Download Total versus Incremental Costs

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:
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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.