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ESTIMATING THE RETURNS OF INVESTING IN RMNCH
Malcolm Bryant and Susan Foster
Overview
Why calculate ROI Overall approach Developing a framework for policy-
makers How it will work Challenges
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Why calculate returns on investment for RMNCH?
Economic benefits of investing in health have been calculated for a range of populations and diseases
Identification of the economic benefits of investing in HIV, TB, malaria—presented persuasive cases
Financing agencies understood these arguments, and as a result, increased funding
RMNCH have not benefitted from the same form of detailed analysis
Country-level decision-makers require tools to understand and support RMNCH
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Overall approach
Review and list the RMNCH challenges faced by women and their children in low-income environments
Identify the major health, social, and other impacts of each challenge
Identify the economic impact of each challenge
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Creating a framework
Identify the most important costs associated with each impact Use an expanded cost-of-illness approach; Capture direct and indirect costs; Individuals Households Healthcare systems Societies
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Populate the framework
What data is required to estimate each cost at the national level?
What are the possible sources of such data in typical country settings? Current burden of morbidity and mortality Unit costs to estimate the cost of illness Estimate current costs of providing RMNCH
interventions and services Identify data needed to calculate
productivity losses
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How will it work?
1. What are the RMNCH challenges?
All common maternal, neonatal, and childhood illnesses and conditions!
How to make sense of them? The Continuum of Care
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Adolescence and before pregnancyStage/Event
Challenges Outcomes Impacts
Menarche and before
Rituals – e.g. FGM
Pain, shame, fear, psychological and mental illness, dyspareunia, perineal tears during labor
Burden on health systemMarital discord+/- divorceNeonatal deaths and asphyxia, postpartum hemorrhage and death
Menstruation
Pain, inconvenienceEarly marriage
Lost days at school, lost days at work,
Decreased female literacy; increased child mortality;Lost productivity
Early Sexual Activity
Unwanted pregnancy, STI, HIV/AIDS
Social rejection, dystocia in young girls, Infertility, divorce, early end of schooling
Burden on health systemNeonatal death and asphyxia, decreased female literacy, increased child mortality
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Selecting priorities
RMNCH is infinitely complex (it makes HIV, TB, and Malaria seem simple). We have to make rational choices about which impacts to address
Proposed Criteria: Must be proven interventions to address impact Feasibility Political visibility
Attractive to politicians and can be understood by them
Evidence of cost-effectiveness
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Possible criteria that could be used Health services costs averted Lives saved – RMNCH is unique in being able to
save more than one life with one treatment episode, e.g. a mother and the baby
Long term sequelae of birth injuries, e.g. asphyxia - need for lifetime of care, low or no income earning, etc.
Long term sequelae of maternal injuries e.g. fistula – divorce, stigma
Indirectly, loss of a mother often means poor survival of remaining children
Increasing under five survival has a disproportionate effect on national life-expectancy
Societal costs – low morale, fatalism, orphans, widowers
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Who is our target audience
International funding agencies? Politicians and policymakers at national
level Ministry of Finance Ministry of Health
National medical and nursing staff and thought leaders
Local politicians and funding groups in decentralized settings
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How closely to link with health and non-health solutions
Where does female education fit in with this?
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Next Steps
Link RMNCH challenges to health, social, economic and other impacts
Estimate the costs to the individual, household, community, health system, and country of each impact
Create a simple tool that can be used to estimate the costs Simple is key. Methodological soundness is
required, but a balance must be maintained between the perfect and the practical
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