CALL FOR EXPRESSIONS OF INTEREST TECHNICAL REVIEW OF COSTING TOOLS

Transcription

1 WHO, UNICEF, the World Bank, and UNFPA, in collaboration with the Partnership for Maternal, Newborn and Child Health and the Norwegian Government CALL FOR EXPRESSIONS OF INTEREST TECHNICAL REVIEW OF COSTING TOOLS for the health MDGs DEADLINE FOR SUBMISSION OF PROPOSALS: June 29,

2 TECHNICAL REVIEW OF COSTING TOOLS For the health MDGs This call for expressions of interest is being made jointly by WHO, UNICEF, the World Bank, and UNFPA, in collaboration with the Partnership for Maternal, Newborn and Child Health and the Norwegian Government 1. Background Despite international commitment to achieving the health MDGs, health systems in many developing countries still fail to reach large proportions of the population that would benefit from these interventions. In order to determine how much funding is required to overcome these constraints and to move towards attainment of the MDGs, a number of "costing" tools have been developed and tested over recent years, some of which also include ways of estimating the impact of the interventions on health outcomes. These tools take different approaches to costing and budgeting health sector plans and activities, and this has lead to some confusion and duplication at country level. Many of the agencies involved in this review receive regular questions about what are the differences between these tools, and which ones can be used to answer specific questions posed at the country or global level. 2. Scope of the Review The purpose of this Review is to provide an independent assessment to the agencies and organizations participating in this review on the questions each tool seeks to answer and whether they answer these questions in a valid way. At the same time, but as a separate process, a meeting will be held with users of the different tools in countries to understand how the tools have been used to date, their user friendliness and impact at the country level. The overall purpose is to have a clear description of what questions each tool can help to answer and whether they answer these questions in a technically correct manner. The focus will be on costing tools linked to the diseases or conditions mentioned in the MDGs, The review will cover the tools listed below. The most recent version of all the tools with documentation such as user-guides will be made available to the selected proponent. Tool developers will also complete a template that provides information to the reviewers on why the tool was developed and what questions it seeks to answer. Note that a sample of the tools are now available publicly and can be downloaded by prospective proponents. Marginal Budgeting for Bottlenecks (MBB) - was developed by UNICEF and the World Bank. This tool aims at estimating the potential impact, resources needs, costs and budgeting implications of country strategies to remove implementation constraints of the health system. It estimates the marginal/incremental resources required for overcoming those constraints, and achieving better results and relates these resources to the country s macro-economic framework. MBB is 2

3 intended to help formulate medium-term national or provincial expenditure plans and poverty reduction strategies that explicitly link expenditure to health and nutrition MDGs,. MBB is meant to facilitate a process of budgeting for government health expenditures that provides a basis for policy dialogue and planning. One of the strengths of the tool is that it helps simulate the potential impact as well as cost and budget implications of alternative health service delivery strategies using different integrated production functions (community/family based, population/outreach based, or clinic based). MBB has been used in Benin, Burkina Faso, Ethiopia, Nigeria, Rwanda, Mali, Mauritania Madagascar, Mozambique, Niger, Senegal and Sierra Leone and several states in India. Main contacts: Agnes Soucat asoucat@worldbank.org and Rudolf Knippenberg rknippenberg@unicef.org Choosing Interventions that are Cost Effective (CHOICE) - WHO/HSS has developed, in collaboration with others, a range of financial costing tools for child and maternal plus a health system backbone costing tool. It is intended for medium-to-long term planning and costing and covers both programme and patient costs of recommended evidence-based interventions. Main contact is Tessa Tan-Torres Edejer tantorrest@who.int Reproductive Health Costing Tool -developed by UNFPA, the RH costing tool is designed to estimate the resource requirements and costs of providing an essential package of reproductive/maternal health interventions at country or district-level. Its main purpose is to help countries to quickly cost and create budgets for existing sector strategies and plans, such as maternal mortality reduction plans. In particular, the model calculates a) The cost of providing/scaling up an essential package of RH interventions (family planning, ANC, delivery care, EmOC, STIs and HIV prevention and treatment) b) the cost of activities/health systems improvements required to improve RH/MH in a country/district (training and supervision, equipment, RHCS, referral system, IEC, etc.) One of the key features of the tool is the incorporation of population dynamics (e.g., the impact family planning has on the demand for maternal and child health services). Main contact is Eva Weissman weissman@unfpa.org : Making Pregnancy Safer Module of Integrated Healthcare Technology Package (MPS-IHTP, formerly known as Essential HealthCare Technology Package) - developed jointly by WHO and the Medical Research Council, Cape Town, South Africa. This is a resource planning and costing tool designed to provide guidance on the mix of technologies needed to provide the key maternal and newborn health services. The services that are included are taken from the WHO recommended interventions menu, which is part of the Integrated Management of Pregnancy and Childbirth clinical guidelines and tools. Algorithms have been developed for each of 22 maternal and 8 newborn interventions, at primary and referral levels. Software simulation allows for identifying resource needs and costs for each intervention. MPS-EHTP integrates maternal and newborn health needs, demographics, health and disease profiles, clinical practice, technology requirements and availability constraints. Training currently under way in Malawi; two more countries from other regions will be selected shortly for testing and training of trainers. Guide book not yet available. Main contacts: Andrei Issakov 3

4 Peter Heimann Matthews Mathai, WHO, Spectrum, PMTCT module - developed by Constella Futures, designed to answer a number of "what if" questions, this tool evaluates costs and benefits of intervention programs to reduce transmission of HIV from mother to child. Three different sets of interventions are included in the module: drug treatment (seven options), type of delivery, and type of infant feeding (formula, breastfeeding or mixed). Each treatment option requires data on costs of interventions, as well as user fee costs if these apply. The vertical transmission rate is set as a program default, varying according to treatment, mode of delivery and infant feeding option. Outputs include benefit-cost ratios (total costs savings divided by total costs of the intervention) as well as cost-effectiveness measures such as cost per HIV infection averted, and cost of death averted. Fully documented on the Constella website, Main contact is John Stover, jstover@constellagroup.com Goals - developed by Constella Futures, this model is intended to support strategic planning at the national level by linking program goals (in the HIV area) and funding. This tool is intended to answer questions related to funding requirements to achieve goals, what goals can be achieved with available resources, the effect of alternate pattern of resource allocation on the achievement of program goals, and training requirements for delivery of projected services. The model was designed to help planners to understand how funding levels and patterns can lead to reductions in incidence and prevalence of HIV and improved coverage of treatment, care and support programs. The tool does not calculate an optimum package. (same contacts as above) Planning, Costing and Budgeting Framework -- This is a spreadsheet-based tool developed by MSH with USAID funding for UNAIDS Global Fund training activities in Southern Africa. It provides a framework for setting out time-bound measurable goals and objectives, estimating the variable resources required for attaining the goals and objectives, and calculating the related costs of activities linked to the goals and objectives. It also includes a section for showing sources and amounts of funding going into the activities. The goals, objectives, activities, resources and costs are all quantified and are linked through formulas, allowing the user to see the impact of changes in goals and objectives on costs. A manual is available. Main contact is David Collins, dcollins@msh.org CORE Plus is a spreadsheet-based tool developed by MSH with USAID and other funding to help determine projected and actual costs of integrated primary health care services broken down by individual interventions. It is a "bottom-up" costing tool that allows the user to estimate a standard cost for each intervention, broken down by drugs, tests, medical supplies and staff. The standard costs are multiplied by the number of each type of interventions to build the total direct costs for a facility or group of facilities, to which are added indirect costs. It includes a demographic component that allows users to project estimated service utilization and compare it with actual service utilization and compare costs for different numbers of patients and different service delivery models. The strength of the tool is that it can predict the cost of different interventions, such as child 4

5 survival, within the context of an integrated PHC system, and the impact of changes in those interventions on the cost of the system as a whole. The tool has been used in many countries, including South Africa, where it was used to estimate the total cost of the primary health care package for the Ministry of Health. The tool is available in several languages and is accompanied by a detailed manual, available from Elizabeth Lewis elewis@msh.org or David Collins dcollins@msh.org. cmyp - Costing and Financing Tool for Childhood Immunization - is a tool designed to allow users to estimate past and future costs, and financing needs for immunization. Financing gaps and sustainability can then be analysed. The tool is an excel spreadsheet which assesses costs annually, over a medium term time frame of up to 5 years. It incorporates both national and sub national information, and shared health systems costs as well as patient-specific costs. Users define demographics, coverage and scale-up needs. Intervention impacts are not assessed. Contact: Patrick Lydon lydonp@who.int WHO Department of Immunization, Vaccines and Biologicals (IVB). UNDP Integrated Health Model The primary purpose of the Integrated Health Model is to help country governments estimate the total resources human, infrastructural, financial required to meet the health-related Millennium Development Goals (MDGs). It is one of a suite of sector tools used by the MDG Support Team in UNDP to aid countries in MDG-based planning. The Integrated Health Model consolidates and builds on several health costing tools developed by other development partners, including WHO, UNICEF, UNFPA and UNAIDS. The model's key feature is the coherent scale-up of integrated health services anchored in a comprehensive treatment (including costing and identification of constraints) of the health system. It has been used widely across sub-saharan Africa and is being rolled out in the Asia Pacific. Planning and budgeting tool for Tuberculosis (TB) is a spreadsheet-based tool developed by the WHO Stop TB department with USAID funding. It provides a framework to develop plans and budgets for TB control in line with the Stop TB Strategy and the Global Plan to Stop TB, , i.e. total costs for TB control from the provider perspective. It includes epidemiological, demographic and financial historical data relevant to TB as well as projections of these up to These are set as default values and can be changed by countries if necessary. Targets for the coming years are set-out at the beginning and are linked with the relevant interventions. Each worksheet represents one intervention of the Stop TB Strategy and within each worksheet there is a readymade list of likely inputs and activities to consider for planning and budgeting. Besides costing information, it also collects sources of funding for each intervention and calculates funding gaps. It produces summary tables and figures automatically, including summary tables required by the TB Financial Monitoring Project of WHO and The Global Fund. Field-tested in at least one country of AFRO, AMRO, EMRO and SEAR. Used in a planning and budgeting workshop for the African Region and currently promoted also through the Global Fund Round 7 workshops. It is distributed through a sharepoint site hosted by WHO 5

6 where also guidelines are available. Main contacts: Katherine Floyd Andrea Pantoja Resource Needs for HIV/AIDS: Model for Estimating Resource Needs for Prevention, Care, and Mitigation Bollinger, L. and others (IADB) The Resource Needs Model (RNM) calculates the total resources needed for prevention, care, and orphan support for HIV/AIDS on a national level. The RNM can assist national-level strategic planning efforts by providing a tool and methodology to examine the financial resources needed to implement a variety of prevention interventions, care and treatment programs, and orphan support. Resource Needs Model = An Excel worksheet for calculating the funding required for an expanded response to HIV/AIDS at the national level. It includes 14 prevention programs, six care and treatment programs and orphan support. The program and manual are available in English, Spanish and Russian. This manual was developed for the Inter American Development Bank by Lori Bollinger and John Stover of Futures Group International and Stefano Bertozzi and Juan Pablo Gutierrez of the Instituto Nacional de Salud Publica of Mexico. A version is available at eds. This version is currently being revised to include programme costs and to allow an ingredients approach in costing. The Malaria Cost Estimation Tool - is for estimating the resource requirements of proven malaria interventions over a period of time. The tool is based on a review of costing studies and an extensive consultation with malaria experts. It provides a simple user interface requiring only basic technical and computer skills. The tool is intended for use by malaria control programme staff as well as other individuals working in the field of malaria. In the Tool, the following preventive and curative interventions are covered: Insecticide-treated nets (ITN), Targeted indoor residual spraying (IRS), Source reduction, Intermittent preventive treatment (IPT), Antimalarial case management, Community/Homebased Antimalarial Treatment, Treatment of Complicated Malaria and Refugees and Internally Displaced Persons. The tool estimates the costs of various resources used by the selected interventions. In addition, some of the crucial health system costs have been covered. The costs are calculated for selected levels of health care national, province and district. The tool has been tried most recently in Zambia Key Questions to be addressed The questions to be answered by the formal review of tools are described here - called the technical review. The questions to be addressed in the users' meeting are found subsequently. To provide some initial input to the technical reviewers, a questionnaire completed by the tool developers will be made available to them. The technical review will address the following issues: 1. What are the questions the tools seek to answer? 6

7 2. What interventions are included? Are interactions between them taken into account and how appropriately? 3. Does the tool address health system improvements and if so, which ones and how appropriately? 4. What health conditions/diseases and MDGs are addressed? 5. Internal validity - does the tool answer these questions in a technically valid way? This consists of the following items, although the reviewers need to interpret this broadly. What is the conceptual basis? What methods? How are demographic, epidemiology, costing (including systems) and financing components incorporated, if they exist. What are the parameters for which data are required (demographic, epidemiology, costing (including systems) and financing)? Does the tool have default values (if so which ones), are sources identified, can defaults be changed by country analysts? Does the tool provide, in a valid way, the output(s) it is designed to produce? (computation and formulae review) What suggestions are made for improvements to computations/approach? Note: Reviewers are NOT expected to review the validity of each parameter included in each model - e.g. the current coverage of childhood vaccinations. They ARE expected to review the formulae in the spreadsheet to understand and evaluate how the calculations are made using the different parameters. To facilitate this, they should run a set of data on all the tools under discussion and compare and understand differences in outputs. 6. Ease of Use: What features of the tool facilitate its use? (with respect to ease of navigation, clarity of the use of the guide, need for technical assistance when applying the tool, presence of default values, automatic report generation, access to a help desk for questions, presence of "bugs") Can the tool be adapted easily to different types of countries with different systems, disease problems etc.? 4. Output from the Technical Review The technical review will be expected to produce a report with two sections. Section 1: A summary report of the questions that are addressed by the tools taken as a group, with a description of which tools answer each question in a technically valid way. It may be that some questions are answered by a number of tools, and some are answered by none. The reviewers will also discuss any complementarities they see between the existing tools. This will be accompanied by a 2 page executive summary. Section 2: A summary of each tool, answering the questions described above with the reasons for the conclusions. 5. Current Experience with the Tools A meeting of people who have used the tools in an attempt to answer practical questions at country and global levels will be convened to answer the following issues. 7

8 1. What questions have the tools been used to address? 2. How user friendly have they been? See the questions for the technical review, which would also be posed to the users. 3. How has the process - undertaking the analysis and using the results - helped or hindered the policy process? 4. Who have used the tools subsequent to the initial analysis, in what context, with what results? Reviewers will be asked to attend this meeting. 6. Time Frame and Reporting The technical review can be completed by December 31, The report would be submitted to the technical review committee, consisting of representatives of the organizations participating in the review. 7. Technical Reviewer Expertise The reviewers will need to have credible, senior expertise in health economics (particularly health sector costing and budgeting); demography and epidemiology/medicine: In addition, someone in the review team will need strong excel skills to enable them to understand the formulae, links, and possibly macros written for the tools. Importantly, review team members should have no prior involvement in the development or application of any of the tools under review, and should be neutral and perceived to be neutral by the international health community. 8. Timeframes, Deliverables and Payment Schedules This call closes on 29 June The selection committee expects to have identified and informed successful applicants by 6 July, with contracts to follow shortly thereafter. A preliminary report should be made available by 14 December, and changes incorporated for the final report on 31 December Payment schedules will be: on signing of contract: 50% on completion of satisfactory final report: 50% 8. Structure of the Proposal Interested individuals or organizations should apply using the template provided in Annex 1. The evaluation grid for to be used in selecting the winning proposal is provided in Annex 2. The completed application form and proposal should be ed to: vogelm@who.int by June 29, 2007, 5 pm CEST. Further information can also be obtained by contacting Marilyn Vogel at the same address. We will acknowledge receipt of all proposals. 8

9 Annex 1 Template for Applications to the Call for Proposals on "Technical Review Of Costing Tools for the health MDGs" PART I. ADMINISTRATIVE INFORMATION 1. Name of team leader and institutional affiliation: Title: Surname: First name: Name of Department and Institution Full postal address of team leader to be used for correspondence: Telephone: Fax: 2: 2. Names and affiliations of all co-investigators, if any PART II - PROPOSAL 1. Review Outline Please indicate briefly how you would plan to undertake the review. What are the activities that will be undertaken (a work plan step that will be implemented linked to an objective), who would do them and when would they be completed. 2. Reviewer or Review Team Please indicate why you think the review team is appropriate for the task. Please also attach the CVs of the team and any similar work that the team has already undertaken. The lead proponent, on behalf of the team (if any), should declare the absence or presence of any potential conflict of interest in the cover letter; and if any, to provide enough detail to allow evaluation of the stated potential conflict of interest. 9

10 3. Costs and Financing. Note: approximately 80,000 USD is available for this work. Please use the format below to present your Budget. Budget item 1. Personnel Name (if known) and position Estimated number of working days / weeks Cost a. b. c. d. 2. Services & Supplies 3. Equipment 4. Local Travel 5. Internation al travel 6. Other expenditure s Total Personnel Please enter details of items to be purchased and unit cost here Total Services & supplies Total equipment Total local travel Total international travel Total other expenditures GRAND TOTAL Notes on budget 1. For personnel, indicate for each individual staff person proposed as part of the team, the role they would have, and the percentage of time they would devote to the project. The budget requested should reflect salary multiplied by the amount of time spent on the project. Justify personnel salaries in relation to institutional remuneration policies. 10

11 2. For services and supplies, include telephone, fax, internet hook up, subscription to electronic databases, photocopying, and office supplies. Itemize budget for each individual service or type of supplies. 3. For equipment, indicate needs for computers, printers etc. 4. For local travel, enter details for local air tickets, hotel costs, per diem within the country. 5. For international travel, enter details of international air tickets, hotel costs, per diems for international travel. 6. For other expenditures, include space rental, clerical and other administrative costs. Note that unspecified institutional overheads cannot be supported but specific activities can be. 11

12 Annex 2: TECHNICAL REVIEW OF COSTING TOOLS For the health MDGs The Call for Expressions of Interest is being made jointly by WHO, WHO, UNICEF, the World Bank, and UNFPA, in collaboration with the Partnership for Maternal, Newborn and Child Health and the Norwegian Government. Proposal Evaluation Criteria and Points Awarded Criteria Possible points awarded General understanding of the Terms of 15 Reference and the aims of the Review, specifically How tools are used by countries The decision-making processes that are influenced by applying tools Other Methodology 40 Feasibility of approach Work plan Level of effort by team members Creativity Team composition 30 Seniority, credibility Complementarity of skills Independence Clarity and overall presentation 15 Total