Financial Aspects

This paper evaluates the effectiveness and cost-effectiveness of alternative training strategies for increasing access to emergency obstetric care in Burkina Faso. [adapted from abstract]

This report summarizes the key problems in the health sector and their implications on human resources for health and financing of the health sector; discusses the issues on human resources for health; explores options for improving the production, deployment, retention and management of these workers; analyzes the current state of financing in the health sector; explores options for the financing of essential health services and non-EHP services; and summarizes the way forward. [adapted from introduction]

This paper seeks to provide nurses and nursing representatives with insights into the economic rationales for investing in health, health systems and the health workforce. It aims to support interaction and advocacy between nurses and those involved in public sector resource allocation such as governments, international agencies and private investors and health administrators. [from executive summary]

This presentation was part of the WHO-OECD Hosted Dialogue on migration and other
health workforce issues in a global economy. It discusses the cost of providing the minimum number of health workers for developing countries in terms of increasing the production of health workers, taking into account the diversity and competencies of health workers, and augmenting financial rewards and improving the working environment. [adapted from author]

In response to the critical HRH shortages in Africa, DFID and Office of the US Global Aids Coordinator (OGAC) have been in discussion with a number of African countries to develop strategies and country level actions. The aim is to demonstrate the maximum flexibility of disease specific programmes to support broad based primary care in line with countries’ health plans.

This introductory presentation on maintaining economically sustainable staffing levels was offered during a dialogue hosted by the WHO and OECD.

Improving the capacity of developing countries to respond to emerging diseases and especially influenza pandemics is essential to reduce both transmission around the globe and the human toll of outbreaks in the developing world. Investing in this capacity in developing countries is thus increasingly seen as a shared concern within the global community. [from introduction]

This presentation discusses the various aspects of private providers as they pertain to contracting for health services. [from presentation]

This article outlines different efforts at making strategic HRH plans in the developing world. The article focuses on the financial aspects of HRH planning and provides some general guidelines on the best way to make these plans.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It details the financial issues involved in scaling up health worker training such as the cost of hiring additional staff, educating health workers and expanding training capacity. It also outlines the current and possible future sources of increasing expenditure for health worker training. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It reviews a study of how Rwanda, faced with constrained fiscal conditions, has implemented innovative reforms to create fiscal space for human resources and to make these resources more responsive to needs through an analysis of budget documents and policy and regulation changes and key informant interviews. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It talks about goverment spending policies on health worker wages and how they affect the health workforce.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It breaks down current health spending including HRH resource needs and gaps, provides a critical assessment of HRH financing by some of the top donors and addresses campaiging for adequate and sustained donor financing. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It presents five questions on the financial concerns of scaling up the number of health workers to provide adequate health care.

The Health Sector Strategic Plan (HSSP) aims to ensure access to basic health care by the Ugandan population. This requires availability of well-trained health professionals. This study demonstrates that the Private-Not-For-Profit Health Training Institutions - the majority in Uganda - have remained grossly under-funded, which poses a threat to achievement of the HSSP. It is recommended that government increases and guarantees its support to these Health Training Institutions as a way of maintaining quality of health worker training. [from abstract]

Recent comments from the Global Fund suggest an intention to focus more on the three diseases, and to leave the strengthening of health systems and support for the health workforce to others. This could create a “Medicines without Doctors” situation in which the medicines to fight AIDS, tuberculosis, and malaria are available, but not the doctors or the nurses to prescribe those medicines adequately. [author’s description]

Health care organizations often do not know what their costs are and have no simple way of assessing costs on a regular basis… This cost analysis tool involves site administrators and service providers themselves in measuring recurrent direct costs of providing services. [author’s description]

This is the first in a series of three papers that examines the financing of services in developing countries. This paper focuses on external assistance in the form of aid and debt cancellation to finance the recruitement, training and salaries of health and education workers. It also discusses the factors that contribute to the critical shortage of these workers and explores some approaches to scaling-up the recruitment of health workers and teachers. [adapted from author]

The objective of this article was to compare the cost-effectiveness of the tuberculosis programm run by the Bangladesh Rural Advancement Committee, which uses community health workers (CHWs), with that of the government program which does not use CHWs. [adapted from author]

Home-based care (HBC) for HIV/AIDS is increasingly looked to as a more accessible and affordable alternative to more costly inpatient care, both for patients who are unable to travel to or pay for inpatient care as well as for governments that must fund inpatient facilities. Partners for Health Reformplus estimated the cost of HBC for HIV in Rwanda, based on a sample of eight programs offering care in early 2004. The sample comprised facility- and community-based programs. Both types of program implement the medical care recommended in the Ministry of Health guidelines for HBC. [from abstract]

There is a growing acknowledgment of the importance of the continuum of care and support services to people living with HIV/AIDS outside of health facilities. Greater reliance on communities to provide care and support to people living with HIV/AIDS as well as non-complex maintenance and adherence support for treatment of those who are under antiretroviral treatment is seen as a way to alleviate the burden placed on traditional health systems in countries highly affected by HIV/AIDS. This report presents findings from the field-test of the Partners for Health Reformplus guidelines developed for costing home-based care (HBC) programs, with cases drawn from nine HBC programs in Uganda.

The purpose of this study is to estimate the cost implications of implementing the newly proposed Integrated Management of Childhood Illnesses algorithm in first-level health care facilities in rural areas of Bangladesh. Bangladesh policymakers need to know the cost of IMCI prior to its implementation so that they allocate adequate resources, particularly personnel and drugs, and the associated financial resources to health facilities. [from author]

This paper describes the application of activity-based costing (ABC) to calculate unit costs for a healthcare organization in a developing country. It also describes the ways in which these calcualtions can provide information for improving the efficiency and quality of healthcare services. [from abstract]

The Family Planning Manager’s Handbook is a standard text in management training courses around the world and has received wide recognition as a practical guide for managers of health and family planning programs. [publisher’s description]

This report presents findings from Phase 3 of an assessment of the human resources implications of HIV/AIDS services scale-up in Rwanda. It focuses on the staffing implications and associated costs of HIV/AIDS services scale-up. By documenting current staffing levels and the level of effort necessary to provide HIV/AIDS services, Phase 3 of the study analyzes how many full-time equivalent (FTE) staff will be needed, and at what costs, if the Government of Rwanda is to meet its HIV/AIDS service delivery objectives. The human resources projections are based on data gathered during Phases 1 and 2 of the study.

Government and donor funds fail to meet growing demands for reproductive health care in the public sector. Strategies to support uch services include: convince governments to invest more in family planning; use market segmentation to direct subsidies to the poor and to direct clients who can afford to pay to the private sector; encourage public-private partnerships to increase use of the private sector; increase the efficiency of service provision in the public sector; plan for the phase-out of donor-provided contraceptives. [author’s description]

The Christian Health Association of Ghana (CHAG) is a large faith-based NGO which currently serves an estimated 35 percent of the Ghanaian population, mainly in remote rural areas. CHAG’s financial sustainability is threatened due to declining donations from missionary groups and donor agencies, uncertain support from government, and low cost recovery in member facilities. Although knowledge of costs is essential to program management, CHAG members had no information on the costs of the services they provided. Thus, CHAG had no economic benchmarks for evaluating efforts to control costs, no denominator for calculating cost recovery for different services, and no empirical data on service costs that could be used to approach donors and the Ghanaian government with requests for funding.

Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. [author’s description]

Many NGOs providing reproductive health (RH) services are facing reductions in donor funding, requiring them to generate more of their own resources. Prosalud, CIES and APSAR, Bolivian NGOs, wanted to build skills in costing and market research to support efforts to improve financial sustainability. Staffs attended a one-week workshop, followed by implementation of three operations research (OR) studies designed to reinforce skills and generate information for decisionmaking. The Prosalud and CIES studies included the calculation of unit cost per service; measurement of client willingness to pay (WTP) higher prices for services, and a market segmentation assessment in selected areas where Prosalud clinics are located.

Presbyterian Church of East Africa (PCEA) Chogoria Hospital is a faith based non-governmental organization providing a wide range of healthcare services. The organization faces a number of challenges related to sustainability: declining donor support (especially for reproductive health services), low cost recovery levels, and increasing poverty levels among its clientele. In response to these concerns, a team from Chogoria Hospital attended a one-week workshop held in Ghana on financial sustainability and developed a small scale operations research project to determine the cost of providing a selected number of reproductive health (RH) services and to evaluate their cost recovery levels.