Cost-Estimate Strategy for Reproductive Health Commodity ManagementTool Name: Cost-Estimate Strategy for Reproductive Health Commodity Management Origin / Source: Developed by the Rational Pharmaceutical Management Project of Management Sciences for Health, with the MotherCare Project of John Snow Inc., and the United States Pharmacopeia, for the US Agency for International Development. Technical Area: Maternal Health Tool 26 Basic Description: The Cost-Estimate Strategy (CES) is a planning, budgeting, and management tool, which provides information to enable program managers to make better-informed decisions about all aspects of reproductive health (RH) commodity management. It offers a mechanism for estimating reproductive health commodity costs under a variety of alternative scenarios to facilitate planning, budgeting and the efficient use of reproductive health funds. Through its survey component, CES guides the collection and analysis of information on commodity availability and management to assist in the improvement of drug and equipment supply systems, to identify gaps in drugs, medical supplies and equipment, and to promote rational use of drugs and equipment. Country Applications: The CES was field-tested in Kenya in collaboration with the Ministry of Health's Division of Primary Health Care in 1997. Subsequently, following refinement, it was applied at a provincial hospital in Kenya to develop the RH commodity budget for the maternity ward (1999). In 1999, the CES was implemented in collaboration with the Zambian Ministry of Health, the Central Board of Health and the USAID-funded Zambia Integrated Health Project, to estimate the costs of providing RH commodities in 11 project districts and nationally. It was also used to assess service and commodity availability at health facilities, and provider practices. Language(s) Available: English Technical Scope/Purpose: The CES costing spreadsheet facilitates the calculation of the episodic cost of the treatment of a single (average) RH condition or the provision of a RH service to one client. By applying target population caseload or morbidity information to the episodic costs, the spreadsheet generates an estimate of the total costs of providing RH treatments and services. This information can be used to allocate resources, seek funding, or estimate the costs of expanding a program geographically or by introducing additional service. By adapting and using the CES Survey instruments in the local situation, the user obtains information on
The CES can be applied at national, regional, or district levels, or at individual health facilities. Design: The spreadsheet tool was developed for use in Excel 97. Method: quantitative Frequency of Administration: The costing tool may be used as frequently as revised data on the costs of RH drugs, medical supplies and medical equipment are required for decision making. One example of its use would be to generate the annual procurement needs for RH services. The implementation of the full scope of the CES Survey would provide baseline data on the availability and use of RH services and commodities, and on health provider practice, following which the selection and use of specific components of the Survey would provide a mechanism to monitor the system. Key Users of the Information:
Objectives and Scope of the Tool: The primary goal of the CES tool is to help improve reproductive health commodity management by providing valuable information and tools which program managers can utilize and implement. It offers a mechanism for estimating reproductive health commodity costs under a variety of alternative scenarios to facilitate planning, budgeting and the efficient use of RH funds. Through its survey component, CES guides the collection and analysis of information on commodity availability and management, and on prescribing practice, to assist in the improvement of drug and equipment supply systems, identify gaps in drugs and commodities, and to promote rational use of drugs and equipment. Key Indicators:
Tool Design: The CES consists of two components -- the spreadsheet models to estimate the costs of RH commodities and the survey to assess the current situation regarding the availability and use of RH commodities within the program. Costing models: Estimates of the costs of RH commodities can be made in three ways, each requiring a different level of effort in terms of data collection and analysis. In each case an episodic cost -- the cost to provide commodities for a single case -- is determined as the first step. The Normative model is based on WHO and other internationally recognized standard treatment guidelines and uses international procurement costs for drugs and supplies to estimate the episodic cost. Both the STGs and the commodity costs are installed in the spreadsheet model. The user may obtain an estimate of commodity costs for the program by applying appropriate caseload information to the episodic costs of those reproductive health conditions and services of interest to them. The Country-specific model uses official (or establishes) STGs for the program context and uses local (centrally managed) cost information to derive episodic costs for commodities, then applies the caseload information for the target population to obtain total program estimates. The Actual version uses information from the CES Survey (see below) component to model current practice in the provision of RH services and then can incorporate local (decentralized) costs to estimate the cost of a single case. Again, local epidemiological or caseload data are applied to estimate the total commodity costs for the program under prevailing health care practice. Survey: Parts or all of the CES Survey can be implemented in order to examine selected issues of the following aspects of reproductive health commodity management: (1) service and commodity availability at health facilities; (2) the use of RH commodities by health care providers; and (3) the local cost of RH commodities. For example, this information can be used to: assess the extent to which providers have necessary commodities on hand; examine the feasibility of existing STGs; identify under- or over-supply of RH commodities; assess the efficiency of procurement; ascertain inappropriate practices by health care providers and identify any training needs relating to proper use of essential commodities. Implementation and Training: The implementation of the CES Survey requires data collectors be trained to have a full understanding of the purpose of the tool, the survey instruments, and how they would handle problems during data collection. The number of trainees would depend upon the number of facilities to be surveyed and the time frame for data collection. Manuals and Guidelines (if applicable): The CES User's Guide -- a comprehensive text describing how to implement the CES components -- is accompanied by a diskette containing the Normative CES Model (Excel file), the CES Model Template (Excel file), and the CES Survey Instruments (Word file) containing sample questionnaires. Data Processing and Analysis: The tool includes spreadsheet model templates to estimate program commodity costs -- following identification of essential reproductive health commodities -- and sample survey instruments to gather information on current practices in reproductive health commodity management. Information from the CES Survey may be analyzed using a suitable program such as Epi Info. Reporting and Dissemination of Results (if applicable): Reports on the costs of RH commodities will need to be prepared with the nature of the decision making for which the cost information has been derived, and the intended audience (program manager, government budget committee, or donor agencies, for example) in mind. Reports on the findings of the Survey may be used to inform policy options discussions. Cost: The costing component of the CES may be used at the local level using local resources. The Survey component, depending upon the extent of the program to be surveyed and the time frame for data collection may need significant resources for the training of the data collection team, survey work and data input and analysis. Lessons from Experience: Full implementation of the CES methodology requires a range of skills and a real commitment of resources. Ideally a CES implementation team would include members with clinical expertise in reproductive health, pharmaceutical and supply management expertise, operational service delivery skills, and analytical skills for examining survey data and identifying clinical, supply, financial and policy implications. Because of the level of effort and expertise required to successfully conduct a survey and analyze the information collected, it is important to give careful consideration to the scope and objectives of the CES survey work. More limited objectives may be attained with selective use of the survey instruments and adaptation of these to the local situation and consequently lower levels of staff time. The spreadsheet models require familiarity with Excel software, but no specialized expertise, and step by step instructions are contained in the CES User's Guide. Conducting the CES survey requires appropriate expertise in data collection, validation and analysis. Interpreting the results and utilizing these in the decision-making process -- for example, through a policy options workshop -- may require technical assistance. Contact: |