Karin Stenberg WHO Health Systems Financing Department (WHO/HSF) OneHealth for Strategic Planning and Costing A tool developed by the UN Inter-Agency Working Group on Costing A tool developed by the UN Inter-Agency Working Group on Costing Workshop on Country Perspectives on Decision Making for control of chronic diseases Institute of Medicine of the National Academies July 19-21, 2011

To date UN agencies have supported the development of numerous costing tools for health programmes. Inter-Agency Working Group on Costing established in 2008 (WHO, UNICEF, WB, UNAIDS, UNFPA, UNDP) A User's meeting in Senegal reviewed 13 commonly used tools.  Recommendations from countries (users): – Request for standardised approaches across UN agencies – Request for joint UN tools for MDG planning – Harmonised technical support UN costing tools: Background

3 |3 | Department of Health Systems Financing Better Financing for Better Health Context Health systems: composed of interacting subsystems; health systems development takes time. High Level Taskforce on Innovative International Financing for Health Systems (2009) Challenge: the need to address health systems strengthening as part of national planning processes

4 |4 | Department of Health Systems Financing Better Financing for Better Health Context Asynchronous disease programme planning: Review of national health plans show asynchronous disease programme planning; uneven development of health system Source: WHO planning cycle data base Uneven attention to health system components within national plans (ongoing research, forthcoming)

5 |5 | Department of Health Systems Financing Better Financing for Better Health OneHealth: purpose and audience A tool to support processes for medium term (3-10 years) health systems to planning at country level Covers the national health sector, with focus on public sector health interventions. Allows for incorporating activities in private sector and costing of selected non-health sector activities that may have health impacts. audience: Intended audience: – Health Sector planners (department of planning, Ministry of Health) – 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, academe and UN agencies

6 |6 | Department of Health Systems Financing Better Financing for Better Health OneHealth development process Wide stakeholder engagement process Inter-Agency Working Group on Costing (IAWG-COSTING) established in 2008 (WHO, UNICEF, WB, UNAIDS, UNFPA, UNDP). 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 Vert, Ghana, Mali, Mauretania).

National Hospital Health Centre Outreach Community HS4. Health Information HS5. Governance and Leadership HS6. Financing Policies HS3. Logistics HS1. Infrastructure and Equipment HS2. Human Resources Malaria Disease Programmes TBHIVReproductive HealthWASHImmunizationChild HealthNutrition …NCDs…

8 |8 | Department of Health Systems Financing Better Financing for Better Health OneHealth : what is new and better? #1 Unified model in 3 aspects: – Planning, Costing, Budgeting, impact analysis, financial space analysis. – Bringing disease programme planning and health systems planning together – One UN Aligned with Joint Assessment of National Strategies (JANS) principles on situation analysis, informed priority setting, and financial sustainability considerations. Incorporates UN epidemiology impact models to demonstrate the achievable health gains, e.g., Lives Saved Tool (LiST), AIM; with new modules developed where there was previously a gap, e.g., TB impact. Programme planning is carried out within a framework of: – Health system capacity assessment – Financial sustainability assessment

9 |9 | Department of Health Systems Financing Better Financing for Better Health OneHealth : what is new and better? #2 User friendly interface closely resembles the formats and structures of existing tools, thus allowing transfer of skills from old tools The tool is modular in format and can easily be adapted to different country contexts Allowing for flexibility within a structure and language that corresponds to the ways in which real world health care system planning is performed. User can choose the level of detail for planning, down to ingredients based, population-based costing; provided with default values from UN health statistics databases Software updated on a regular basis including recent updates of epidemiology impact models. Direct links and checks are built in between different modules, allowing for real time integrated planning discussions.

10 | Department of Health Systems Financing Better Financing for Better Health Planning by programmes Nutrition Child Health Immunization Maternal and Reproductive Health Malaria TB HIV/AIDS WASH + (user defined) + NCDs (forthcoming) Planning by levels National District Hospital Facility Outreach Community A flexible approach that emphasizes integration and inter-relationships between Disease/ Program/ Level-specific Planning Planning for systems Human Resources for Health Infrastructure, Equipment and Vehicles Logistics Health Information Systems Governance Health Financing Policy Gender, Equity and the Private Sector as cross-cutting considerations

11 | Department of Health Systems Financing Better Financing for Better Health Selected questions answered by OneHealth What set of interventions will lead to what impact? What are the overall health systems constraints that need to be addressed in order for me to scale-up? Given the existing health system, what would be the feasibility of scaling up using different approaches (e.g., community- based vs. outreach based)? How much funds will I need for my programme budget? What demands on the system would my programme training goals have and how could I better integrate my training with other MOH programmes? Compare different scenarios – cost, impact and financing implications

12 | Department of Health Systems Financing Better Financing for Better Health Detailed sheet for drugs and commodities, as well as the human resource requirements – by level of service delivery. Specify ingredients for intervention costing

13 | Department of Health Systems Financing Better Financing for Better Health Some NCD interventions already included in default list

14 | Department of Health Systems Financing Better Financing for Better Health Bottom-up detailed estimation of cost for activities to support the national programme Programme-Specific staff Training Supervision Monitoring & Evaluation Infrastructure & Equipment Transport Communication, Media & Outreach Demand generation Advocacy General Programme Management Technical Assistance

15 | Department of Health Systems Financing Better Financing for Better Health Example of activity costing: Training

16 | Department of Health Systems Financing Better Financing for Better Health Procurement $ Inventory $ Transport $ Warehousing $ $ per unit delivered product Central WH Regional WHs SDPs Warehousing $ Inventory $Transport $ Health system modules Example: Logistics Supply Chain Costs Health system modules Example: Logistics Supply Chain Costs Quantity of drugs derived bottom-up from program plans

17 | Department of Health Systems Financing Better Financing for Better Health Assessing impact on health systems and opportunities for integration

18 | Department of Health Systems Financing Better Financing for Better Health Program planning takes into account systemic constraints Example: Child health /Nutrition programme sets target to scale up Complementary feeding counselling to 90% coverage by 2015 …Child health /Nutrition programme revises target to a more realistic level in line with the planned system investments – for example 70%. Human Resource Planning indicates that sufficient Human Resources will not be available to allow for reaching 90% target – Based on the HRH plan for educating and hiring health personnel Programme-specific plans are compared against Health System capacity Costs and predicted health impact is adjusted to align with new target

19 | Department of Health Systems Financing Better Financing for Better Health Outputs: consolidating implications of programme plans to facilitate discussions on priority setting and integration

20 | Department of Health Systems Financing Better Financing for Better Health

21 | Department of Health Systems Financing Better Financing for Better Health Mapping costs to the national budget classification

22 | Department of Health Systems Financing Better Financing for Better Health Up to 7 budget classifications can be implemented simultaneously

23 | Department of Health Systems Financing Better Financing for Better Health Detailed budget mapping per item

24 | Department of Health Systems Financing Better Financing for Better Health Looking at financial sustainability and opportunities for increasing financial (and fiscal) space

25 | Department of Health Systems Financing Better Financing for Better Health

26 | Department of Health Systems Financing Better Financing for Better Health Giving national programmes a common platform where consistent methods are used across programme areas Ensuring that health system capacity is driving the planning process,  set realistic goals Health impact and other criteria to drive priority setting process Provides a check list function, promote comprehensiveness and inclusiveness Bringing NCDs into the mainstream planning process for national strategic health plans Strengths and Opportunities: utility for policy makers

27 | Department of Health Systems Financing Better Financing for Better Health Data requirements Strengthening health information systems Building capacity to use strategic planning tools to inform the decision making process ChallengesChallenges

28 | Department of Health Systems Financing Better Financing for Better Health Next steps: roll out and capacity building (a) Desk review; test application on costed national health plans (ongoing) (b) Roll out of OneHealth version 1.0 September 2011 MDG programme planning HSS modules for HRH, Infrastructure, Logistics + some financing and HIS Budgeting and financial space Health impact (c) Early Implementation (3 countries) (d) Roll out of OneHealth version 2.0 October/November 2011 – Added modules for NCD costing, Health Information Systems (e) Further development expected (2012 onwards) - Model to be continuously refined as new evidence available - Develop models for projecting health gains from NCDs, adult malaria

29 | Department of Health Systems Financing Better Financing for Better Health Summary recommendations for designing and applying a costing model as part of an NCD tool kit Design: be clear on the specific policy question(s) to be answered; how the tool(s) will be used and by whom. Design: opting out of a silo approach: consider broader health sector planning processes and how to cost integration across programmes. Need to invest as much in training, application, validation, proof of concept studies, communication and advocacy as in development of tools; to ensure their use for the intended purpose.

30 | Department of Health Systems Financing Better Financing for Better Health Thank you