Estimating Financing Needs Using Examples from LMICs

Collins, David W.; Kagubare, J

doi:10.1142/9789811212413_0003

Cited by 3 publications

(7 citation statements)

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“…The growing consensus now is that services provided by CHWs, when implemented properly, “form the foundation of PHC services by being the first provider sought by families in times of need” [ 16 ] (p. 54). The chapter “Community Platforms for Public Health Interventions” in the third edition of the publication Disease Control Priorities [ 17 ] puts it this way: Without initiatives to help community platforms flourish around the world, the health gains promised by interventions will cost more and deliver less.…”

Section: The Value Of Investing In Community-based Phc Services Provided By Chwsmentioning

confidence: 99%

Community health workers at the dawn of a new era: 4. Programme financing

Masis

Gichaga

Zerayacob

et al. 2021

Health Res Policy Sys

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Background This is the fourth of our 11-paper supplement on “Community Health Workers at the Dawn of New Era”. Here, we first make the case for investing in health programmes, second for investing in human resources for health, third for investing in primary healthcare (PHC) workers, and finally for investing in community health workers (CHWs). Methods Searches of peer-reviewed journals and the grey literature were conducted with a focus on community health programme financing. The literature search was supplemented with a search of the grey literature for information about national health sector plans, community health strategies/policies, and costing information from databases of various countries’ ministries of health, and finally a request for information from in-country partners. Results The global shortage of human resources for health is projected to rise to 18 million health workers by 2030, with more acute shortages in Africa and South Asia. CHWs have an important role to play in mitigating this shortage because of their effectiveness (when properly trained and supported) and the feasibility of their deployment. Data are limited on the costs of current CHW programmes and how they compare to government and donor expenditures for PHC and for health services more broadly. However, available data from 10 countries in Africa indicate that the median per capita cost of CHW programmes is US$ 4.77 per year and US$ 2574 per CHW, and the median monthly salary of CHWs in these same countries is US$ 35 per month. For a subset of these countries for which spending for PHC is available, governments and donors spend 7.7 times more on PHC than on CHW programming, and 15.4 times more on all health expenditures. Even though donor funding for CHW programmes is a tiny portion of health-related donor support, most countries rely on donor support for financing their CHW programmes. Conclusion The financing of national CHW programmes has been a critical element that has not received sufficient emphasis in the academic literature on CHW programmes. Increasing domestic government funding for CHW programmes is a priority. In order to ensure growth in funding for CHW programmes, it will be important to measure CHW programme expenditures and their relationship to expenditures for PHC and for all health-related expenditures.

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Section: The Value Of Investing In Community-based Phc Services Provided By Chwsmentioning

confidence: 99%

Community health workers at the dawn of a new era: 4. Programme financing

Masis

Gichaga

Zerayacob

et al. 2021

Health Res Policy Sys

View full text Add to dashboard Cite

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“…The PHC-CAP Tool is an activity-based costing tool in Microsoft Excel, which allows users to estimate recurrent actual and normative costs of PHC services provided by health facilities in a geographic area ( 18 ). Actual costs are calculated using facility-level input and output data collected from a sample of health facilities and extrapolated to the corresponding universe of facilities in the geographic area of interest ( 19 , 20 ). Normative costs represent the resources needed to deliver PHC services in the health facilities in the area of interest with reasonable quality and efficiency.…”

Section: Methodsmentioning

confidence: 99%

“…For estimates A1 and A2, simple averages of actual cost per capita were calculated for each facility level and these averages were multiplied by the population of the nine regions to obtain the total actual cost. A limitation of estimates A1 and A2 is that catchment populations are often difficult to establish ( 19 , 20 ). The differences between estimates A1 and A2 reflect the fact that most facilities reported larger catchment populations than those prescribed by government norms.…”

Section: Methodsmentioning

confidence: 99%

Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage

Alebachew,

Abdella,

Abera

et al. 2023

Front. Public Health

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IntroductionThe Government of Ethiopia (GoE) has made significant progress in expanding access to primary health care (PHC) over the past 15 years. However, achieving national PHC targets for universal health coverage will require a significant increase in PHC financing. The purpose of this study was to generate cost evidence and provide recommendations to improve PHC efficiency.MethodsWe used the open access Primary Health Care Costing, Analysis, and Planning (PHC-CAP) Tool to estimate actual and normative recurrent PHC costs in nine Ethiopian regions. The findings on actual costs were based on primary data collected in 2018/19 from a sample of 20 health posts, 25 health centers, and eight primary hospitals. Three different extrapolation methods were used to estimate actual costs in the nine sampled regions. Normative costs were calculated based on standard treatment protocols (STPs), the population in need of the PHC services included in the Essential Health Services Package (EHSP) as per the targets outlined in the Health Sector Transformation Plan II (HSTP II), and the associated costs. PHC resource gaps were estimated by comparing actual cost estimates to normative costs.ResultsOn average, the total cost of PHC in the sampled facilities was US$ 11,532 (range: US$ 934–40,746) in health posts, US$ 254,340 (range: US$ 68,860–832,647) in health centers, and US$ 634,354 (range: US$ 505,208–970,720) in primary hospitals. The average actual PHC cost per capita in the nine sampled regions was US$ 4.7, US$ 15.0, or US$ 20.2 depending on the estimation method used. When compared to the normative cost of US$ 38.5 per capita, all these estimates of actual PHC expenditures were significantly lower, indicating a shortfall in the funding required to deliver an expanded package of high-quality services to a larger population in line with GoE targets.DiscussionThe study findings underscore the need for increased mobilization of PHC resources and identify opportunities to improve the efficiency of PHC services to meet the GoE’s PHC targets. The data from this study can be a critical input for ongoing PHC financing reforms undertaken by the GoE including transitioning woreda-level planning from input-based to program-based budgeting, revising community-based health insurance (CBHI) packages, reviewing exempted services, and implementing strategic purchasing approaches such as capitation and performance-based financing.

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“…Per capita actual costs for Kaduna and Kano were determined by dividing the total cost of each estimate for each state by the respective populations. This approach of approximating total actual PHC costs in a geographic area by extrapolating from a sample of health facilities has been employed in several previous studies ( 31 , 32 , 37 , 38 ).…”

Section: Methodsmentioning

confidence: 99%

“…The financial resource gaps for PHC services in Kaduna and Kano were calculated as the difference between actual and normative costs ( 31 , 32 , 37 , 38 ). We calculated resource gaps using actual estimates 1 and 2 described above.…”

Section: Methodsmentioning

confidence: 99%

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

Ogundeji,

Abubakar,

Ezeh

et al. 2023

Front. Public Health

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IntroductionThe availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states.MethodsWe collected primary data from 50 health facilities (25 per state), including PHC facilities—health posts, health clinics, health centers—and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider’s perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state.ResultsWe found that average actual PHC costs per capita at PHC facilities—where most PHC services should be provided according to government guidelines—ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals—where approximately a third of PHC services are delivered in both states—the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano.DiscussionBridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

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Estimating Financing Needs Using Examples from LMICs

Cited by 3 publications

References 0 publications

Community health workers at the dawn of a new era: 4. Programme financing

Community health workers at the dawn of a new era: 4. Programme financing

Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

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