

% share by programme

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Non Communicable disease

Nutrition

Vaccination

HIV/AIDS

Malaria

TB

Child health

Maternal/newborn and

reproductive health

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• Baseline situation analysis: Epidemiology, Demography, current coverage, and some HSS.

• Intervention standards: drug and supply cost per average case (based on WHO treatment guidelines + international drug prices from UNICEF, MSH and IDA) + estimated personnel type & time required.

• Disease Programme activity standards: e.g., specific training courses; surveys; specific equipment, etc.

• Standardised activities for health system strengthening: Activities for Logistics, Governance, etc.

• Prices: from WHO-CHOICE database, WHO, MSH, UNICEF

• Expenditures & GDP growth: WHO/NHA database, IMF

Responding to data challenge:Responding to data challenge:Availability of Default data in the toolAvailability of Default data in the tool

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Website: http://www.internationalhealthpartnership.net/en/Website: http://www.internationalhealthpartnership.net/en/working_groups/working_group_on_costingworking_groups/working_group_on_costing

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User Guidance & Technical DocumentationUser Guidance & Technical DocumentationHelp screens in the tool

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• Common platform for national programmes + Health systems.

• Ensure that health system capacity is driving the planning process, to set realistic goals.

• From situation analysis activities outcomes

• Use evidence on expected health impact to inform priority setting process.

• A "checklist" function, promote comprehensiveness and inclusiveness.

• Transparent and accountable planning.

How can YOU use OneHealth to make a How can YOU use OneHealth to make a difference?difference?

How can YOU use OneHealth to make a How can YOU use OneHealth to make a difference?difference?

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• FLEXIBILITY – Country contextualisation

• STANDARDS– Internal consistency, use of standards and defaults

• INTEGRATION

3 key words3 key words3 key words3 key words

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