National Health Policies, Strategies and Plans and costing (NHPSP)

Transcription

1 National Health Policies, Strategies and Plans and costing (NHPSP) 1 Overview Current state of health systems and need for integrated planning Planning and costing Role of onehealth in integrated planning and costing 2

2 New foundations since Building global capacity for policy dialogue 06 February Building global capacity for policy dialogue 06 February 2012

3 5 Building global capacity for policy dialogue 06 February 2012 Viet Nam salaries for Cambodia salaries for health HIV/AIDS programs programs 1, MoH DFID 500 WB 900 GFATM* ,200 MoH DFID GFATM GFATM Round 4 Round5 800 National programs MoH salaries ranged $ per month MoH salaries ranged from $50 DFID offers health worker to few hundred per month incentives in HIV/AIDS program; CCM decided to pay GFATMassociated employee $1,200 significantly higher pay in per month WB begins programs with overlapping districts where For Round 5 grant poaching will occur proposal, CCM further escalating salary cap ($1,200 + GFATM granted PR (MoH annual increase) HIV/AIDS program) salary request of $900 per month for program National programs followed suit managers for increasing salaries, resulting in Donor and GHP practices lead to major country-wide salary escalating distortion of salaries inflation and poaching of resources within This has been phenomenally HIV/AIDS sector destructive. 6 * Increase for program managers only of GFATM grants

4 Impact on countries Fragmented funding and/or funding outside the national budget and plan Undermines government capacity too many proposals, too many meetings, too many monitoring demands Duplication of services and supplies or even competition between projects and donors Waste of scarce resources Inefficient use of funds Lack of country leadership and ownership 7 What is a coherent and balanced health plan? Coverage of programs Narrow sub-set of health sector e.g. govt services only Scope of plan Broad - whole of health sector, e.g. public, NGO, church, private services Health sector & beyond e.g. plus Education None Partial Full 8

5 Review of national health plans shows asynchronous disease programme planning Example: Afghanistan National Health Plan Immunization TB HIV/AIDS Reproductive Health Maternal Health CAH Nutrition 9 Global Source: Learning WHO Program planning for cycle National data Health base Strategic Planning A health systems approach to strategic planning Health systems: composed of interacting subsystems; health systems development takes time. HLTF: 10

6 Assessment of national health plan regarding HSS 11 Planning and Costing 12

7 Costing in national health plans: (R4D, 2006) Assessing costing in national aids strategic plans : 7 country plans reviewed: 6 had scores of 2-3 out of a maximum 16. (UNFPA,2009) African MNH Road Maps Assessment Report: Although 26 out of 33 countries had costed their MNH plans, "only 11 countries have developed long term budgets, until 2014 or 15, based on some scaling-up strategy. " TRP (GFATM, 2011) Global Fund Information Note: Most Common Weaknesses identified by the TRP in Round 10 proposals :"The budget information was inaccurate, questionable and/or not sufficiently detailed. Although they do not normally represent the only reason for a proposal not to be recommended for funding, budget-related issues are the most frequent weaknesses raised by the TRP during proposal review and poor budgeting calls into question the soundness of work planning." 13 How was OneHealth developed? 2008: a meeting in Senegal reviewed 13 commonly used tools 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 linputs. Health Planners in Country Reference Group provide technical and user related inputs into model development (Burkina Faso, Cap Verde, Ghana, MliM Mali, Mauritania). i

8 Fiscal Space envelope HS4. Health Information HS5. Governance and Leadership HS6. Financing Policies Hea alth System Envelop pe Service delivery planning National Hospital Health Centre Outreach Community Others NCD Ch ild Health Nutrition Reprod ductive He ealth Disease Programmes WASH Imm munization n TB Malaria HIV HS1. Infrastructure and dequipment HS2. Human Resources HS3. Logistics How does OneHealth support disease programme planning to be aligned with Health lths Systems planning?

9 Programme Link between programme MNCH related activities Planning & Health Systems implications: #1 and Health HSS lthw Worker investments time (1/2) PROGRAMME SYSTEM MNCH Programme Minutes of staff time required for patient care "Check" (calculated) HRH Staff requirements Staff Costs HRH planner decides on HRH plan Potential adjustment of coverage targets MNCH Programme # of staff that need in service training Programme Planning & Health Systems implications: #1 Health lthw Worker time: example b Estimated time required for programme scale-up Available health worker time

10 Programme Planning & Health Systems implications: #2 Demands on the Supply Chain PROGRAMME SYSTEM MNCH Programme Specific requirements for drugs /commodities Direct input (calculated) Logistics Total volume of commodities > Supply Chain Requirements > Supply Chain Costs Programme Planning & Health Systems implications: #2 Demands on the Supply Chain: example Volume of commodities transported in Logistics system, % share by yprogramme Non Communicable disease Nutrition Vaccination HIV/AIDS Malaria TB Child health Maternal/newborn and reproductive health

11 Programme Planning & Health Systems implications: #3 Facility Infrastructure t (Services) PROGRAMME SYSTEM MNCH Programme Number of inpatient daysneededfor hospitalcare "Check" (calculated) Infrastructure Comparison with planned number of hospitals and available beds Facility planner decides on final plan for infrastructure t Potential adjustment of coverage targets Programme Planning & Health Systems implications: #3 Facility Infrastructure t (Services): example a Predicted number of outpatient visits, by programme area 70,000,000 60,000,000 50,000,000, 40,000,000 30,000, ,000,000 10,000, Nutrition HIV/AIDS Malaria Vaccination Child health Maternal/newborn and reproductive health

12 Programme Planning & Health Systems implications: #3 Facility Infrastructure t (Services): example b Predicted number of needed hospital bed days, compared to estimated capacity 12,000,000 10,000, ,000,000 6,000,000 Combined programme need 4,000,000 Estimated inpatient 2,000,000 capacity Type 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, facilitiesandand communityservices 3. Costs: Costs by year, by programme, by inputs, etc. 4. Financial i projections, fiscal space and expected shortfall 5 S i h i t d i tdiff t f 5. Scenarios: how is cost and impact different for alternative scenarios of packages, targets and activities?

13 Responding to data challenges: Availability ofdefault data in the tool 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 User Guidance Help screens in the tool

14 Technical Documentation Website: working_groups/working_group_on_costing