Date post: | 12-Apr-2017 |
Category: |
Documents |
Upload: | dr-purna-chandra-dash |
View: | 42 times |
Download: | 0 times |
1
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)
2
3
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
4
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
5
Cost Categories Infrastructure Cost Program Fixed Cost Program Variable Cost
6
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)
7
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
8
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
9
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...)
11
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
12
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)
13
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
14
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
15
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
17
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
18
Calculation of Program fixed costProgram Fixed Cost Unit of measurement
Managerial Time Hours
Technical staff time Hours
Equipment Hours
19
Program Variable cost
20
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
21