HEALTH SYSTEMS Andhra Pradesh: Health Scenario, Health Systems Interventions and Cost-Benefit Studies Cost-Benefit Analysis PR Sodani Neeraj Sharma Md Mahbub Hossain D K Mangal AUTHORS: Acting President IIHMR University IIHMR University Dean Research IIHMR University Jaipur, Rajasthan, India Jaipur, Rajasthan, India IIHMR University, Jaipur, Rajasthan, India Jaipur, Rajasthan, India SD Gupta Chairman IIHMR University, Jaipur, Rajasthan, India © 2018 Copenhagen Consensus Center [email protected] www.copenhagenconsensus.com This work has been produced as a part of the Andhra Pradesh Priorities project under the larger, India Consensus project. This project is undertaken in partnership with Tata Trusts. Some rights reserved This work is available under the Creative Commons Attribution 4.0 International license (CC BY 4.0). 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Andhra Pradesh: Health Scenario, Health Systems Interventions and Cost-Benefit Studies Andhra Pradesh Priorities An India Consensus Prioritization Project P R Sodani (Acting President), Neeraj Sharma, Md Mahbub Hossain, D K Mangal (Dean Research), S D Gupta (Chairman) IIHMR University, Jaipur, Rajasthan, India. Working paper as of May 16, 2018 Acknowledgement The authors are grateful for invaluable advice and support from Brad Wong and Bjorn Larsen, Copenhagen Consensus Centre, and Amar Chanchal, Tata Trusts. ACADEMIC ABSTRACT ...................................................................................................................................... 1 POLICY ABSTRACT ............................................................................................................................................ 2 THE PROBLEM ........................................................................................................................................................ 2 INTERVENTION 1: STRENGTHENING BASIC AND SURGICAL CAPACITY FOR REDUCING MATERNAL AND NEONATAL DEATHS .............. 3 Overview ....................................................................................................................................................... 3 Implementation Considerations .................................................................................................................... 3 Costs and Benefits ......................................................................................................................................... 3 INTERVENTION 2: IMPROVED EMERGENCY REFERRAL MANAGEMENT BY 108 AMBULANCE SERVICES ........................................ 4 Overview ....................................................................................................................................................... 4 Implementation Considerations .................................................................................................................... 4 Costs and Benefits ......................................................................................................................................... 4 Costs ........................................................................................................................................................................... 4 Benefits ...................................................................................................................................................................... 4 INTERVENTION 3: FAMILY PLANNING .......................................................................................................................... 5 Overview ....................................................................................................................................................... 5 Implementation Considerations .................................................................................................................... 5 Costs and Benefits ......................................................................................................................................... 5 Costs ........................................................................................................................................................................... 5 Benefits ...................................................................................................................................................................... 5 BCR TABLE ............................................................................................................................................................ 6 1. INTRODUCTION ............................................................................................................................................ 7 1.1 India’s Health Scenario ............................................................................................................................ 7 1.2 Andhra Pradesh: Health Systems, Status and Driving change ................................................................ 9 2. STRENGTHENING BASIC AND SURGICAL CAPACITY FOR REDUCING MATERNAL AND NEONATAL DEATHS . 11 2.1 DESCRIPTION OF INTERVENTION ......................................................................................................................... 11 2.2 DATA ............................................................................................................................................................ 12 2.3 SITUATION ANALYSIS ........................................................................................................................................ 13 2.4 CALCULATION OF COSTS AND BENEFITS ............................................................................................................... 14 2.4.1 Costs and Benefits .............................................................................................................................. 14 Costs ......................................................................................................................................................................... 15 Benefits .................................................................................................................................................................... 19 Calculation of Benefit-Cost Ratio ............................................................................................................................. 20 2.5 ASSESSMENT OF QUALITY OF EVIDENCE ............................................................................................................... 21 3. IMPROVED EMERGENCY REFERRAL MANAGEMENT USING 108 AMBULANCE SERVICES ............................ 21 3.1 DESCRIPTION OF INTERVENTION ......................................................................................................................... 21 3.2 DATA ............................................................................................................................................................ 22 3.3 SITUATION ANALYSIS ....................................................................................................................................... 22 3.4 CALCULATION OF COSTS AND BENEFITS ............................................................................................................... 23 3.4.1 Costs ................................................................................................................................................... 23 3.4.2 Benefits............................................................................................................................................... 24 Calculation of Benefit-Cost Ratio ............................................................................................................................. 25 3.5 ASSESSMENT OF QUALITY OF EVIDENCE AND SENSITIVITY ANALYSIS .......................................................................... 26 4. FAMILY PLANNING ..................................................................................................................................... 26 4.1 DESCRIPTION OF INTERVENTION ......................................................................................................................... 26 4.2 DATA ............................................................................................................................................................ 27 4.3 LITERATURE REVIEW ........................................................................................................................................ 27 4.4 CALCULATION OF COSTS AND BENEFITS ............................................................................................................... 28 4.5 CALCULATION OF BENEFIT-COST RATIO ..............................................................................................................