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CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia Economic Evaluation of.

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1 CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia Economic Evaluation of Public Health Supply Chains: What’s It Worth? Joseph McCord for James Rosen, USAID | DELIVER PROJECT

2 Public health supply chain strengthening can be viewed as an investment How much should we invest in supply chain strengthening versus other health system areas? Which elements of supply chain strengthening should we invest in? Is the expense of a new investment justified? Should we remove a tier of the supply chain? Is it more cost effective to implement an ELMIS or keep the paper system? Should we invest in a direct delivery system?

3 Economic evaluation involves comparing costs to consequences -- either supply chain outcomes or monetary benefits

4 Two basic approaches to economic evaluation: Cost Effectiveness Analysis –Costs of different approaches related to a common non-monetary ‘effect’ Cost per facility stocked to plan Cost per couple years protection Cost per deaths averted Cost Benefit Analysis –Costs of different approaches related to monetary savings Cost per savings from better supply chain performance Cost per savings from better health outcomes Return on Investment (ROI): (Financial Gain – Cost of Investment)/Cost of Investment (%))

5 Example: Zambia: Comparing cost- effectiveness of standard versus alternative distribution systems Problem –A large percentage of facilities are stocked out of contraceptives and other reproductive health commodities Policy question –Is it worthwhile to invest in supply chain strengthening to improve performance, even if it might cost more? Study objective –Compare the cost-effectiveness of the standard system versus two alternative supply chain systems. Comparison –A traditional pull supply chain and two pilot systems varying in their use of the district level as a cross dock or stock holding level

6 Cost measures Costs of labor, communication, commodity transport, administration, and training Effectiveness measures Example: Zambia: Comparing cost- effectiveness of standard versus alternative distribution systems Category of effectivenessIndicators Supply chain performanceStock availability (percentage of time facilities had stock of 15 essential medicines) Service useUse of malaria services Health outcomeMalaria deaths averted, DALYs averted

7 Example: Zambia: Results (stock availability)

8 Example: Zambia: Results (Health Outcomes) Standard SystemModel B Days Stocked Out per Month across Average District 1704756 Incremental Cost per District per Month --$3,971 National Cost over 5 Years--$17.2 Million Estimated YLL Averted from Increased Availability of ACTs over 5 Years 155,003 Cost/YLL Averted$110

9 Know your audience, but keep the costs in mind! Increasingly being asked for by funding partners Include cost effectiveness when evaluating large projects or when looking at new/untested approaches Understand stakeholder expectations, put outcomes in terms that resonate with them (within reason) Anticipate collecting more cost data along with effectiveness data for interventions  USAID | DELIVER PROJECT Resources available: Guide to Econ Evaluation of PH Supply Chains Supply Chain Costing Tool and Costing Methodology

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