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Introduction to Health Sector Models Overview: The health sector package allows the user to determine the resources required to provide a basic set of health interventions for achieving the MDGs. The package comprises seven different components: • • • • • • • Maternal health (model and user guide) Child health (model and user guide) HIV/AIDS prevention and care (link to publicly available model and user guide) HIV/AIDS treatment (link to publicly available model and user guide) Malaria prevention and treatment (model and user guide) TB treatment (relevant papers and user guide) Health systems including: infrastructure, human resources, community demand, management, monitoring and evaluation, quality improvements (user guide) The interventions included in these sectors are listed in the attached table. How to Use the Package: The health sector models can either be used individually to assess the costs of a disease specific program (e.g., AIDS treatment plan) or as a package to assess the costs of providing basic health services. To use the model as a package, the user must begin by calculating the total costs (20042015) for each of the disease-specific models. A user guide for each of these models is included in this package. The user should then add these costs on a separate workbook. It is possible to do so since the models have been designed to avoid double-counting. Once this sum has been calculated, adjustments should be made to account for the necessary strengthening of the health system (as explained in the health systems user guide). The required adjustments are detailed on a separate user guide. Basic Assumptions: Total versus Incremental Costs: We have adopted a full cost methodology, rather than an incremental cost approach. A full cost analysis calculates the costs of all resources needed to achieve the given coverage target. An incremental analysis only considers the resources required to cover the gap between current coverage and the target coverage. If the user would like to calculate the incremental costs of increasing service provision, he/she must subtract the full cost in the target year (from the model) from the full cost in the baseline year (also from the model). This incremental cost can then be added to current government spending in the sector to calculate total needs. Note that the total needs calculated by this method do not necessarily equal the full costs provided by the model; this is because the model costs current coverage according to the model’s specifications which may differ from the actual methods of service delivery. Public Sector Role: We have calculated all spending necessary to reach specified targets. Users are free to decide how the spending should be allocated between the public and private sectors. However, the Millennium Project recommends that basic interventions such as those in the health sector should be funded entirely by the public sector (with significant input from donors) and not through outof-pocket or other co-payment schemes which can hinder access. Of course, the delivery of the health interventions (as opposed to the funding of it) can be done by public or private sector employees, depending on the structure of the local health system. Targets and pace of scale-up: The targets in the health models indicate what percentage of the population in need of an intervention should be gaining access to it by 2015. These targets, in almost all cases will be much higher than current coverage levels, to enable the countries to reach the Millennium Development Goals. The targets reflect international consensus of what countries should strive for to have greatest impact on the health of their populations. In general, we have used a linear scale-up method to calculate the percentage of the population in need that would have access to a set of interventions in a given year. This means that the models assume the target coverage will be reached in 2015. In practice, the pace of scale-up of these critical interventions should be as rapid as possible and each country should determine whether it can reach the desired target earlier than 2015, thus saving many more lives. The coverage level can be manually re-set in all the models by the user on the first page. Synergies and cost savings: The health models are based on constant prevalence of illness over time. Of course, instituting health and non-health sector interventions early will prevent many cases of illness in the later years, thus reducing the population in need of curative services. Examples of interventions which will reduce treatment costs are: water, sanitation and hygiene education, use of clean cooking fuels, increased condom use, and widespread use of insecticide-treated nets. We have estimated that broad provision of these interventions to the population can reduce total health costs by 2035% in different countries. We recommend that the policy planner in each country attempt to estimate the impact of these and other preventive interventions in their setting (based on pace of scale-up and effective delivery) and factor the resulting cost savings into their budgeting for the out years. Health sector interventions Category Child health Intervention Package Neonatal integrated package Maternal health Antenatal care HIV/AIDS Description Clean delivery, newborn resuscitation, prevention of hypothermia, kangaroo care (skin-to-skin contact to promote parent/infant bonding especially for premature babies), antibiotics for infection, tetanus toxoid, breastfeeding education, hygiene education and antenatal interventions Immunization Vaccines for polio, diptheria, pertussis, tetanus, measles, hepatitis B, Hib and yellow fever Integrated Management of Integrated approach to child health that focuses on the well-being of the whole child. IMCI aims Childhood Ilnness (IMCI) to reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. Skilled attendance and clean delivery Emergency Obstetric Coverage (EmOc) Contraception and family planning services Safe abortions Prevention: Behavior change programs STD Control Voluntary Counseling and Testing (VCT) Harm reduction for injecting drug users Prevention of Mother to Child Transmission Blood safety interventions (e.g., HIV antibody screening, exlcuding high risk donors) Care and Treatment: Antiretroviral therapy Treatment of opportunistic infections Orphan support TB Malaria Access to Essential Medicines BCG vaccine Directly Observed Treatment Short Course (DOTS) Insecticide treated nets Artemisinin combination therapy Interventions to ensure availability, affordabilty, and appropriate use Visits with skilled personnel during pregnancy to check that all is well with mother and baby. It includes being offered a range of tests and should be implemented in accordance with the new WHO antenatal care model Presence of trained and registered midwives, nurses, nurse/midwives or doctors at birth Treatment for ecclampsia, haemorrhage, obstructed labor and sepsis. Universal access to family planning counselling and all forms of contraception. Provision of safe abortions and counseling as well as post-abortion care. Programs to encourage safer sexual behavor including condom social marketing, peer-based education, mass media campaigns and school based AIDS education. Routine screening and effective treatment of sexually transmitted diseases (e.g., syphilis, gonorrhea, vaginitis) VCT includes both pre and post test counseling and is available to people testing positive or negative Actions to prevent transmission of HIV and other infections that occurs through sharing of nonsterile injection equipment and drug preparations. Specific programs include provision of sterile syringes and needles and drug substitution treatment. Prevention of transmission of the HIV virus from infected women to their infants during pregnancy, labour and delivery, as well as during breastfeeding. Includes short-term antiretroviral prophylactic treatment, infant feeding counselling and support, and the use of safer infant feeding methods.. Measures to reduce the risk of receiving infected blood through a transfusion. Includes HIV antibody screening, avoiding unnecessary blood transfusions and excluding high risk donors. Combination of protease inhibitors taken with reverse transcriptase inhibitors used in treating AIDS and HIV. Treatment of any infection caused by a microorganism that would not normally cause disease in individual but occurs in persons with abnormally functioning immune systems (as in AIDS patients) Provision of support to orphans to minimize the impact of AIDS on their lives. Includes school fee support, provision of orphanages and community support. Bacillus of Calmette and Guérin vaccine for TB in high prevalence settings. Internationally-recommended TB control strategy combining five elements: political commitment, microscopy services, drug supplies, surveillance and monitoring systems, and use of highly efficacious regimes with direct observation of treatment. Mosquito nets that are treated with insecticide, which can provide a physical and chemical barrier to mosquitos. The chemical halo that extends beyond the mosquito net itself also shortens the mosquito's life span. Combination of drugs used to treat multi-drug resistant falciparum malaria, which is now widespread in Africa. Provision of procurement and distribution facilities, adequate transportation, monitoring systems to assure drug quality; elimination of user fees for essential medicines; programs to improve the way drugs are prescribed, dispensed, and used, including development and implementation of national essential medicines lists and clinical treatment guidelines, public media campaigns and education of providers.