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Costing Health Interventions

Interventions at Comprehensive sites:

(1)Counseling and Testing (2) PMTCT(3) TB Clinics(4) ART(5) LAB SERVICES(6) CARE AND SUPPORT

Costing Approach Calculation of the cost per case (Unit Cost)

for: (1) Counselling and testing (2) PMTCT (3) TB-HIV (4) ART(5) LAB SERVICES(6) CARE AND SUPPORTNote: Unit cost to be calculated separately and total cost will be

arrived at by multiplying with the number of persons receiving the intervention (Typically for one year)

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Pre Requisites for an Intervention

Target population [person covered under the Intervention (PCI)] – That is done through a Typical Course of Events (TCE)

Resource requirements that are in the form of Infrastructure, Fixed and Variable cost (Units of measurement differ for the type of resources used)

Typical course of events

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Persons entering into the Intervention tree for Counselling and testing from H2H

1. OPD, IPD-Wards, Haematology, Voluntary blood donors, self referrals to H2H Center

2. ANC Clinics 3. TB-Clinics

+Ve -ve Persons entering into the Intervention tree for Counselling and testing from ANC clinics

Branched out - Ve

+ve

ART Clinic Registration and Meeting the doctor Rx

Pharmacy

Not eligible for Rx.

Cost Centers 1. CT Centres 2. ART Clinic 3. Laboratory 4. Pharmacy 5. PMTCT6. TB-HIV Clinic

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Cost Categories Infrastructure Cost Program Fixed Cost Program Variable Cost

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What is Health infrastructure and what it produces

The infrastructure available at different level of facilities that are directly or indirectly used for the patient care

The health infrastructure produces different type of services i.e., HH visit, OPD, Diagnostic and Lab services, Hospitalisations, surgeries, specialist consultations etc.. (The unit of measurement of the infrastructure is PCI)

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Program Fixed Cost The specific costs are usually techno

managerial outfits to plan, execute, monitor and evaluate the program.

Example: Cost of Program Managers Cost of refresher training of Lab

technicians and other staff

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Program Variable Cost These are the recurring expenses such

as, medicines, consumables and other supplies for the test.

This cost is linked to the utilisation of the facilities and therefore linked to the PCI

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Calculation of Infrastructure Cost- Information requirements and source The infrastructure for our program

include (a) Building (b) Equipment (c) Manpower

Sources: (1) Program experience (2) Rapid assessment/Time and motion study –

information on duration of counselling and test, waiting time etc.

(3) Expert opinion10

Cost of Building Space Assumption: 1. One comprehensive site on an

average need to have 282 square meter of space (study by Steve) – assume it as 280 square meter

2. Distribute the space for different sites (ANC clinic/TB clinic/H2H center/ Counselling and testing room etc...)

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Cost of Building Space 3. Calculate the present cost of construction

value for 282 sq. meter. 4. Take the Life span of the building as 25

years and on the basis of actual number of years back the facility was constructed depreciate it and find out the annual cost of the building.

5. Cost per day / hour can be calculated by further division and sub divisions

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Cost of equipment 1. Divide the equipment in different categories

(Categories are already specified by Steve) FHI Nigeria Asset classification 110510.xls

2. Under each category there are various instruments 3. Methodology: Step -1

E1=(e11, e12, e13, …,e 1n) E2=(e21,e 22, e 23,…, e 2n)

……………………….……………………….

Em= (em1, em2, em3,…, emn)

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Cost of Equipment

Where, and eij, represents jth type of instrument within ith category of equipment

or i = 1, 2, …,m and j = 1, 2, …, n. If pij represents the price vector for the same, then the cost of instruments under equipment category 'i' ( CEi) equals: CEi = m

i =1nj =1 eijpij

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Cost of Equipment Step 2:Annual cost of ith category of equipment

(ACEi) equals: ACEi = [mi =1n

j =1 eij pij'] [mi

=1nj =1 LEij], where, LEij is the life

expectancy of instrument 'j' within ith category.

Cost per day = ACEi / 365 (assuming that the equipments are used throughout the year)

Cost per Hour = Cost per day / Number of hours the equipment functions Maintenance costs 160410.xls

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Costing the Manpower List out the staff under each sub-category and find

out the range of their salary [(max+min)/2]. The salary of each sub-category of staff per day /

hour could be arrived at by dividing the total monthly salary with the number of working days / hours in a month.

Further desegregations could be made by appropriate division / multiplication with time.

The cost contribution of each category of staff could be arrived at by adding the unit (hourly / daily) cost of each sub-category under respective categories. 16

Costing the Manpower Look at the functional specificity of various

categories and sub-categories of staff, and allocate their cost on the basis of functions carried out by them at different service points.

The monetary values of the time spent for different activities in a day could be arrived at on the basis of percentage of time devoted by them for different activities.

Typical Example Manpower cost.xlsx

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Components of Infrastructure and Unit of Measurement Services Unit of Measurement OP Contact Number Lab tests (all types) Number X-Ray type tests Number Manpower Time (including all) Hours Time for the Machine Hours Vehicle time Hours Building Space Cost/Sq. Feet

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Calculation of Program fixed costProgram Fixed Cost Unit of measurement

Managerial Time Hours

Technical staff time Hours

Equipment Hours

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Program Variable cost

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Cost Components Unit of measurement Operational cost NairaCost of training NairaTravelling expenses NairaFuel and maintenance Naira

Future Course of Action Sl No Time

PlanCompletion of Data collection template – 30% Finished 17th MayPretesting the data collection tool 20th MayFinalisation of the tool 22st May Collection of data from one comprehensive site, analysis and presentation

30th May

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