Financing and Sustainability
Postabortion Care Services
March 2002
Financial Sustainability
What does it take? Not about numbers only But numbers do count Not “business as usual”
Not About Numbers Only
Sustainability plan included in strategic plan Business plans also for NGOs?
Change of attitude
Efficiency in service delivery
Awareness of cost implications of quality Costs of high vs. poor quality
Numbers Do Count
How much does it cost to provide services: current level and at scale?
What price to charge for PAC services If no cost recovery, who pays for any
subsidies offered? Budgetary recognition and allocation
by ministries of health
Not Business As Usual
Organizational sustainability Need business-like approach Leadership Strategic partnerships/collaboration External relations – creatively managed
Business-like Approach
“Not-For-Profit is not a management style, but a tax status” (P. Drucker)
Relevant business-type principles: Use of financial management information Cost analysis Synergy through integration Customer/patient/client focus
Leadership
Born or taught?
Need for champions to promote
Political will creates enabling environment
Partnerships
Training – who has comparative advantage?
Logistics for MVA and other supplies Procurement of supplies
External Relations
These need to be managed well Costs/burden of donor support
Weaning out of donor dependence – is this in the sustainability plan?
Cost of PAC Services
Availability of information on cost Some studies on cost effectiveness of
MVA vs. D&C Little information on the costs involved in
scaling up of PAC services What cost information is relevant?
Scaling Up: What Costs Are Relevant?
Incremental costs only: MVA or D&C supplies
Additional staff time costs
Other supplies and equipment required
Relevant Costs (cont)
Opportunity costs of scaling up PAC services What happens to funding for other RH
services
Scaling up FP reduces need for PAC; Unwanted pregnancy implies failure in FP
Cost Estimation
Step 1: Strategic mapping to identify what exists and service delivery gaps
Step 2: Estimation of demand. Step 3: Incremental resources needed
over time. Step 4: Cost of additional resources
Costing Tools CORE
(Cost and Revenue analysis tool developed by MSH)
Cost Estimate Strategy (developed by MSH)
Cost Analysis Tool (developed by EngenderHealth)
A Guide to Assessing Resource Use for the Treatment of Incomplete Abortion (Developed by Ipas)
Scaling Up: Cost Determinants
Capital costs – Buildings, equipment, initial training Takes into account existing infrastructure
Projected demand for services Treatment protocols Ease of replication of pilot
Cost Drivers
The key cost drivers include: Treatment protocols, e.g.
The re-use of canulla Length of stay/Discharge from hospital
Drugs and medical supplies and staff time are the most significant costs
Need to control the key cost drivers.
Financing PAC Services User fees Community health funds Health insurance Cost savings through:
Lower hospital stay Use of MVA where possible as this has
been proven to be more cost effective than D&C
Public funds (taxation) External assistance
Policy Considerations
Financing issues Service sustainability
Staff capacity Continued availability of supplies
Support for PAC at policy level Budgetary support Clarity on legal issues to enhance use
Classification of PAC services as “emergency” care?
Conclusions
Importance of financing and sustainability in PAC
Complex subject Cost effectiveness of MVA vs. D&C Need to do more research on issues of
financing and sustainability in scaling up PAC