2. Outline How costing pilot interventions differs from costing services Phases of pilot interventions From phases to resources Converting resources into costs Data sources Example: Introducing CBD of DMPA

3. Average Costs of Health Services Health facility represents a production process (inputs- processes-outputs) Defined outputs produced Measured and costed all resources used to produce these outputs Result: average cost per service ART CT PMTCT Other Program Costs

4. Incremental Costs Associated with Interventions Many health interventions begin as small pilot projects Pilot projects often carried out within an existing program Which costs should we consider? Program Costs Incremental Costs

5. Costs of a Pilot Project Inputs Outputs Processes (activities) Labor Supplies Capital Planning the intervention Implementing the plan Carrying out new service delivery Increased or improved provision of services Outcomes Higher use of ARVs Improved Adherence Higher PMTCT coverage

6. Economic Taxonomy of a Pilot Project Pilot Project –Phase

7. Phases of a Pilot Project Planning Implementing the Plan Initial service delivery

8. Economic Taxonomy of a Pilot Project Pilot Project Phase Activity

9. Phase 1: Planning Examples of objectives/activities in the planning phase: Work sessions to create curricula and job aids Design training materials Meetings with MoH, community leaders, service providers, etc. Build stakeholder support Work sessions to decide on intervention size and scope Design Intervention

10. Phase 2: Implementing the Plan Examples of objectives/activities in the “implementing the plan” phase: Consultations with supervisors to explain changes in system Improve supervision system Workshops to introduce the intervention to providers Train providers Workshops to form cadres of trainersTrain ToTs

11. Phase 3: Initial service delivery Additional time spent by supervisors Increased use of supplies and commodities Additional time spent with clients New / improved service provision Examples of objective/activities in the “service delivery” phase:

12. Economic Taxonomy of a Pilot Project Pilot Project Phase Activity – Resource » Cost

13. Approach to Costing Identify resources used for each activity –Labor –Supplies –Capital

14. Approach to Costing, cont’ Measure resources in natural units –hours, items, days of per-diem Assign Unit Value to each resource –wage rate, unit cost Cost calculation for activity –Σ (quantity of resource x unit cost)

15. Costing a planning activity: MoH stakeholder meeting ResourceQuantityUnit CostTotal Facilitator time3 person-hours$18/hr$54 Facilitator travel1 RT taxi$6/RT$6 Tea/snack8 portions$2/portion$16 Grand Total$76

16. Costing an implementation activity: workshop for clinic staff ResourceQuantityUnit CostTotal Trainer time5 person-days$120/day$600 Lodging/food24 person-days$80/day$1,920 Venue fee3 days$60/day$180 Trainee time21 person-days$8/day$168 Grand Total$2,868

17. Costing a service delivery activity: increased supervision visits ResourceQuantityUnit CostTotal Supervisor time3 person-days$80/day$240 Lodging2 nights$50/night$100 Per-diem3 days$60/day$180 Transport3 days$100/day$300 Grand Total$820

18. How and where do we obtain data to cost out a pilot project?

19. Retrospective vs. Prospective Retrospective data collection is the only option if the intervention has already been carried out Quality of data highly variable; depends on financial systems and reporting requirements of implementing agency Best case – worst case

20. Prospective is Preferred The Ideal: build economic component into pilot project from beginning Assess routine financial reporting of implementing agency Build on existing systems for financial reporting Introduce forms to intervention staff Monitor. Monitor. Monitor.

21. Example: CBD of DMPA What is DMPA? Progestin-only injectable contraceptive Highly effective (99%) when timely injections given over the first year Administered as an intramuscular Injection (IM) Fertility resumes after 4 months

22. Facilitating Factors Government support is essential An active, strong CBD program Existing demand for injectables State-of–the art service guidelines Effective commodity logistics system

23. Planning Phase for CBD of DMPA: Building Stakeholder Consensus Gauge support among national health authorities Create advocacy strategy Establish national core team Conduct sensitization meetings with various stakeholder groups

24. Costing a planning activity: MoH stakeholder meeting ResourceQuantityUnit CostTotal Facilitator time3 person-hours$18/hr$54 Facilitator travel1 RT taxi$6/RT$6 Tea/snack8 portions$2/portion$16 Grand Total$76

25. Total Costs of Building Stakeholder Consensus ActivityQuantityUnit CostTotal MOH Meetings4 meetings$76$304 Sensitization meetings 8 meetings$140$1,120 Advocacy Strategy2 meetings$50$100 Subtotal$1,524

26. Planning Phase for CBD of DMPA: Designing the Intervention Develop training curriculum Design supervision system Develop messaging strategy

27. Total Costs of Designing the Intervention ActivityQuantityUnit CostTotal Training Curriculum15 consultant days $200/day$3,000 Supervision System5 consultant days$180/day$900 Messaging Strategy1 package$1,600 Subtotal$5,500

28. Planning Phase: Total Costs Stakeholder consensus$1,524 + Intervention Design$5,500 = Total Planning Cost$7,024

29. Implementation of Plan: CBD of DMPA Intervention staff conduct TOT Trainers train CBAs in central location Improve supervision system Improve logistics system for commodities

30. Costing an implementation activity: workshop for CBAs ResourceQuantityUnit CostTotal Trainer time5 person-days$120/day$600 Food/Lodging24 person-days$80/day$1,920 Venue fee3 days$60/day$180 Trainee time21 person-days$8/day$168 Grand Total$2,868

31. Total Costs of Implementing the Plan ActivityQuantityUnit CostTotal ToT workshop1$1,880 CBA workshop3$2,868$8,604 Supervisor training3$200$600 Logistics upgrade3$85$255 Total cost of “implementing the plan”$11,339

32. Initial Service Delivery Phase for CBD of DMPA More DMPA provided (maybe fewer OCs?) Increased supervision visits/content CBAs spend more time with clients

33. Total Costs of Initial Service Delivery (6 months) ActivityQuantityUnit CostTotal DMPA commodity420 units$0.92$386 Supervisor visits3 visits$250$750 Additional CBA time with clients 4200 minutes$0 Total cost of initial service delivery$1,136