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Issues in costing cross cutting HSS interventions in GFATM proposals
Afghanistan experience
Najibullah Safi, MD, MSc. HPM
Health system building blocks
• Health services • Health workforce• Health information system• Medical products, vaccines and technologies• Health financing• Leadership and governance
Areas covered under HSS
• Globally*:– Human resources– Infrastructure and equipments– Communication – Training– Health product– Procurement– Monitoring and evaluation– Management
* Activities supported under GFATM R8
Areas covered under HSS cont.
• Afghanistan:– Expansion of lab network (R8 &R10)– Training– Long term programs (community nursing program
(R8 &R10), FETP (R8), female community health supervisor (R10))
– Short term programs– Revision of HMIS (R8)– Technical support – Research – Salary support
Measuring unit costs• Unit cost: – Relationship between financial investments and outcomes
• Required development of tools for standardized unit costing e.g. – Cost per person-year of ART (variations)– Cost per DOTS patient treated (variations)– Cost per LLIN distributed (is this practical?)
• Routine unit costing is expected to:– Improve budgeting, planning, and target setting– Optimize resource allocation
• Is this practical to calculate unit cost for HSS interventions?
Issues in costing, Afghanistan experience
• Lack of local expertise• HSS cover wide range of services (make it difficult to
use standardized procedures/tools for costing)• Unavailability of costed national strategies and
standard procedures for costing • Difficult to properly link inputs (investment) with
outcome/impact • Inadequate preparation for proposal writing/costing• Significant proportion of budget goes to salaries (less
structured)
Issues in costing, Afghanistan experience cont.
• Lack of required data for planning – Estimation of the required quantities/number– Geographical distribution (cost varies) – Estimation of the unit cost (e.g. FETP, BHC labs)
• Too much assumptions• Duplication with the supported programs by other
donors • Inflated budget