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ESTIMATES of COSTS to ACHIEVE the HEALTH Mdgs

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ESTIMATES of COSTS to ACHIEVE the HEALTH Mdgs UN-EDITED CONFERENCE VERSION 29-30 OCTOBER 2009 Health Systems for the Millennium Development Goals: Country Needs and Funding Gaps Background Document for the Taskforce on Innovative International Financing for Health Systems Working Group 1: Constraints to Scaling Up and Costs World Bank/ UNICEF/UNFPA/Partnership for Maternal, Newborn and Child Health 2 Acknowledgements This report was prepared by Agnes Soucat and Netsanet Walelign Workie (World Bank), Rudolf Knippenberg and Carlos Carrera (UNICEF), Howard Friedman (UNFPA), and Hendrik Axelson (PMNCH). The report also contains important contributions from Laurence Lannes, James McQueen Patterson, Nicole Klingen, Feng Zhao, and Ajay Tembon (World Bank), as well as Carole Hie, Archana Dwivedi, and Susie Villeneuve (UNICEF). The authors are thankful to the peer reviewers Peter Berman, Adam Wagstaff, Pablo Gottret, Alex Preker, Meera Shekar, Robert Hecht, GNV Ramana and Mariam Claeson for their comments. The work was conducted under the general direction of Julian Schweitzer and Yaw Ansu (World Bank), Peter Salama and Ian Pett (UNICEF), and Flavia Bustreo (PMNCH Secretariat). 3 4 Contents I. Executive Summary................................................................................................................9 II. Introduction...........................................................................................................................20 III. Background and objectives ..............................................................................................22 III.I. Africa Strategic Framework and Asia-Pacific Investment Case ....................................22 III.II. Objectives of this analysis...........................................................................................25 IV. Methods..............................................................................................................................26 IV.I. Time frame ......................................................................................................................26 IV.I.I Countries included ..................................................................................................26 IV.II. Targets of the simulations: the health MDGs.............................................................27 IV.III. Simulations..................................................................................................................28 IV.III.I Overview of the simulation model..........................................................................28 IV.III.II Conceptual framework........................................................................................29 IV.III.III Data requirements and limitations ......................................................................30 IV.IV. Selecting high-impact health interventions.................................................................32 IV.IV.I Generic interventions included in the tool..............................................................32 IV.IV.II Specific interventions selected for this exercise .................................................32 IV.IV.III Phasing of interventions......................................................................................35 IV.V. Determining coverage targets through bottleneck analysis ...........................................36 IV.V.I General methodology..............................................................................................36 IV.V.II Specific bottleneck reduction by group of countries ..............................................37 IV.VI. Calculating impact......................................................................................................38 IV.VI.I Evidence of effect on reducing child mortality and malnutrition...........................38 IV.VI.II Evidence of effect on reducing maternal mortality.............................................42 IV.VI.III Evidence of effect to reduce deaths from AIDS, TB, and malaria in adults and during pregnancy ....................................................................................................................43 IV.VI.IV Steps in calculating impact .................................................................................44 IV.VII. Calculating costs.........................................................................................................45 IV.VII.I Methodology.......................................................................................................45 IV.VII.II Cost assumptions for this costing exercise .........................................................47 IV.VIII. Phasing assumptions for investment and recurrent costs to calculate funding requirements ...............................................................................................................................52 IV.VIII.I Methodology.......................................................................................................52 IV.VIII.II Phasing assumptions for this exercise.................................................................53 IV.IX. Fiscal space and estimates of financing gap ..............................................................53 V. Results ....................................................................................................................................58 V.I. Scaling up for the health MDGs in the 49 countries ......................................................58 V.I.I Potential impact on the health MDGs.........................................................................58 V.I.II Overall additional costs...........................................................................................61 V.I.III Cost distribution by service delivery mode ............................................................61 V.I.IV Cost distribution by disease, program, and component of the health system.........63 V.I.V Cost distribution by economic classification ..........................................................66 V.I.VI Health facilities and health workers required .........................................................70 5 V.I.VII Financial space and funding gaps ...........................................................................71 V.II. Scaling up for the health MDGs in sub-Saharan Africa.................................................74 V.II.I Potential impact on the health MDGs....................................................................74 V.II.II Overall additional costs...........................................................................................80 V.II.III Cost distribution by service delivery mode ............................................................81 V.II.IV Cost by disease, program, and component of the health system ............................82 V.II.V Cost distribution by economic classification ..........................................................85 V.II.VI Health facilities and health workers required .........................................................88 V.II.VII Financial space and funding gaps in SSA...........................................................89 V.III. Scaling up for the health MDGs in non-SSA countries...............................................92 V.III.I Potential impact on the health MDGs.....................................................................92 V.III.II Overall additional costs...........................................................................................98 V.III.III Cost distribution by service delivery mode ........................................................98 V.III.IV Cost by disease, program, and component of the health system ......................100 V.III.V Cost distribution by economic classification ........................................................102 V.III.VI Health facilities and health workers required ...................................................106 V.III.VII Financial space and funding gaps in non-SSA countries..................................107 V.IV. Financial space and funding gap analysis by country..................................................109 VI. Discussion.........................................................................................................................111 VII. Conclusions......................................................................................................................113 VIII. References....................................................................................................................114 List of Figures Figure 1. Estimated impacts and costs framework (49 countries) .................................................................................17 Figure 2. Estimated impacts and costs framework (SSA countries)..............................................................................18 Figure 3. Estimated impacts and costs framework (non-SSA countries) ......................................................................18 Figure 4. Two levels of health production functions.....................................................................................................30 Figure 5. MBB steps for impact calculation..................................................................................................................45 Figure 6. Calculation of incremental costs to increase coverage of health services ......................................................46 Figure 7. Financial space under five scenarios, 46 countries ........................................................................................72
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