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Costing

HP+ More recent Costing publications are available.

  • The 2013 Kenya Household Health Expenditure and Utilisation Survey (2013 KHHEUS), explores the health-seeking behavior, use of healthcare services, out-of-pocket health spending, and health insurance coverage of Kenyan households. The first health survey to take place since Kenya decentralized its government; the 2013 KHHEUS collects data from the country’s 47 newly-created counties. By interviewing members of 33,675 households and comparing results with those of previous years (2003 and 2007), the 2013 survey provides important insights into how healthcare utilization, spending, and insurance coverage have changed in Kenya over the past decade. The 2013 KHHEUS was conducted by the Kenya Ministry of Health with support from the USAID-funded Health Policy Project and in conjunction with the Kenya National Bureau of Statistics. The survey provides critical evidence to inform the development of Kenya’s latest health financing strategy and policy decisions related to the future universal health coverage and the National Hospital Insurance Fund, and will support the wider national health accounts estimation process.

  • Tracking health budget allocations is critical in assessing whether resources allocated in the health sector are aligned to key policy objectives as articulated in policy documents. In Kenya, the Constitution requires that at least 15 percent of the national revenues should be allocated to the county governments to fund the devolved functions that include health. This study assessed the trends in allocations between 2013/14 and 2014/15, and sought to establish whether the allocations were aligned to sector priorities both at the national and county level.

  • The Uganda Family Planning Costed Implementation Plan, 2015–2020, published by the Ministry of Health, was launched by the government in November 2014. Its objective is to reduce unmet need for family planning to 10 percent and to increase the modern contraceptive prevalence rate among married women to 50 percent by 2020. The plan includes strategies to improve demand creation; service delivery and access; contraceptive security; policy and enabling environment; financing; and stewardship, management, and accountability. The cost of the total plan is $235 million USD between 2015 and 2020, which will increase the number of women in Uganda currently using modern contraception from approximately 1.7 million users currently in 2014 to 3.7 million in 2020.

    Uganda's gap analysis found a total financial gap of about $113 million for all six years of the FP-CIP. As the total cost for the FP-CIP is $235.8 million, less than half of the activity costs in the CIP are covered by currently planned funding between 2015 and 2020. The size of the gap in Uganda differs by year; the largest gap is in 2019, with a gap of $21.8 million. The larger gaps in the later years are due to a steady increase in reach of activities within Uganda in line with projected scale-up of demand and services for FP in line with the country’s goal to reach a 50% modern contraceptive prevalence rate among married women by 2020. In addition, government and development and implementing partners often have insufficient knowledge of what would be funded past the initial first few years of the FP-CIP due to funding cycles and programme timelines.

    The gap analysis provides clear evidence that the Ugandan government and in-country development partners are focusing significant effort on financing the purchase of contraceptives. However, evidence has shown that for family planning interventions to be effective, financial support and efforts need to be dedicated to providing a holistic rights-based FP programme that includes demand generation efforts, improvement in the quality of service provision, supply chain improvements, strong policies and financing, and coordinated planning, management and supervision at national and decentralized levels.

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) conducted a budget analysis to examine the GOT’s final FY 2015/16 health sector budget. HPP’s analysis examined the trends in budget allocations for health, patterns of distribution, and funding sources. Findings from this analysis may be used to advocate for efficient and effective budget allocations for HIV and essential medicines, and can be shared with key stakeholders, including decisionmakers from the Ministry of Health and Social Welfare (MOHSW), the National AIDS Control Program (NACP), TACAIDS, national- and district-level elected leaders, the media, and the public.

  • Healthcare in many developing countries, including those in sub-Saharan Africa, is predominantly funded through out-of-pocket spending by households. Providing financial protection from exorbitant out-of-pocket expenses is an important tool for a country’s health system to ensure equitable access to care and ensure families are not unnecessarily faced with financial catastrophe and impoverishment. Using data from the Kenya Household Health Expenditure and Utilization Surveys and descriptive analysis, the Health Policy Project, with support from USAID and PEPFAR, estimated the incidence and intensity of catastrophic healthcare expenditure and impoverishment in Kenya in 2003 and 2007. Among other findings, the Catastrophic Health Expenditures and Impoverishment in Kenya analysis revealed that in 2007 an estimated 2.5 million people were pushed below the national poverty threshold as a result of paying for healthcare. Results from this analysis provide strong evidence for the need to implement policies that offer more financial protection to the poor and vulnerable in order to achieve the country’s overall goal of universal health coverage.

  • The USAID- and PEPFAR-funded Health Policy Project partnered with the government of Côte d’Ivoire and PEPFAR on a study to estimate the cost and impact of HIV treatment scale-up by calculating the cost of antiretroviral treatment (ART) for one person per year for adults, children, and pregnant women. This annual ART cost was analyzed as a function of regimen, stage of illness at treatment initiation, retention, and response to treatment. The average cost was used to project the total investment necessary to scale up ART between 2015 and 2020 and achieve the country’s 90-90-90 goal, in which 90 percent of people living with HIV know their status, 90 percent of those diagnosed with HIV are on treatment, and 90 percent of those on treatment are virally suppressed. Using the Spectrum suite of policy models, the study estimated the number of lives saved and pediatric infections averted if this treatment scaleup is achieved. This study fills the critical information gap on cost as it relates to outcome. The government of Côte d’Ivoire and its development partners will be able to understand the resource needs for treatment scale-up and have the necessary data to inform decision making to effectively target available resources for HIV treatment.

  • The Government of Ghana in 2012 included family planning commodities and services in the benefit package of the National Health Insurance Scheme and thus the need to assess the cost. The analysis in this report focuses on costing family planning services provided in the National family planning protocol of 2007 which are currently being delivered in health facilities and NGOs in Ghana. The objective of the study was to determine the unit cost (direct and indirect) of providing family planning services in Ghana and also project the resource requirements for scaling up family planning services in Ghana from 2012 to 2016.

  • Given the importance of effective HIV-related programs for key populations in Kenya, several government entities, donors, and stakeholders expressed the need for country-specific data on the costs of providing oral pre-exposure prophylaxis (PrEP) to prevent HIV infection. Such data would contribute to the development of evidence-based oral PrEP policies and help ensure that the required resources are made available for appropriate implementation and scale-up. In collaboration with the National AIDS and STI Control Program and the Sex Worker Outreach Program, the Health Policy Project conducted a study to address the following questions: How much does it cost to provide oral PrEP to one sex worker for a year? And, how much would it cost to scale up oral PrEP to all sex workers country-wide? The findings show that the average, annual unit cost of providing oral PrEP to one sex worker is US$602 and the total cost to extend the intervention to all HIV-negative male and female sex workers in Kenya ranges from US$24 million to US$48 million, depending on coverage from 50 to 100 percent. The report concludes with recommendations for the Government of Kenya on factors to consider when planning any future scale-up of oral PrEP.

  • Costed Implementation Plans (CIPs) are concrete, detailed plans for achieving the goals of a national family planning program over a set number of years. A CIP details the program activities necessary to meet the goals and the costs associated with those activities, thereby providing clear program-level information on the resources a country must raise both domestically and from donors. The Health Policy Project, with various partners, has developed a collaborative, 10-step approach to creating a CIP that aligns with ongoing government planning and coordination efforts. This brief outlines these 10 steps, which when implemented, should result in a consensus-driven strategy, roadmap, and budget for achieving family planning targets under the Ouagadougou Partnership, FP2020, and/or other national programs. To date, the following countries have completed CIPs for family planning: Senegal, Burkina Faso, Niger, Togo, Mauritania, Guinea, and Zambia.

  • The Health Policy Project's final costing study entitled Estimating the Unit Cost of Providing a Minimum Package of HIV Services to Female Sex Workers and Men Who Have Sex with Men, provides useful information for national program planners, donors, and other stakeholders.It does now, however, include operational details on how these different stakeholders can use the study results for their individual planning, budgeting, and resource mobilization and/or allocation purposes. This companion guide provides details on how study results may be used to inform decision making at multiple levels.

  • The USAID-funded Health Policy Project (HPP) formed a study team to estimate the unit costs associated with a minimum package of HIV services for female sex workers (FSWs) and men who have sex with men (MSM).

    To support the use of the analysis and cost data presented in the final study, the HPP study team also identified the need to develop a companion user guide to provide policymakers and program planners with a practical, stepwise approach to using data for decision making and evidence-based HIV programs, services, and policies, that address the needs of people living with HIV (PLHIV), MSM, and FSWs in Côte d’Ivoire.

    Using a stepwise approach with accompanying tables and worksheets, the guide first explains the importance of calculating average costs using data analysis presented in the larger study. Next, it explains how to determine and use program reach to estimate annual unit costs for HIV programs. Finally, the reader is shown how to project programmatic and national annual costs for FSWs and MSM. 

    The guide is available in English and French.

  • Knowledge of HIV status is essential for achieving universal access to HIV services. As such, HIV testing and counseling (HTC) are fundamental elements of all HIV prevention, care, and treatment programs. As the need for HTC expands in Kenya and resources dwindle, the efficiency and effectiveness of HIV spending is of utmost importance. One method to reduce HTC costs involves re-working the testing algorithm. The Health Policy Project (HPP) was invited by the National AIDS and STI Control Programme (NASCOP) to help conduct an analysis, whereby incremental costs, defined as the costs in addition to that of the current algorithm, were calculated for three newly proposed algorithms. Based on the results of this analysis, which highlights the cost savings of each option, a recommendation for a more cost-efficient algorithm was proposed.

  • The National AIDS Control Program (NACP) in the Ministry of Health and Social Welfare (MoHSW), with support from the USAID-funded Health Policy Project (HPP), engaged in a stakeholder-driven process to estimate the costs of the Third Health Sector HIV and AIDS Strategic Plan (HSHSP III) for the fiscal years 2013/2014-2017/2018. This report describes the HSHSP III costing process and shows the cost results by NACP program unit and HSHSP III impact area and strategic objective.

  • The Government of Tanzania (GoT) has recognized the need to stop gender-based violence and strengthen services for survivors of GBV. In 2011, the Ministry of Health and Social Welfare (MoHSW) developed management guidelines for GBV services delivered within the health care setting and began training service providers in accordance with these guidelines. In 2012, with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through its Gender-based Violence Initiative (GBVI), the MoHSW began a phased rollout of these guidelines through training and facility support. The GBVI was aimed at strengthening coordination of GBV prevention and response efforts and their integration within existing HIV interventions. As the MoHSW moves forward with scale-up of the national guidelines, policymakers and program managers have identified the need to better understand the costs associated with GBV service delivery – for the purposes of estimating resource requirements for scale-up and also for exploring factors that drive the costs of GBV service delivery. The purpose of this study was to estimate the cost of delivering GBV services per client encounter at public health facilities in Tanzania and to understand the cost drivers of GBV service delivery in order to inform scale-up policies and planning. 

  • The Crosswalk of Family Planning Tools provides a comparison of 19 commonly used family planning costing, planning, and impact analysis tools. The Health Policy Project designed the guide to help advocates, program planners, decisionmakers, and others to (1) select which tool might best fit their goals or questions and (2) interpret the outputs of each tool. The guide contains information on each tool's overall goal; intended use; primary target audience; interventions included; unit costing approach (if applicable); and health, cost, economic, or demographic outputs. In addition, the guide compares the requirements for each tool related to data needs, training and skills, and usability.

    The guide is accompanied by a chart to use as a quick reference for general information and comparison. To print the chart, 11 x 17 paper is required and "fit to page" and "landscape orientation" must be selected under printer properties.

  • The Health Policy Project assembled this directory to help government agencies, development partners, and other local and international organizations identify Kenyan institutions with the skills and experience to support their health policy, finance, and governance needs. The directory is also designed to promote information sharing among the institutions it lists, as well as collaboration and partnerships, both international-local and local-local. The capabilities and accomplishments of 14 Kenyan organizations and consulting firms are highlighted, along with their mission, program and geographic areas, and contact information.

  • The Plano Estratégico do Sector da Saúde (PESS) 2014-2019 (the Health Sector Strategic Plan), is the overall expression of the priorities, implementation approaches, and resource commitments for health of the government of the Republic of Mozambique (GRM). With support from the USAID-funded Health Policy Project (HPP), the Ministry of Health (MISAU) applied the OneHealth model to estimate the financial and health system resources need to implement the plan, and the likelihood of meeting key indicators in maternal and child health and HIV/AIDS related to the Millennium Development Goals. Detailed cost analysis was conducted for over 40 disease programs across primary and secondary health. Financial requirements for the overall human resources for health (HRH), logistics, health infrastructure, governance and leadership, and health information systems were also estimated. The report identifies potential constraints for the scale-up of services, such as inadequate human resources, and includes an HRH gap analysis. It also contains a review of the strategic planning process at MISAU, and recommendations for the institutionalization of the OneHealth approach.

    The report is available in English and Portuguese.

  • As the Government of Botswana (GOB) moves forward with a plan to expand coverage of health services, increasing the “value for money” of current health service delivery and identifying new financing sources is critical. As part of the 2010 Integrated Health Service Plan, a 10-year strategic plan for the health sector, the Ministry of Health (MOH) will introduce the Essential Health Services Package (EHSP)—health interventions to be provided as part of a package to the entire population. Although understanding the costs of delivering health interventions and the major cost drivers is critical to expanding the health sector, current knowledge of these costs is limited. This study aims to shed light on the overall costs of key interventions that address the major disease burden in Botswana.

    The study comprised two parts. In Part I, the Health Policy Project (HPP) technical team assessed the unit costs of providing specific HIV interventions at two levels of service delivery. In Part II, the team used the OneHealth tool (Avenir Health, n.d.) to project the overall resources required between 2013 and 2018 to provide EHSP services, based on normative inputs.

  • The government of Cote d'Ivoire is committed to the fight to gain control and turn the tide of the HIV epidemic. Striving to offer the best standard of HIV treatment, the country aims to adopt the new 90-90-90 target. The country also plans to roll out “test and offer” for the general population in the near future and begin piloting Option B+ for pregnant women in 2015. Such an intense scale-up of HIV treatment services will require intensified coordination to mobilize resources and effectively target those funds for treatment scale-up and sustainability.

    The aim of this cost-outcome analysis study was to estimate the cost of HIV treatment scale-up and the impact of such an expansion by estimating the cost of treatment for one person per year for adults, children, and pregnant women. Currently, limited data exist around the unit cost of HIV treatment in Cote d’Ivoire. To inform policy decisions on how best to finance scale-up of treatment with the limited resources available, understanding the outcome of HIV treatment—and the levers for improving the chances of successful treatment—is critical.

    The study found that the cost of the full year of treatment expected by following the national treatment guideline would be CFA142,431 (US$288) for adults, CFA217,603 (US$440) for children, CFA85,063 (US$172) for PMTCT Option B, and CFA 151,827 (US$207) for PMTCT Option B+. A total investment of approximately CFA147 billion (US$297 million) is required over the next five years, leading up to the year 2020, to achieve the 90-90-90 target and a 100 percent roll-out of the Option B+ approach for the prevention of mother-to-child transmission (PMTCT). This investment will save more than 35,000 lives and prevent more than 6,000 children from becoming infected via PMTCT compared to the status quo, in which treatment coverage increases at the historical pace.

  • The purpose of this guidance manual is to outline steps for estimating the cost of post-GBV services at the health-facility level. It provides the user with practical steps for conducting a costing study, including preparing for data collection, collecting and managing data, and analyzing and using the results. It provides detailed instructions on how to use the GBV Program Cost Calculator, an MS Excel-based tool developed under the Health Policy Project (HPP) that enables the use to generate unit cost estimates of providing health facility-based post-GBV interventions to a single client during one health facility visit. The cost data generated from these steps are meant to represent the cost of providing services and not on the cost to the client for seeking services. The results on the cost of post-GBV services generated from implementing these steps are to support program managers, policy makers, funding partners and government ministries to plan and scale-up GBV intervention services.

  • The USAID and PEPFAR-funded Health Policy Project team, at the request of and in collaboration with the National Department of Health, conducted a detailed study in 2015 of the costs of providing medical male circumcision in South Africa. The objectives of this study were to:

    • Derive the unit cost of delivering medical male circumcision in South Africa at the facility level

    • Assess costs from a client perspective

    • Identify the level of spending currently incurred for demand creation

    The study’s findings, presented in this report, provide a detailed investigation, through a comprehensive bottom-up approach, of the costs to providers in offering medical male circumcision, as well as the cost to clients in receiving medical male circumcision. Results from the study will assist the South African government to assess the actual unit costs of medical male circumcision delivery and scale-up and provide information about the financial barriers medical male circumcision clients might face. This analysis will also support the National Department of Health, development partners, and implementing partners to better project resources needed for medical male circumcision service delivery and to understand cost drivers and cost variances across provinces and different modes of medical male circumcision service delivery (e.g., circumcision provided at fixed sites vs. circumcision provided as part of outreach programs). The cost data from this report will also inform the second round of South Africa’s investment case analysis.

  • The 2013 Kenya Household Health Expenditure and Utilisation Survey (2013 KHHEUS), explores the health-seeking behavior, use of healthcare services, out-of-pocket health spending, and health insurance coverage of Kenyan households. The first health survey to take place since Kenya decentralized its government; the 2013 KHHEUS collects data from the country’s 47 newly-created counties. By interviewing members of 33,675 households and comparing results with those of previous years (2003 and 2007), the 2013 survey provides important insights into how healthcare utilization, spending, and insurance coverage have changed in Kenya over the past decade. This brief summary highlights the key findings from the survey which will be used to inform Kenya health and health financing policy and will support the national health accounts estimation process. The 2013 KHHEUS was conducted by the Kenya Ministry of Health with support from the USAID-funded Health Policy Project and in conjunction with the Kenya National Bureau of Statistics.

  • A newer version of this product is available on the HP+ website.

    The Family Planning CIP Costing Tool helps countries understand the costs associated with implementing the detailed roadmap of FP activities outlined in their family planning costed implementation plan (CIPs). This tool was developed to both standardize the CIP costing approach across countries and streamline a sometimes complex process to make it easier for countries to revise inputs as commitments and implementation strategies are updated. The tool is Excel-based and includes pre-loaded equations, making it easier and quicker for new users to generate data.

    The tool can be used at the national level—and at subnational levels where lower-level CIPs have been developed—to help policymakers, decisionmakers, partners, and donors better plan and advocate for an effective FP strategy. 

    The Family Planning CIP Costing Tool was developed as part of the CIP Resource Kit, and is meant to be used in conjunction with the The Family Planning CIP Gap Analysis Tool. The CIP Resource Kit can be accessed at http://www.familyplanning2020.org/cip. The CIP Costing Tool User Guide provides step-by-step instructions for applying the tool.

  • A newer version of this product has been integrated with the CIP Costing Tool available on the HP+ website.

    The Family Planning CIP Gap Analysis Tool is an Excel-based tool that helps countries estimate the financial gap between the costs associated with implementing detailed costed implementation plan (CIP) activities and the annual funding commitment by government and donors for supporting the plan’s implementation. The gap analysis tool is designed to be used in conjunction with the Family Planning CIP Costing Tool (also part of the CIP Resource Kit), but allows the user to input cost data from any source (for instance, if the original CIP was costed using a different methodology). The tool can be used at the national level—or subnational levels—to help policymakers, decisionmakers, partners, and donors better plan and advocate for an effective FP strategy and is most effective as part of the initial CIP development or an annual CIP review process. The CIP Gap Analysis Tool User Guide provides step-by-step instructions for applying the tool. 

    The Family Planning CIP Gap Analysis Tool is designed for use in developing a comprehensive plan that meets the standard level of costing and gap analysis detail recommended for CIPs, which includes costs associated with specific activities within each CIP thematic area. For countries that wish to apply the CIP Gap Analysis Tool in support of an existing CIP or strategic plan that does not include activity-level costs, the Simplified CIP Gap Analysis Tool may be more appropriate.

    This resource is part of the CIP Resource Kit, which can be accessed at http://www.familyplanning2020.org/cip.

  • Increasing eligibility for treatment necessitates reallocation of resources and strategic investment to prepare the healthcare system and ensure access to treatment. This policy will increase the number of patients needing treatment in the near term, which will put stress on human resources for health, facilities, and the supply chain. Recognizing these challenges, the USAID- and PEPFAR-funded Health Policy Project (HPP) provided technical assistance and programmatic support to the government of Botswana to address its ongoing efforts to restructure the health sector. Using the OneHealth Tool, HPP analyzed the costs of implementing the WHO 2013 recommendations and the test and treat model in 2016.

  • In June 2013, President Uhuru Kenyatta of Kenya announced policies to remove user fees in dispensaries and health centers and to provide free maternal health services in all public health facilities. This report presents the findings of a study conducted in Kenya by the USAID-funded Health Policy Project (HPP) to establish baseline measures for evaluating the impact of these policies. The Kenya Ministry of Health, with support from HPP, identified the need to monitor and evaluate the impact of the policies on utilization, service provision, and revenue collection, among other indicators.

  • The Kenya AIDS Strategic Framework 2014/15–2018/19 (KASF) is the overarching strategic document guiding the HIV response in Kenya’s devolved governance system. The implementation of KASF goals will contribute to the achievement of Vision 2030 targets by ensuring universal access to comprehensive HIV prevention, treatment, and care. Kenya has also committed to reaching UNAIDS’ ambitious 90-90-90 targets by 2019. These targets call for 90 percent of all people living with HIV (PLHIV) to know their status, 90 percent of those diagnosed to be on antiretroviral therapy (ART), and 90 percent of people on ART to be virally suppressed. Several resource gaps for HIV programs have been estimated in the past. This brief attempts to harmonize the methodologies used in estimating HIV commodity gaps in the past. To do so, major stakeholders (Clinton Health Access Initiative, National AIDS & STI Control Programme, and National AIDS Control Council) were consulted in arriving at the assumption and targets used in the resource-gap estimation model. In this model, two scenarios are considered: financial needs for key commodities under the current guidelines, and a more ambitious “scale-up” scenario. In addition to harmonizing the way Kenya estimates HIV commodities gaps, the model will also support the mobilization of resources toward attaining the 90-90-90 targets.

  • The Harm Reduction Expenditure Tracking Tool assesses total and unit expenditure in-country over two fiscal years for needle and syringe exchange programs (NSPs) and opioid substitution therapy (OST). The user guide provides step-by-step instructions for using this Excel-based tool. 

    The USAID- and PEPFAR-funded Health Policy Project (HPP), in collaboration with the Eurasian Harm Reduction Network (EHRN), developed the Harm Reduction Expenditure Tracking Tool. The tool was created for use by civil society groups to advocate for increased funding for harm reduction as HIV prevention in Eastern Europe and Central Asia. The tool and user guide are available in English and Russian.

  • This Harm Reduction Funding Gap Tool shows the difference in financial resource needs and commitments by year for needle and syringe exchange programs (NSP) and opioid substitution therapy (OST) programs. The user guide provides step-by-step instructions for using this Excel-based tool.

    The USAID- and PEPFAR-funded Health Policy Project (HPP), in collaboration with the Eurasian Harm Reduction Network (EHRN), developed the harm reduction funding gap tool. The tool was created for use by civil society groups to advocate for increased funding for harm reduction as HIV prevention in Eastern Europe and Central Asia. The tool and user guide are available in English and Russian.

  • This Harm Reduction Unit Costing Tool estimates the in-country unit cost per client per year for opioid substitution therapy (OST) and needle and syringe exchange (NSP) services. The user guide provides step-by-step instructions for using this Excel-based tool.

    The USAID- and PEPFAR-funded Health Policy Project (HPP), in collaboration with the Eurasian Harm Reduction Network (EHRN), developed the harm reduction unit costing tool. The tool was created for use by civil society groups to advocate for increased funding for harm reduction as HIV prevention in Eastern Europe and Central Asia. The tool and user guide are available in English and Russian.

  • In order to expand and ensure widespread access to healthcare services and protect households from what are termed "catastrophic" health expenditures, Kenya needs alternative and sustainable healthcare financing mechanisms. The Health Policy Project supported the government of Kenya to analyze the long-term health delivery costs and health financing options available to the country. Employing a number of economic and health financing tools, the analysis, Healthcare Financing Options for Kenya: FY 2013/14–2029/30, revealed a need to increase domestic financing and improve the efficiency of the service delivery and social health insurance systems. Results from the analysis will be used to support the country’s move toward universal health coverage.

  • In 2010, Kenya adopted a new constitution which both guaranteed the right to health and devolved health service delivery to Kenya’s 47 counties. A few years later, in 2014, counties became responsible for delivering health services. Although funding to support service delivery has also been devolved to the counties, it remains inadequate for county health needs, forcing the health sector to compete with other priority sectors for scarce resources.

    To help County Departments of Health secure greater allocations for the health sector, this how-to guide provides a summary of each of the main stages of the budget cycle and key milestones, suggests actions that county leaders can take during the budget process to influence county budgets, and highlights some of the potential bottlenecks at each stage. 

  • ImpactNOW, a new family planning advocacy model, generates evidence to make the case for immediate FP investments by modeling gains in maternal and child deaths averted, unintended pregnancies, and financial savings to the healthcare system as a result of FP uptake. ImpactNOW is currently being pilot-tested in Ethiopia's Amhara Region. On August 27, 2013, the Health Policy Project held a one-day stakeholders meeting to introduce ImpactNOW, provide a live demonstration of the model, and obtain feedback and impressions of it from family planning stakeholders, advocates, and policymakers. Stakeholders included representatives from the Amhara Regional Health Bureau (ARHB), the Regional Finance and Economic Development Bureau (BoFED), university partners, and nongovernmental organizations. Their primary focus in applying ImpactNOW will be the linkage between FP uptake and maternal and child deaths.

  • ImpactNow is an Excel-based model that estimates the health and economic impacts of family planning (FP) in the near term. It is designed to model the impacts of different policy scenarios, and to compare the results of those scenarios in advocacy materials. It can help to estimate the impacts of many “what if” questions about policy options. ImpactNow is designed to analyze impacts in the two- to seven-year time horizon; for example, it could be used to estimate the impacts of meeting Family Planning 2020 (FP2020) commitments. The outcomes are focused on reproductive health metrics, as well as economic metrics, such as cost-benefit ratios and incremental cost-effectiveness ratios (ICER).

    ImpactNow was adapted from Marie Stopes International’s (MSI) Impact 2 as a collaboration between MSI and the Health Policy Project (HPP), with support from USAID. The ImpactNow Manual: Estimating the Health and Economic Impacts of Family Planning Use is also available to help health analysts use the ImpactNow model to estimate the health and economic impacts of FP programs.

  • The HIV epidemic in Ukraine is severe and concentrated: it is estimated that there were 211,800–237,000 HIV-positive individuals in the country in 2013. Once dominated by infections among people who inject drugs (PWID), the adult HIV incidence in Ukraine is increasing among other key populations and the national prevention strategy must adapt. These populations include female sex workers (FSWs), clients and casual partners of FSWs, and men who have sex with men (MSM), among others. In this context, the USAID- and PEPFAR-funded Health Policy Project partnered with the State Service of Ukraine on HIV/AIDS and the Institute for Economy and Forecasting to analyze the cost and effectiveness of HIV prevention from 2014–2018. Conducted in July 2013, the analysis aimed to inform the National AIDS Programme (NAP) 2014–2018. This poster was presented at the 20th International AIDS Conference in Melbourne, Australia.

  • Saving Mothers, Giving Life (SMGL) is five-year public-private partnership aiming to drastically reduce maternal mortality in sub-Saharan Africa. As part of the proof of concept, the USAID- and PEPFAR-funded Health Policy Project conducted an expenditure analysis to identify what additional expenditures were made to reduce maternal mortality in the eight SMGL pilot districts in Uganda and Zambia. The overall study findings showed that investments in infrastructure, transportation, training for healthcare workers, and demand creation for facility-based deliveries led to maternal mortality decreases in both countries in one year—30 percent in one, 35 percent in the other. HPP's expenditure analyses complement these evaluations, and help to inform budgeting and planning for scale-up of the district strengthening model.

  • This USAID- and PEPFAR-funded Health Policy Project report synthesizes the findings of the County Health Accounts (CHAs) of 12 selected counties for financial years (FY) 2013/14 and 2014/15. The 12 counties are Bomet, Isiolo, Kakamega, Kisumu, Makueni, Migori, Mombasa, Nairobi, Nyeri, Siaya, Tharaka Nithi, and Turkana. The report compares health expenditures in the 12 counties to provide evidence of a pattern for sources and uses of health funds. It pays special attention to key financing sources for healthcare, the role of financing agents in managing healthcare funds, providers of healthcare goods and services, and the services purchased with these funds.

  • In March, the Kenya Ministry of Health convened an international consultation forum in collaboration with the World Bank Group and the United States Agency for International Development (USAID) through the Health Policy Project to deliberate on the challenges of providing universal health coverage (UHC) to all Kenyans, regardless of their ability to pay, and to explore strategic and sustainable health financing options. The Kenya Health Policy Forum reviewed options and lessons learned from other countries, and proposed recommendations on how the country can improve efficiency to achieve UHC.

    The meeting brought together local and international experts with diverse expertise spanning the health sector, including both the public and private sectors. Participants from Kenya included representatives from both levels of government, nongovernmental organizations, faith-based organizations, and the private sector. International speakers shared experiences from Brazil, Ethiopia, Ghana, India, and Mexico. Development partners who support Kenya’s health sector were also represented, including the USAID, the UK Department for International Development, the German Federal Enterprise for International Cooperation, and the World Bank.

  • Countries in West Africa (WA) have made significant progress in addressing the HIV epidemic. However, HIV prevalence among sex workers (SWs) and men who have sex with men (MSM) remains high, and data are unavailable for transgender (TG) populations. Services that meet the needs of SWs, MSM, and TG are often unavailable outside of major cities. Stigma and discrimination (S&D) against key populations impact service uptake and increase migration, making it harder to reach these populations. Policies—such as laws, national strategies, and operational procedures—impact service availability and uptake. To inform decisionmakers and improve access to HIV-related services for mobile SWs, MSM, and TG populations in West Africa, the USAID- and PEPFAR-funded Health Policy Project (HPP) conducted an analysis of key policies in countries along the Abidjan-Lagos corridor and Burkina Faso.

  • The Saving Mothers, Giving Life partnership (SMGL) is a global partnership between governments, donors, and the private sector to accelerate reduction in maternal and neonatal mortality in sub-Saharan African countries.As part of the SMGL program, the USAID-funded Health Policy Project (HPP) has worked with Zambia’s Ministry of Community Development, Mother and Child Health (MCDMCH) and its Ministry of Health (MOH) to develop their capacity to use the OneHealth Tool (OHT) to model reproductive, maternal, neonatal, and child health (RMNCH) program scale-up and resource needs.In order to make further progress toward reducing maternal, neonatal, and child mortality, MCDMCH requested that HPP conduct a training on the Lives Saved Tool (LiST) (a component of OHT) with programmatic staff from the ministry’s maternal health, child health, and nutrition units. LiST is a computer-based modeling tool that uses input data such as demographic and service coverage levels to estimate the number of deaths that can be averted as a result of expanding effective maternal and child health interventions.

  • Tanzania’s sustained development and transition to middle-income status depend on the health of its people. In recognition of this fact, the Government of Tanzania (GOT) has prioritized reproductive, maternal, newborn, child, and adolescent health (RMNCAH), adopting a broad foundation of policies to inform RMNCAH programming. Yet, in recent years, progress toward achieving Millennium Development Goal (MDG) targets for child, maternal, and neonatal health has been uneven, in large part due to funding and implementation challenges. To overcome these challenges and accelerate progress, the GOT developed a National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child and Adolescent Health in Tanzania (2016-2020): One Plan II. In 2015, the USAID-funded Health Policy Project (HPP) conducted an analysis to project the costs and health impacts of achieving the government’s new commitments outlined in the One Plan II, and to identify the remaining challenges for implementing the plan.

  • Until recently, the primary focus of Botswana’s health agenda (as with many of its neighbors) has been on infectious disease control—particularly HIV, since the country has one of the highest prevalence rates in the world (22% of adults ages 15–49 are HIV positive). Noncommunicable diseases (NCDs) were not a priority on the global health spectrum, but rising affluence and urbanization have contributed to increases in NCDs in the last decade. In Botswana, NCDs are estimated to account for 31 percent of all deaths. The most common NCDs include cardiovascular disease, hypertension, cancer, chronic obstructive pulmonary diseases, and diabetes. 

    In recognition of these challenges, and with the overall emphasis shifting from care and treatment to prevention of these diseases, the USAID- and PEPFAR-funded Health Policy Project (HPP) provided technical assistance and programmatic support to the government of Botswana to analyze the resource implications of this shift for CVD, type II diabetes, and kidney disease.

  • Like many sub-Saharan African countries, Kenya is exploring the adoption of the World Health Organization Option B+ strategy as the standard of care for its program to prevent mother-to-child transmission of HIV. The Health Policy Project (HPP) was invited by the National AIDS and STI Control Programme (NASCOP) to help conduct a cost-effectiveness analysis of scaling up Option B+ versus other strategies. Results of the analysis suggest that implementing a scale-up of Option B+ will avert infant and adult infections but at a significant additional cost. Kenya should consider these results to assess whether Option B+ is affordable given the available resources.

  • In Côte d'Ivoire (CdI), the Health Policy Project (HPP) supported national institutions to estimate the unit cost of HIV programs targeting key populations such as males who have sex with males and sex workers. This final report provides estimates for the cost of delivering HIV services to key populations in CdI as well as projections of how costs could change over time in varying scenarios of program scale-up and service packages. These results can be used by stakeholders at all levels of the country to better plan and budget for HIV service delivery.

  • The USAID-funded Health Policy Project (HPP) conducted a readiness assessment in Mozambique to see if would be possible and useful to conduct a costing study of post-GBV Care Services. Broadly the readiness assessment was designed to assess if there is a shared understanding about GBV and the need to scale up services. On a narrower level, the readiness assessment looked specifically at whether the data and information needed to apply HPP’s GBV Cost Calculator are available . The Calculator was initially developed and tested using the GBV management guidelines for the Ministry of Health and Social Welfare for the United Republic of Tanzania, which has invested heavily in standardized care protocols, training and data collection. The assessment highlights several important challenges to conducting a GBV costing study in Mozambique as well as some clear opportunities. The challenges include a lack of agreement about what constitutes GBV, a lack of protocols on what constitutes a GBV facility, and  a deficiency in national data collection protocols. The opportunities are reflected in a policy environment that offers a range of multisectoral and health sector policy documents and in the commitment by donors and the government of Mozambique to expand the quality and accessible of support for GBV survivors. 

  • In order to assess the pricing policies of family planning (FP) products and understand the impact of these policies on the accessibility of family planning services, the USAID-funded Health Policy Project (HPP), collaborated with the USAID | DELIVER Burkina Faso, Mauritania, Niger and Togo to formulate regional and national recommendations for improving contraceptive pricing policies to ensure the availability and sustainability of FP programs in West Africa.

  • The OneHealth Model (OneHealth) is a tool for medium term (3 to 10 years) strategic planning in the health sector at the national level, ideally suited for public sector planners. It estimates the costs by disease program, as well as estimating the costs of utilizing the health system building blocks in delivering the targets involved in the disease programs. In Kenya, at the request of the Ministries of Health, HPP provided technical assistance in applying OneHealth to cost the Kenya Health Sector Strategic Plan III, 2012-2017, reflecting the interventions under the Kenya Essential PAckage of Health, as well as national disease strategies for programs that include HIV/AIDS, tuberculosis, malaria, non-communicable diseases, maternal, reproductive and child health, etc. The results include an assessment of the overall financial gap between resources needed and the government and donor resources available for all years of the analysis. This brief is intended for a policy audience in Kenya to support sustainable health sector planning, and may be of interest to other countries in the region who wish to apply OneHealth or similar approaches to assessing costs and financial gaps.

  • Kenya's Health Sector Coordinating Committee, a joint forum of government and development partner representatives, commissioned a study in late 2012 to determine the implications of a lack of Global Fund resources for Kenya related to HIV, tuberculosis, and malaria. Conducted in 2012, and later revised in 2013, the assessment was carried out by Health Policy Project in partnership with the German technical support agency, GiZ. The study analyzes changes to the Global Fund, (e.g., the New Funding Model) and considers Kenya’s policy risks related to future Global Fund resources. The risk analysis also includes projected financial gaps for the three diseases and set of policy recommendations to the Government of Kenya to mitigate the risks of a decline in Global Fund resources and the potential challenges of implementing grants under the New Funding Mechanism.

  • At the Ouagadougou Partnership and Family Planning 2020 (FP2020) meetings, governments committed to improving access to family planning services and information. Costed Implementation Plans (CIPs) for family planning services and information provide a framework and tools for governments to achieve their international family planning commitments. This booklet, prepared by the Health Policy Project, highlights the methodology behind CIPs, walks through 10 steps for designing and implementing a national CIP for family planning, and shares experiences from seven African countries that have developed national CIPs for family planning to inform their decision making. It is estimated that implementation of the CIPs will accelerate each country's progress toward both achieving its target contraceptive prevalence rate and reducing maternal and child mortality.  

  • Tanzania's Ministry of Health and Social Welfare chose the OneHealth Tool, a model for medium- to long-term strategic planning in the health sector, to inform development and prioritization of the Fourth Health Sector Strategic Plan 2015/16–2019/20 (HSSP IV). Specifically, the OneHealth Tool was used to estimate the resource requirements and resources available for the health sector over the next five years, the impact on maternal and child health and HIV if HSSP IV service delivery targets are met, and the human resources constraints in scaling up health services. The results of Tanzania's OneHealth application are summarized in this report and provide an evidence base for strategic planning and resource allocation.

  • It is estimated that 80,000 infants born annually in Zambia are at risk of acquiring HIV from their mothers. In 2011, more than 415,000 Zambians were on antiretroviral therapy (ART), but the number of children accessing ART services lagged significantly behind that of adults. Ensuring universal access to ART requires more information about the costs of scaling up services to reach every child in need. To inform the resource investment required to increase coverage of pediatric ART, the USAID- and PEPFAR-funded Health Policy Project (HPP), along with the Ministry of Health of the Government of the Republic of Zambia (MOH), examined the average additional cost to infant and child health services at the health facility level (incremental cost) of providing clinical pediatric ART services for children living with HIV. HPP and the MOH also analyzed the cost drivers of treatment to identify opportunities for increasing efficiencies. This poster shows the results of this work and was presented at the 20th International AIDS Conference in July 2014.

  • This study, conducted by the USAID- and PEPFAR-funded Health Policy Project (HPP), assessed the costs and benefits of different prevention of mother-to-child transmission of HIV (PMTCT) treatment options (baseline treatment as currently offered, Option B, and Option B+). It is intended to inform the scale-up of PMTCT services in Nigeria’s 13 high-burden states, which account for 70 percent of the mother-to-child transmission burden.

  • This manual provides the user with step-by-step instructions to apply the GAP Tool (Gather, Analyze, and Plan). The GAP Tool is a simple Excel-based tool to help policymakers, ministry officials, health officials, and advocates understand and plan for the costs associated with expanding family planning to achieve their country's contraceptive prevalence or fertility goals. The two main outputs produced by the tool are the country’s funding gaps for a national family planning program and for family planning commodities. 

    The U.S. Agency for International Development (USAID) supported development of the GAP Tool through the USAID | Health Policy Initiative, Task Order 1, and continues to support work on the tool, as well as this manual, through the Health Policy Project. 

  • Using the ImpactNow model, the USAID-funded Health Policy Project collaborated with the Amhara Regional Health Bureau (RHB) to estimate the near-term benefits of achieving Ethiopia’s ambitious family planning goals in the region. This brief summarizes key health and economic benefits associated with achieving these goals and offers recommendations for the Regional Health Bureau to increase investment in and improve family planning services. The analysis found that if the contraceptive prevalence rate (CPR) in the Amhara Region increases from 46 percent in 2014 to 73 percent in 2020 and if women adopt more long-acting and permanent methods (LAPMs), family planning would save the lives of 13,000 mothers and 112,000 children over that time period. Moreover, compared to current trends in the CPR, the Amhara Region would save an additional US$19 million in maternal and child healthcare costs. Using these results, the RHB promotes data-driven FP policy development and can advocate for increased access to family planning and LAPMs to achieve national FP goals in the region. 

  • The response to HIV and AIDS is an integral component of efforts to improve social and economic conditions in Ghana and Côte d’Ivoire. Available data suggest that HIV prevalence rates among key populations, particularly female sex workers (FSWs) and men who have sex with men (MSM), are several times higher than the national averages for both countries. These groups also face additional barriers to social acceptance and access to services, compared with the general population. Accordingly, Ghana and Côte d’Ivoire each completed a Strategic Framework to guide interventions and service delivery specifically for key populations. The frameworks propose a package of services that includes HIV prevention; HIV treatment, care, and support; and psychosocial support and legal services. This brief describes the costing analysis conducted by HPP and in-country stakeholders to provide country-specific costing data on key populations to provide an evidence base for policy-making processes.

  • As part of its overall effort to promote evidence-based policies, decision making, planning, and advocacy, the Health Policy Project has worked with the Ghana AIDS Commission (GAC) and other important  stakeholders to conduct a costing study of services to key populations in Ghana (males who have sex with males and female sex workers). This will ensure that Ghana has country-specific costing data available. The study team collected information from service providers at eight purposively selected facilities and from program managers at the regional and central levels. The costing data are now being used to update Ghana's Goals Model and for planning, budgeting, and decision-making purposes (e.g, in conjunction with the development of Global Fund proposals and development of operational plans and budgets). In addition, one of the purposes of analyzing unit costs is to understand what is driving costs and identify areas where there is potential to gain efficiencies and reduce costs without negative impacts on quality.

    The report does not include specific operational details on how each of these different levels may use study results for their individual planning, budgeting and resource mobilization, and/or allocation purposes. The accompanying Estimating the Unit Costs of Providing Key HIV Services to Female Sex Workers and Males Who Have Sex with Males in Ghana: A Data Use Guide summarizes key findings from the study and provides specific details on how study results may be best used to inform the evidence base for the Ghana HIV program.

  • As part of its overall effort to promote evidence-based policies, decision making, and planning and advocacy, the Health Policy Project has worked with the Ghana AIDS Commission (GAC) and other important stakeholders to conduct a costing study of services to prevent mother-to-child transmission of HIV. This will ensure that Ghana has country-specific costing data available. The study selected 14 sites within the country, including teaching, regional, and district hospitals providing PMTCT services. To understand differences in services being delivered at the community level, the study included three community-based health planning service sites and three maternity home sites. The study team interviewed two programmatic and finance staff at the 14 sites and central-level program managers and financial officers during data collection. The costing data are now being used to update Ghana's Goals Model and for planning, budgeting, and decision-making purposes (e.g., in conjunction with the development of Global Fund proposals).

    The report does not include specific operational details on how each of these different levels may use study results for their individual planning, budgeting and resource mobilization, and/or allocation purposes. The accompanying Estimating the Unit Costs of Providing HIV Prevention of Mother-to-Child Transmission Services in Ghana: A Data Use Guide summarizes key findings from the study and provides specific details on how study results may be best used to inform the evidence base for the Ghana PMTCT program.