![](media/image1.jpeg){width="7.751388888888889in"
height="9.866666666666667in"}

![](media/image1.wmf)

**Acknowledgement**

This work was supported by the Centers for Disease Control and
Prevention (CDC), the World Health Organization Regional Office for
Africa (WHO-AFRO), and the United States Agency for International
Development (USAID) Africa Bureau.

We would like to thank the IDSR team at CDC and WHO-AFRO for their
tremendous cooperation in providing information and assisting in the
development of the study protocol. We thank Diane Speight for her
assistance with the graphics and lay out of the manual.

AUTHORS

Zana C. Somda, Martin I. Meltzer, and Helen N. Perry

Centers for Disease Control and Prevention, U.S. Department of Health
and Human Services, Atlanta, GA

CONTACT

For additional help or feedback, please e-mail your comments or
questions to the authors: Zana C. Somda (<ZSomda@cdc.gov>), Martin I.
Meltzer (<MMeltzer@cdc.gov>) or Helen N. Perry (<HPerry@cdc.gov>)

SUGGESTED CITATION

Zana C Somda, Meltzer MI, Perry HN. *SurvCost* 1.0: a manual to assist
country and district public health officials in estimating the cost of
the implementation of Integrated Disease Surveillance and Response
systems (Beta test version). Centers for Disease Control and Prevention,
National Center for Prevention, Detection and Control of Infectious
Diseases (NCPDCID), Division of Emerging Infections and Surveillance
Services (DEISS), U.S. Department of Health and Human Services; 2007.

DISCLAIMER

The numbers generated through *SurvCost* should be treated as estimates
rather than considered as actual or true costs of a surveillance system
and IDSR program. Not all potential scenarios in terms of economic costs
could be included in this model.

The methodology, findings and conclusions presented in this manual and
in the accompanying tool are those of the authors and do not necessarily
represent the views of the Centers for Disease Control and Prevention
(CDC), the World Health Organization Regional Office for Africa
(WHO-AFRO), and the United States Agency for International Development
(USAID).

SYSTEM REQUIRMENTS

***SurvCost*** uses the Windows\* operating system (Microsoft Windows
2000 or higher) and Excel (Microsoft Office 2000 or higher). We
recommend using a computer with at least a 486 Pentium processor and at
least 128MB RAM. ***SurvCost*** requires up to 2 megabytes of storage
space on the computer's hard drive.

\*Microsoft Windows and Office are copyrighted products produced by
Microsoft Corporation, WA. Use of trade names and commercial sources is
for identification only and does not imply endorsement by the U.S.
Department of Health and Human Services.

TABLE OF CONTENTS

*Page*

ACKNOWLEDGMENTS\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
iii

DISCLAIMER\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
iv

SYSTEM
REQUIREMENTS\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....v

TABLE OF
CONTENTS......\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....vi

SECTION 1 -
INTRODUCTION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
1

Background\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
1

Cost-Analysis
.....................\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
2

Aim and intended
audience\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
3

Structure of the
manual\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
3

SECTION 2 -- SOURCE OF COST
DATA\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
4

SECTION 3 - OVERVIEW
DESCRIPTION\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
5

Data Collection
Spreadsheet\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
5

Data Synthesis
Spreadsheet\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
6

Data Summary
Spreadsheet\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
8

SECTION 4 - USING
*SurvCos*t\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....
8

Setting Excel's Security
level\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...
9

Loading and
Starting......\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....
10

SECTION 5 - ENTERING
DATA\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...11

Background
Information......\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....11

Personnel
data\.............\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....12

Office operating
data......\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....14

Transportation data
......\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...17

Laboratory data
...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....18

Treatment
data.............\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....20

Media
data..................\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....21

Capital
data\...\...\...\...\...\......\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....22

SECTION 6 - CALCULATING
COSTS...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....24

Personnel
costs\...\...\...\......\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...25

Office operating
costs\...\...\...\......\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....26

Transportation
costs...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....27

Laboratory operating
costs\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....27

Treatment
costs\...\...\...\........\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...28

Media
costs...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....29

Capital
costs...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....29

SECTION 7 - SUMMARIZING
COSTS...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....30

Recurrent
costs\...\...\...\........\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....30

Total
costs\...\...\...\...\...\...\......\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....31

SECTION 8 -- PRINTING, RESTARTING AND EXITING
*SurvCost*\...\...\...\...\...\...\...\...\...33

REFERENCES\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...34

APPENDIX\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...35

Appendix 1: Tool for Planning for Collection of Data for Economic
Analysis\...35

> Appendix 2: Description of Resources Used to Operate the Surveillance
> and Response
> System\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...38

**1 INTRODUCTION**

**1.1 Background**

Communicable diseases are the most common causes of death and disability
in the African region. Murray and Lopez estimated that, in 2000, 2.43
million children under 5 years of age died in Africa of infectious and
parasitic disease (1). In addition to this human toll, the economic cost
in terms of prevention, treatment, and loss of productivity is enormous
(2, 3).

In sub-Saharan Africa, many disease-specific surveillance and response
systems involve similar functions and often use the same structures,
processes and resources, especially at the level of district and primary
health facility. In 1998, the Regional Committee of the World Health
Organization Africa region (WHO/AFRO) adopted a strategy for improving
the availability and use of data to better detect and respond to
priority diseases. This strategy is called Integrated Disease
Surveillance and Response (IDSR) (4, 5). Under the IDSR strategy,
country select a number of priority of diseases and health risk
conditions to monitor, with the goal of combining surveillance
activities and resources to collect data that will help improve public
health responses (6). There are 19 priority diseases recommended by AFRO
to be routinely surveyed under IDSR guidelines (Figure 1). These
guidelines involve the following core activities and functions: 1)
surveillance for the 19 diseases (or a sub-set selected by the adopting
country), consisting of case detection, notification, data analysis and
interpretation, feedback provision, 2) outbreak response, comprising of
case investigation and control and treatment of confirmed cases; 3)
support functions, such as supervision and monitoring, training, and
resources and social mobilization; and 4) provision of resources for
detecting and responding to priority diseases and conditions.

Implementation of the IDSR started in some of the WHO/AFRO Member
countries in 2000. These countries commit national resources to public
health surveillance and response systems each year. They also receive
technical and financial support from WHO, other international agencies,
national partners, and private foundations to strengthen national
capacities in terms of human resources, laboratories, data management,
reporting, and epidemic response. However, little is known about the
investment and implementation costs of this IDSR strategy.

As a result, the IDSR task force that guides the implementation of this
regional strategy has recommended cost analyses of the IDSR systems in
the sub-Saharan Africa. In this context, we developed a spreadsheet
tool, called SurvCost, for measuring the incremental or additional costs
of establishing and subsequently operating IDSR-related activities.

![](media/image2.png){width="6.882638888888889in"
height="4.4527777777777775in"}

> Figure 1: Recommended IDSR priority diseases, core activities and
> functions in the WHO African region (3)

**1.2 Cost-Analysis**

Cost analysis is a way to gather and structure information about the
costs for ministries of health, program managers, and other stakeholders
and donors in countries with existing programs as well as those
interested in adopting or funding the IDSR strategy. These cost data can
stimulate the development of new and better ways of carrying out program
activities. Additionally, cost data can be used to project future
program needs, an essential element in the fundraising process.

**1.3 Aim and intended audience**

*SurvCost* has been developed using Microsoft Excel/Visual Basic to meet
the needs of decision-makers for relevant and consistent cost
information. This tool is intended for countries that are integrating
and strengthening their infectious disease surveillance systems.

*SurvCost* was designed to assist:

> **• economists and health service researchers** who conduct and
> appraise the
>
> cost of disease surveillance and intervention programs at the local,
> provincial,
>
> and national level,
>
> **• program staff and policy-makers** who use cost information for the
> purpose
>
> of funding disease surveillance programs. Program staff at the country
> level will
>
> be able to use *SurvCost* to compare program costs in different
> settings in their
>
> own country or other countries in the region,
>
> **• ministries of finance and international development agencies** who
> sponsor
>
> health programs in the country. This audience may wish to use these
> cost data
>
> to help prepare the terms of reference for future economic evaluations
> and may
>
> consider sharing these data with their grantees.

4.  **Structure of the manual**

This manual assumes that the reader is already familiar with the basic
methods of disease surveillance and economic evaluation of health
intervention programs, so lengthy explanations have been avoided.
However, a number of examples are provided to illustrate some of the
more challenging aspects of resource allocation with particular
relevance to national disease surveillance programs and IDSR-only
activities. In this manual, you will find after this introductory
chapter (**Section 1**):

• **Section 2** - describes the range of data sources that could be used
to gather

information about the cost of disease surveillance activities.

• **Section 3** - describes the different features of *SurvCost*.

> • **Section 4** - provides guidance for loading and starting the tool.
>
> • **Section 5** - describes the data collection process for each
> category of resources
>
> used for disease surveillance.
>
> • **Section 6** - focuses on how to estimate, present, and interpret
> the cost data.

1.  **SOURCES OF COST DATA**

> In this assessment, you will need data associated with surveillance of
> all diseases and/or IDSR-only related activities. These data may be
> obtained from disease surveillance budget and program records,
> aggregated pharmacy, clinical and medical records, and from interviews
> with IDSR program coordinators and public health staff. Since the
> sources of data may be located in different Ministry offices and
> levels of the health system, the survey instrument shown in Appendix 1
> may be useful to you in identifying the appropriate sources of data
> (and contact persons, if possible) at your local health system level
> that will be able to provide the requested data for this area.
>
> For each country, region/province and district, you will need to
> collect data on all the resources used in the process of disease
> surveillance activities. These include capital (a one-time purchase)
> and recurrent (on-going) items, donated items, volunteer time, and
> resources provided through other activities.

**Capital items would include:**

> • building infrastructure
>
> • program vehicles
>
> • equipment (e.g. refrigerator, computer, microscope, etc.)
>
> • furniture (e.g. tables, chairs, etc.)

**Recurrent items are:**

> • personnel salary (salaries, benefits, etc.)
>
> • office (supplies, utilities, rent, and maintenance)
>
> • transportation (vehicle operation and maintenance)
>
> • laboratory materials and supplies
>
> • medications and vaccines
>
> • social mobilization and sensitization and media campaigns

The survey instrument also collects information on other variables
related to disease surveillance activities, such as time of operation of
the facility, vehicles or equipment per year.

**3 OVERVIEW DESCRIPTION**

*SurvCost* is composed of three different types of spreadsheets linked
together by formulas. These spreadsheets are divided into:

• Data Collection or Entry - helps you gather information

• Data Synthesis or Results- calculates costs

• Data Summary - provides aggregated totals for each category

![](media/image3.jpeg){width="3.372916666666667in"
height="1.1236111111111111in"}

***3.1 Data Collection Spreadsheets -- Data entry required***

The data collection spreadsheets are designed to help you collect data
on all of the resources used, including capital and recurrent items. The
diagram below explains how the items are grouped. You will enter cost
data concerning personnel; office consumable goods; transportation;
media; drugs or treatment and laboratory supplies in the "recurrent
items" section. Under "capital items" you will enter the costs for
office and laboratory buildings, vehicles, equipment and furniture.

![](media/image4.png){width="5.75in" height="3.75in"}

Each data collection spreadsheet will also help you collect information
on variables related to disease surveillance activities, such as length
of time of operation of the facility, vehicle or equipment use per year,
and resources provided through other activities and organizations. For
each category of resources, you should record cost data for all national
diseases surveillance activities, and then identify the proportion of
those activities that were due to IDSR based on estimates of staff
workload or actual use of resources (if such estimates/ records are
available).

***3.2 Data Synthesis Spreadsheets -- No data entry required***

For each category of resources, all data input are referred to a data
synthesis sheet where costs are directly calculated. [You do not enter
data in this sheet]{.underline}. The calculations are done for you.

![](media/image5.png){width="5.875in" height="3.85in"}

The total cost of individual items of each category is calculated as the
costs of non-surveillance and surveillance activities based on the
actual amount of resource use or personnel time on all disease
surveillance activities that were also broken down by non-IDSR and
IDSR-related activities at the health facility.

The total cost using this formula is the non-surveillance activities
cost plus the surveillance activities cost.

***Total cost = Non-Surveillance cost + Surveillance cost***

The surveillance cost is proportioned out into the costs of all non-IDSR
and only IDSR-related activities based on the proportion of personnel
time or actual amount of resources of all disease surveillance
activities devoted to only IDSR-related activities.

***Surveillance cost = non-IDSR cost + IDSR cost***

These cost results are expressed in local currency and US dollar
equivalents using the annual average exchange rate in the country.

***3.3 Data Summary Spreadsheet -- No data entry required***

These individual costs, in turn, are linked to summary sheets where
aggregated costs of national disease surveillance and IDSR activities
across all resource categories are calculated.

![](media/image6.jpeg){width="5.61875in" height="1.4902777777777778in"}

The total program costs using this chart represent the aggregated costs
of all capital and recurrent resources used on the program activities at
the health facility.

*SurvCost* can also calculate the average costs per capita for
surveillance and IDSR-related activities. This is done by using the
total costs for all categories of resources and population estimates for
the health structure level under evaluation.

**4 USING *SurvCost***

Now that you have gathered your data, you are ready to begin using
SurvCost to calculate your costs. The basic tasks you will perform when
using *SurvCost* are:

![](media/image7.jpeg){width="2.59375in" height="2.3645833333333335in"}

**4.1 Setting Excel's security level**

Because *SurvCost* uses Excel Macro technology, you should set
**[Excel's security]{.underline}** to the appropriate level before
loading and starting the tool. If you change the security level after
*SurvCost* is opened, the tool will not work. You may follow these steps
to set the Excel's security level:

> Step 1 -- Open a Blank Excel file.
>
> Step 2 -- Click **[Tools]{.underline}** and then click on
> **[Macro]{.underline}**, choose **[Security]{.underline}** as shown
> below.

![](media/image8.wmf){width="5.486805555555556in"
height="3.2534722222222223in"}

> Step 3 -- Set Security Level to Medium (see diagram below).

![](media/image9.wmf){width="5.326388888888889in"
height="2.645138888888889in"}

> Step 4 -- Click OK and now you are ready to open *SurvCost*.

**4.2 Loading and Starting**

> Step 1 -- Select the *SurvCost* file from the appropriate folder, and
> then double click to open the file.
>
> Step 2 -- When asked to **[Disable Macros]{.underline}** or **[Enable
> Macros]{.underline}**, click **[Enable Macros]{.underline}** (see
> diagram below).

![](media/image10.wmf){width="5.473611111111111in"
height="3.328472222222222in"}

> Step 3 -- Once you have selected "**Enable Macros**", the tool will
> load and you are ready to begin using *SurvCost*.
>
> ![](media/image11.wmf){width="4.966666666666667in"
> height="3.001388888888889in"}

**5 ENTERING DATA**

As you collect and prepare to enter data, please note that each
spreadsheet template provides a default number of rows. You may add or
delete rows as needed. If you
![](media/image12.png){width="1.0840277777777778in"
height="0.24791666666666667in"} within a category, you can use the
**[Excel Copy]{.mark}** and **[Insert Copied Cells or Rows]{.mark}**
functions to maintain the formulae from the previous row. You may follow
these steps to insert copied cells or rows between existing cells or
rows:

1.  To copy and insert copied cells,

    a.  select the range of cells that contain the formulae you want to
        copy

    b.  click **Copy** ![](media/image13.png){width="0.21875in"
        height="0.20694444444444443in"}on the **Standard** toolbar or on
        the **Edit** menu

    c.  on the **Insert** menu, click **Copied Cells**

    d.  in the Insert Paste dialog box, select Shift Cells down

2.  To insert rows,

    a.  select a range of rows below the first row of the category

    b.  on the **Insert** menu, click **Rows**

The links to summary costs will remain functioning, and will not be
affected by the addition or deletion of rows. (***Note:*** *Do not
**[Paste]{.mark}** or **[Insert]{.mark} r**ows and copied cells in above
the first row and below the last row*. This will affect the embedded
formulae).

Any information you or previous users have entered and saved will
automatically appear. To change this information, simply type over or
use the drop-down button to enter current data. You may then click the
![](media/image14.png){width="0.7013888888888888in"
height="0.22708333333333333in"} button to save the new information you
have entered.

***5.1 ENTERING DATA -- Background Information***

Click ![](media/image15.png){width="0.9722222222222222in"
height="0.28125in"} to enter background information about your local
setting. This includes the year covered by the evaluation, the name and
total population of your country and health structure, local currency
and exchange rate to US dollars. These information are linked to other
sheets to calculate the total annual costs and per capita costs for the
health structure under evaluation.

You may use the dropdown buttons to select the health system level, the
surveillance function, and the targeted diseases you want to evaluate.

![](media/image16.wmf){width="3.3722222222222222in"
height="1.3340277777777778in"}

For the health structure level, National represents just the central
ministry level whereas Region involves only the regional/provincial
office and District includes only facilities at the District level.
These do not include the structures below or above them. If you need to
evaluate different regions, districts and local health facilities, you
should use separate individual spreadsheets.

2.  ***ENTERING DATA -- Personnel data***

Although you may begin with any category, we suggest that you begin with
personnel data, as the percentage results at the bottom of the screen
may be helpful when filling in information for the other categories.

You will first need to organize personnel data. Divide the health
personnel involved in the disease surveillance in the area (i.e.,
country, region/province, district, or locality) covered by the
evaluation period into seven personnel categories: administration,
disease surveillance, laboratory, pharmacy, medical care, support staff,
and other personnel such as consultants, contractual and volunteer
workers.

> ![](media/image17.png){width="1.0625in" height="1.426388888888889in"}
>
> Click on ![](media/image18.png){width="0.7222222222222222in"
> height="0.19375in"} to open the Personnel Data spreadsheet (Note: The
> table shows what the screen looks like when all the data is filled
> in). Again, you may change any existing information by simply typing
> over it and resaving.
>
> ![](media/image19.jpeg){width="5.993055555555555in"
> height="3.808333333333333in"}

Enter personnel data as follows:

1.  **Personnel Category --** Record the job title or function in the
    personnel column. No personnel identifier is required.

2.  **Duration of Work--**You will need to enter the number of months
    each staff member worked during the data collection period (e.g.,
    one year). If a person only works certain days, weeks or months out
    of the year, you should convert that period of work into months per
    year. For example, if a staff member worked only 2 weeks out of the
    year, then the duration of work is:

> ***[2 weeks per year divided by 4 weeks per month = 0.5 month per
> year.]{.mark}***
>
> We assume that all years have 12 months and each month has only 4
> weeks and 30 days.

3.  **Gross Salary per Month --** Salary data for full-time employees is
    entered on a monthly basis in the
    column![](media/image20.wmf){width="0.9493055555555555in"
    height="0.3729166666666667in"}, even for a person who has worked for
    particular days or weeks out of the month.

4.  **Incentives and Overtime Pay -** If the employee received other
    allowances such as over-time payments in addition to salary, record
    the total amount in the column
    ![](media/image21.wmf){width="0.8715277777777778in"
    height="0.3958333333333333in"}otherwise, enter "0" amount. For
    part-time employees (e.g., contractual workers and consultants) who
    received only allowances or per diems, record the amount in that
    column and enter a "0" amount in the
    column![](media/image20.wmf){width="0.9493055555555555in"
    height="0.3729166666666667in"}. ***Note:** For volunteers, it is
    necessary to provide the value of their volunteer time as though
    they are on salary**.***

5.  **Personnel Time % - All Disease Surveillance activities -** Based
    on each staff member's daily or monthly hours worked, estimate the
    proportion of the total work-time spent on all surveillance
    activities for all communicable and non-communicable diseases and
    record that percentage in the column
    ![](media/image22.wmf){width="0.95625in"
    height="0.43333333333333335in"} under Personnel Time.

6.  **Personnel Time % - IDSR as proportion of all surveillance
    activities -** Now, estimate the ratio of IDSR-only activities
    relative to all communicable and non-communicable disease
    surveillance activities and record that percentage in the column
    ![](media/image23.wmf){width="1.2090277777777778in"
    height="0.42083333333333334in"} under Personnel Time. Personnel time
    totals for surveillance of all communicable and non-communicable
    diseases and IDSR-only activities will be calculated automatically
    in the bottom row of each Service Unit. (***[Note]{.underline}**:
    You should not enter data in this last row*)*.*

***5.3 ENTERING DATA -- Office operating data***

Click ![](media/image24.png){width="0.8472222222222222in"
height="0.17777777777777778in"} to open the Office Operating Data
spreadsheet, similar to the table below. Here, you will enter
information related to office operations.

To begin, organize office operating expenses into the following four
major categories:

1.  **Office supplies** - stationery, printing/photocopying, computer
    software and storage devices, postage, and other miscellaneous
    items.

2.  **Utilities** - all water, electricity, telephone communication, and
    heating or cooking gas bills.

3.  **Building and equipment maintenance** - cleaning and cleaning
    supplies, repair and upkeep, including electric bulbs, and waste
    disposal of office and laboratory equipment and building facilities.

4.  **Rent -** building and equipment rental, storage spaces, training
    and conference rooms, and communication equipment (e.g., data
    projector, computer, etc.) leased for short-term use.

![](media/image25.wmf){width="5.995138888888889in"
height="4.329166666666667in"}

For items within each category, you will enter the following
information:

**Office supplies:** Record under the corresponding column heading the
total quantity consumed at your locality, the unit cost, the total cost
as well as the actual amount used for all disease surveillance
activities during the evaluation period. If an item is donated then the
estimated current value (i.e., how much would it cost to buy the item in
its current condition) is entered in the
column![](media/image26.wmf){width="0.7888888888888889in"
height="0.34930555555555554in"}. If there is no information for a
particular item, then enter "0" amount in the appropriate cell.

> You will also need to estimate and record in the columns
> ![](media/image27.wmf){width="1.9986111111111111in"
> height="0.40555555555555556in"} the proportion of each office supplies
> use for all communicable and non-communicable disease surveillance
> activities as well as the ratio of IDSR-only activities relative to
> all communicable and non-communicable diseases surveillance
> activities. If you cannot estimate these percentages, record the
> **Average Personnel Time** shown at the bottom of
> ![](media/image28.wmf){width="0.8833333333333333in"
> height="0.28680555555555554in"} sheet.
>
> For example, in the sample Office Operating Data spreadsheet shown
> above, only the total value of office stationery is known; therefore,
> we entered "0" for total quantity, unit cost, and amount used for all
> disease surveillance. Since we were unable to determine the fraction
> allocated to disease surveillance, we used the value of average
> personnel time, 40% for ![](media/image22.wmf){width="0.95625in"
> height="0.43333333333333335in"} and 34%
> for![](media/image23.wmf){width="1.2013888888888888in"
> height="0.41805555555555557in"}.

**Utilities:** For each item, record the number of months in the
evaluation period, the monthly cost and the total cost in the
appropriate column heading. Handle donated items and missing information
as above. Estimate the proportion or frequency of the facility use
during the evaluation time frame for all surveillance activities as well
as the ratio of IDSR-only activities relative to all diseases
surveillance activities. If you cannot estimate these percentages,
record the **Average Personnel Time** shown at the bottom of
![](media/image28.wmf){width="0.8833333333333333in"
height="0.28680555555555554in"} sheet.

**Building and Equipment Maintenance and Rental:** Enter the total
number of months or days in the evaluation period or units of rental
items. Treat donated items, missing information as well as the
proportion of building and equipment use for all surveillance activities
and IDSR-only related activities as above.

***5.4 ENTERING DATA -- Transportation data***

Click on ![](media/image29.png){width="0.8888888888888888in"
height="0.17916666666666667in"} button to open the Transportation Data
spreadsheet, similar to the table below. Here, you will enter
information concerning transporting personnel and patients, drugs,
vaccines, specimens, and other consumables in the line of IDSR settings
during the year or the evaluation time frame. This spreadsheet is
organized into three sections:

1.  **Program vehicles** (e.g., car, truck, motorcycle, bicycle, etc)

2.  **Rent or non-program vehicles** (e.g., other ministry's vehicles
    and rented vehicles) used for IDSR program activities

3.  **Traveler** expenses related to IDSR program activities.

![](media/image30.wmf){width="6.0in" height="4.097222222222222in"}

For each item within a category of transportation, you will need to
enter the following information.

**Program vehicles** - record information about the total quantity and
cost of fuel consumed, vehicle maintenance and repairs, insurance, taxes
and fees as well as vehicle-use time for all disease surveillance
activities and IDSR-only activities.

**Rent or non-program vehicles** - gather information about the duration
of rent, daily rent charge, cost of fuel consumed, and other
miscellaneous items in addition to the vehicle-use time for all disease
surveillance and IDSR-only activities.

**Traveler** - record information on travel cost items, such as duration
of travel, per diem, cost of using public transportation, and other
miscellaneous items used during travel.

If there is no information for a particular item, then enter "0" amount
in the appropriate cell. Estimate and record the proportion of the total
vehicle-use time or personnel work-time on all communicable and
non-communicable disease surveillance activities under the column
![](media/image22.wmf){width="0.95625in" height="0.43333333333333335in"}
if possible, otherwise enter the **Average personnel time** shown at the
bottom of ![](media/image28.wmf){width="0.8368055555555556in"
height="0.28680555555555554in"} sheet. Record the ratio of vehicle
use-time or personnel time for IDSR-only activities relative to all
disease surveillance activities in the
column![](media/image23.wmf){width="1.2013888888888888in"
height="0.41805555555555557in"}. Again, if this information is not
available, use the **Average personnel** **time** shown on
![](media/image28.wmf){width="0.8722222222222222in"
height="0.28680555555555554in"} data sheet.

***5.5 ENTERING DATA- Laboratory data***

![](media/image31.wmf){width="5.993055555555555in"
height="3.23125in"}Click
![](media/image32.jpeg){width="0.7222222222222222in"
height="0.21944444444444444in"} to open the Laboratory Operating Data
spreadsheet, similar to the table shown below. Here, you will enter cost
data relating to laboratory supplies (e.g., gloves, syringes, pipettes,
tubes, needles, etc) and reagents (e.g., antisera, trans-isolate,
Cary-Blair, etc) required for various diagnostic tests of IDSR priority
diseases.

**Note**: Laboratory equipment (e.g., microscopes, refrigerators,
cold-chains) are capital items and their maintenance and repairs are
included in the Office data.

After you have organized the laboratory operating items into laboratory
materials and reagents, you may enter the information for each item
under the corresponding column heading: total quantity used, unit cost,
total cost, and the actual amount as well as the proportion of the total
quantity used for all disease surveillance activities and IDSR-only
related activities.

If there is no information corresponding to a particular item such as
the quantity and cost, then record a value "0" in the corresponding
cell. If the product is imported, then add the shipping/customs cost to
the value under![](media/image26.wmf){width="0.7888888888888889in"
height="0.34930555555555554in"}. And, if these items are repackaged and
transported within the country by means of non-project commercial
transport, this information should be added as well
under![](media/image26.wmf){width="0.7888888888888889in"
height="0.34930555555555554in"}. If an item is donated, then the
estimated current value (i.e., how much would it cost to buy the item in
its current condition) is entered
under![](media/image26.wmf){width="0.7888888888888889in"
height="0.34930555555555554in"}.

For each laboratory supply and reagent, record the actual amount used
for the diagnostic tests of all communicable and non-communicable
diseases in the column![](media/image33.wmf){width="0.76875in"
height="0.5583333333333333in"}; otherwise enter "0" amount. You will
then estimate the relative proportion of the total quantity that was
used for all disease diagnostic tests as well as the ratio of IDSR
priority diseases tested relative to all diseases tested. These are
recorded as ![](media/image22.wmf){width="0.95625in"
height="0.43333333333333335in"} and
![](media/image23.wmf){width="1.2013888888888888in"
height="0.41805555555555557in"}, respectively. If you are unable to
figure out the proportional allocation of an item, you can use the
corresponding **Average personnel time** shown at the bottom of the
![](media/image28.wmf){width="0.8666666666666667in"
height="0.28680555555555554in"} sheet.

***5.6 ENTERING DATA --Treatment data***

1.  Click on the ![](media/image34.png){width="0.9229166666666667in"
    height="0.18194444444444444in"} button to open the Patient Treatment
    and Programmatic Response Data spreadsheet, similar to the table
    shown below.

![](media/image35.wmf){width="5.995138888888889in"
height="4.232638888888889in"}(***Note***: You can rename sub-groups or
leave their corresponding cells blank as necessary. The links to summary
costs will remain functioning. Do not add or delete sub-groups; this
will affect the embedded formulae in the cost sheets).

You will be entering data for the treatment and control of each disease
case detected and outbreak at public health facilities, including
private clinics and hospitals as necessary. This worksheet is divided
into three categories of inputs:

2.  **Drugs -** broken down into the following sub-groups: anti-malaria,
    anti-retrovirus, anti-diarrhea, anti-tuberculosis, antibiotics, and
    intra-venous (I.V.) fluids.

3.  **Vaccines** - include only those used for preventive immunization
    and mass vaccination during an epidemic outbreak.

4.  **Other programmatic response items** - required only for the
    treatment and control of IDSR priority disease cases and outbreaks,
    including items such as impregnated bed nets and water chlorination.

To enter drugs, vaccines, and programmatic response data, you should
record the total quantity, unit cost, and total value of each type of
product consumed at your site. If there is no information corresponding
to a particular item, then enter a "0" value in the corresponding cell.
If the item is imported, shipping/customs cost should be added to the
column![](media/image26.wmf){width="0.7888888888888889in"
height="0.34930555555555554in"}. And, if the item is repackaged and
transported within the country by means of non-project commercial
transport, this information should be added as well. If an item is
donated then the estimated current value (i.e., how much would it cost
to buy the item in its current condition) is entered into the
column![](media/image26.wmf){width="0.7888888888888889in"
height="0.34930555555555554in"}.

Then, give the actual amount used to manage cases of all communicable
and non-communicable diseases under surveillance in the
column![](media/image33.wmf){width="0.76875in"
height="0.5583333333333333in"}, if available; otherwise, enter "0"
amount. Also determine and record the percentage of the total quantity
allocated for the management of these disease cases in the
column![](media/image22.wmf){width="0.95625in"
height="0.43333333333333335in"}. Then, in
column![](media/image23.wmf){width="1.2013888888888888in"
height="0.41805555555555557in"}, give the ratio of IDSR diseases
relative to all diseases under surveillance. If you are unable to figure
out the percentage used on surveillance and the proportion of
surveillance on IDSR, you can use the corresponding **Average personnel
time** shown at the bottom of the
![](media/image28.wmf){width="0.8666666666666667in"
height="0.28680555555555554in"} sheet.

***5.7 ENTERING DATA -- Media data***

Click ![](media/image36.png){width="0.7222222222222222in"
height="0.1798611111111111in"} to open the Mass Media Campaign Data
spreadsheet, similar to the table below. Here, you will enter
information related to social mobilization and public campaigns to
create awareness of and demand for IDSR activities.

![](media/image37.wmf){width="5.992361111111111in"
height="1.8486111111111112in"}

This spreadsheet is set up to gather information involving activities
such as motivation of public through production and telecast/broadcast
of TV/Radio spots, publication of advertisement in newspapers, and
printing of educational pamphlets, leaflets, brochures and manuals on
IDSR targeted diseases and health conditions.

For each type of media, you should give the total number of units (e.g.,
airtime, pages, days, etc), unit charge or cost, total cost as well as
any other related expenses. If there is no data corresponding to a
particular item, enter a "0" value in the appropriate cell. You need
also to give the proportion of media-time spent on all communicable and
non-communicable disease surveillance
![](media/image22.wmf){width="0.95625in" height="0.43333333333333335in"}
activities and the percentage of these activities that are only
IDSR-related
activities![](media/image23.wmf){width="1.2013888888888888in"
height="0.41805555555555557in"}. If you are unable to figure out the
percentage of total media-time on all disease surveillance and the
proportion of surveillance on IDSR, you can use the corresponding
**Average personnel time** shown at the bottom of the
![](media/image28.wmf){width="0.8666666666666667in"
height="0.28680555555555554in"} sheet.

***5.8 ENTERING DATA -- Capital data***

Click on ![](media/image38.png){width="1.0138888888888888in"
height="0.20833333333333334in"} to open the Capital Investment Data
spreadsheet, similar to the table below. In this spreadsheet, you will
record capital items that have a life over one year. These one-time
investment resources are divided into four groups:

1.  **Building infrastructure -** involves all new construction and
    renovation of existing structures or extension of facilities.

2.  **Program vehicles** - includes all new or used transportation
    vehicles, such as cars, trucks, motorcycles, bicycles, etc, bought
    or received as a gift for the program.

3.  **Office equipment** - furniture, photocopier, computer/printer,
    typewriter, etc.

4.  **Laboratory equipment** - includes microscope, centrifuge,
    refrigerator, cold-chain, etc) are all new or used items bought or
    received as a gift for the program.

![](media/image39.wmf){width="5.993055555555555in"
height="4.081944444444445in"}**Note**: Do not insert a range of
**[copied cells]{.underline}**. This will affect the embedded formulae.
You may add or delete **[entire rows]{.underline}** as needed to keep
the links to summary costs functioning.

When entering each capital item, you should provide the acquisition
year, the purchase price or the amount paid for the item, the useful
life-year (i.e., the number of years you expect a capital item to last),
and the item use-time for all communicable and non-communicable disease
surveillance activities as well as the ratio of IDSR-only activities
relative to all surveillance activities.

Purchase price does not include building, equipment and vehicle
maintenance and repairs. These costs are included in the facility,
equipment and vehicle operating costs If an item is donated, estimate
its current value (i.e., how much would it cost to buy the item in its
current condition) and record that value as
the![](media/image40.wmf){width="0.7145833333333333in"
height="0.38055555555555554in"}. If the purchase price is difficult to
trace or an item is used only few times a year for IDSR activities, you
can include it as a rent item in the
![](media/image24.png){width="0.9583333333333334in"
height="0.2013888888888889in"} or
![](media/image29.png){width="0.7777777777777778in"
height="0.2013888888888889in"} section.

We assume for simplicity the following useful life-year: 50 for
buildings, 10-20 for major equipment, 5-10 for motor vehicles, and 1-5
for small equipment. However, you could choose your own number of years
you expect the item will remain in good working condition. We also
assume a depreciation rate of 5% for each capital item (that is, how
much is 'used up' in a given year of the useful-life period of the
item). This number is shown at the bottom of the Capital spreadsheet.
Again, you can make your own assumption of the annual deprecation rate
in your local community.

Building spaces used by the disease surveillance programs are reported
in terms of the total surface area allocated to that program, i.e., if
the space used by the program is shared with other activities, the share
of the space used for the program is estimated and the value is entered
as ![](media/image22.wmf){width="0.95625in"
height="0.43333333333333335in"} and
![](media/image23.wmf){width="1.2013888888888888in"
height="0.41805555555555557in"}. If you cannot estimate the space used
for the program, use the proportion of the staff workload devoted to
surveillance activities in the building facility. Alternatively, you
could record the **Average personnel time** shown at the bottom of the
![](media/image28.wmf){width="0.8666666666666667in"
height="0.28680555555555554in"} sheet.

For equipment used by the program, appropriate allocation is made using
the same allocation factors used for building space. For purchase
vehicles, the estimated share of their use by the program is entered;
otherwise, use the same **Average Personnel Time** from
![](media/image28.wmf){width="0.8722222222222222in"
height="0.28680555555555554in"} sheet.

**6 CALCULATING COSTS - RESULTS**

The result section is organized into three parts. The first part
provides the cost by category of resources used for disease surveillance
in your local setting: personnel, office, transportation, laboratory,
treatment, media, and capital costs. The second and third parts
aggregate these costs into recurrent costs and total program cost,
including the distribution by resource category.

Each data collection spreadsheet has a button labeled **COST** that you
can click to view the cost of that category of resource based on the
information you entered.

***6.1 Viewing Results - Personnel costs***

If you click on the ![](media/image41.jpeg){width="1.1409722222222223in"
height="0.2465277777777778in"} button, you will see a table, similar to
the one below, showing personnel cost by the different service units or
personnel categories: administration, surveillance, laboratory, medical
care, pharmacy, support staff, and other personnel.

![](media/image42.png){width="5.9944444444444445in" height="2.96875in"}

For each category of personnel at the health structure level, costs are
given for three scenarios of ministry's activities: total health
activities (i.e., the cost associated with all ministry's activities),
all disease surveillance activities cost (i.e., the cost for delivering
all communicable and non-communicable disease surveillance activities),
and IDSR activities cost (i.e., the cost of delivering only IDSR
activities), which is also expressed as percentage of all disease
surveillance cost (i.e., IDSR cost divided by all disease surveillance
cost). These categorical personnel costs are summed to get the total
personnel cost (in local currency and US dollar equivalent).

The cost of each category of personnel cost is calculated based on the
information you provided in the
![](media/image28.wmf){width="0.8722222222222222in"
height="0.28680555555555554in"} data sheet: number of workers, their
duration of work and monthly income, and the number of full time
equivalents needed for administration or delivering of all disease
surveillance and IDSR-only activities. For example, the cost for all
communicable and non-communicable disease surveillance is calculated
based on the adjusted proportion of work load of each staff member while
the IDRS is based on the ratio of IDSR activities to all disease
surveillance activities.

***6.2 Viewing Results - Office operating costs***

When you click![](media/image43.jpeg){width="1.2083333333333333in"
height="0.29583333333333334in"}, you will see a table, similar to the
one below, showing the costs of office supplies, utilities, facilities
and equipment maintenance and repairs, and rent for building spaces and
equipment for specific IDSR activities.

![](media/image44.png){width="6.001388888888889in"
height="2.6972222222222224in"}

Here, for example, IDSR-related costs, as a percentage of total
surveillance costs, were calculated based upon the frequency of that
IDSR activity (as measured by total personnel time or actual amount of
resources used). *SurvCost* estimated that nearly 35% of the cost of all
office consumables used for disease surveillance was due to IDSR
activities.

***6.3 Viewing Results - Transportation costs***

You can click ![](media/image45.jpeg){width="1.2083333333333333in"
height="0.27708333333333335in"} to see a table, similar to the one
below, illustrating the costs of operating the program vehicles,
non-program vehicles, including public transportation fares, and other
travel related expenses.

![](media/image46.png){width="5.9944444444444445in"
height="2.3472222222222223in"}

Here, prices of vehicles purchased for the IDSR program are treated as
capital costs (see below) and are not included in transportation cost,
which includes fuel consumed, vehicle maintenance and insurance, rent,
and other travel related expenses such as per diem, conference fees,
public transportation tickets. The transportation cost of the disease
surveillance program, including IDSR, is estimated based on each vehicle
use-time per surveillance activity.

***6.4 Viewing Results - Laboratory operating cost***

Click on ![](media/image47.jpeg){width="1.2083333333333333in"
height="0.25625in"} to show the laboratory operating costs, similar to
the table below, which are disaggregated into cost for laboratory
supplies and reagents.

![](media/image48.png){width="6.001388888888889in"
height="2.123611111111111in"}

Here, the costs are calculated based on the procurement cost and the
quantity of each specific product required for the various diagnostic
test of diseases under surveillance. Then, IDSR-related costs are
estimated using the actual amount of resource and personnel use-time on
IDSR activities at the laboratory facility.

***6.5 Viewing Results -- Treatment and response costs***

When you click![](media/image49.jpeg){width="1.1875in"
height="0.3145833333333333in"}, you will find a table, similar to the
one below, showing the disease treatment costs.

![](media/image50.png){width="5.997222222222222in"
height="3.2930555555555556in"}

Treatment and response costs include all medications (drugs and
vaccines) including all programmatic measures and preventive
intervention items (e.g., treated bed nets and water chlorination) used
in the line of controlling and preventing only IDSR priority diseases.
These costs are calculated based on the procurement cost and the
quantity required of each specific product for the treatment of diseases
under surveillance. Again, IDSR-related costs are estimated using the
actual amount of resource and personnel use-time on IDSR activities.

***6.6 Viewing Results - Media campaign costs***

You can click![](media/image51.jpeg){width="1.1875in"
height="0.26180555555555557in"} to see the costs for media campaigns,
including advertising, broadcasting, and targeted social mobilization,
which are organized like the table below.

![](media/image52.png){width="5.995138888888889in"
height="2.857638888888889in"}

IDSR-related costs are separated from all surveillance activities based
on the proportion of surveillance activities on IDSR at the health
facility.

***6.7 Viewing Results - Capital costs***

Click ![](media/image53.jpeg){width="1.1979166666666667in"
height="0.3111111111111111in"} to see a table, similar to the one below,
showing the capital costs.

![](media/image54.png){width="5.9944444444444445in"
height="2.4604166666666667in"}

The costs of buildings, laboratory and office equipment and vehicles are
depreciated at 3% annually over a 50-, 10- and 5-year useful-life time
horizon, respectively. We then assume that the annual IDSR-associated
costs are equal to the proportion of all surveillance activities that is
due to IDSR activities. We then apportion out annualized capital costs
using the equipment and vehicle use-time and total personnel time
allocated to all surveillance and each IDSR activity at the health
facility.

**7. SUMMARIZING COST RESULTS**

Each resource cost sheet has buttons you may select to view the
summarized costs by category of resources.

***7.1 Summary Results -- Recurrent Costs***

Click![](media/image55.jpeg){width="0.9270833333333334in"
height="0.36875in"} to go to the summary of recurrent costs (i.e.,
summary of all of the costs per line items by category of resources
excluding capital items), similar to the table below.

![](media/image56.png){width="5.993055555555555in"
height="3.102777777777778in"}

Recurrent items or consumable goods are those items used only once to
operate the program, or maintained in stock with a lifespan of \< 1
year, and include personnel costs, office operating costs,
transportation costs, public campaign costs, treatment costs, and
laboratory operating costs.

***7.2 Summary Results -- Total Costs***

Click ![](media/image57.jpeg){width="0.9375in"
height="0.3576388888888889in"} to view a table, similar to the one
below, summarizing the total cost by category of resources.

![](media/image58.png){width="5.997222222222222in" height="3.0in"}

For each category, the costs are given for all activities at the health
structure level, all communicable and non-communicable disease
surveillance (i.e., surveillance activities for all diseases, including
infectious diseases as well as all other diseases and conditions, such
as cancers and fatal injuries), and for IDSR-only activities (i.e.,
surveillance activities related to only IDSR priority diseases and
conditions). The Table also shows the aggregated costs of all disease
surveillance and IDSR activities across all resource categories as well
as the cost per capita based on these aggregated costs and the number of
population living in the area (see Information sheet).

Here, for example, the cost of running the IDSR program varies
significantly by resource-type. The cost of all resources spent per
person living in the study area is approximately 0.03 \$ US for all
disease surveillance activities and approximately 0.01 \$ US for
IDSR-related activities.

If you click on the![](media/image59.jpeg){width="0.65625in"
height="0.3458333333333333in"} button, you will see a graph depicting
the cost profile, similar to the one below, expressed as the percentage
of the total IDSR cost.

![](media/image60.png){width="5.995833333333334in"
height="3.2909722222222224in"}

In the example shown here, personnel costs constitute the largest
component (31% of the total IDSR cost) of all IDSR-related activities
cost at the health facility, followed by transportation (19%) and then
office consumables (13%).

***8 PRINTING, RESTARTING, AND EXITING SurCost***

***8.1 Printing***

Changing the Page Set-up of each spreadsheet to "*landscape*" format
will allow the entire result to be printed on a single page. To change
the page format, you should do the following:

1.  Click **File** and then choose Page Setup;

2.  in the **Orientation** box, select ***Landscape***; and then

3.  Click **OK**.

***8.2 Restarting***

Clicking on the ![](media/image61.jpeg){width="0.75in"
height="0.2972222222222222in"} button located on each data collection,
synthesis and summary spreadsheet will take you back to the Information
sheet if you want to change any data you entered, or to select different
disease syndromes, surveillance activities, and/or resource category.
There is also a ![](media/image62.jpeg){width="0.75in"
height="0.3013888888888889in"} button on each data synthesis spreadsheet
you can click on to go back to the data collection sheet of that
category of resource. If you want to save the input data and results,
you should click ![](media/image63.jpeg){width="0.625in"
height="0.2951388888888889in"} button. It should be noted that saving
may take some time due to the size of the program.

***8.3 Exiting***

On each spreadsheet, you may click the
![](media/image64.jpeg){width="0.6458333333333334in"
height="0.28541666666666665in"} button to go back to the Start Page
where you can select
![](media/image65.jpeg){width="0.6770833333333334in"
height="0.27361111111111114in"} to close all programs and exit the
***SurvCost*** without saving the changes. If you want to save the input
data and results, you should click
![](media/image63.jpeg){width="0.625in" height="0.2951388888888889in"}
before you click on the
![](media/image65.jpeg){width="0.6770833333333334in"
height="0.27361111111111114in"} button. It should be noted that saving
may take some time due to the size of the program.

**REFERENCE**

1.  Murray CJL and Lopez AD (eds). Global Burden of Disease and Injury
    Series. Vol 1: The Global Burden of Disease. Boston MA, Harvard
    School Public Health. 1996

2.  Chima RI, Goodman CA and Mills A. The economic impact of malaria in
    Africa: a critical review of the evidence. Health Policy. 2003;
    63:17-36

3.  Russel S. The economic burden of illness for households in
    developing countries: A review of studies focusing on malaria,
    tuberculosis, and human immunodeficiency virus/acquired
    immunodeficiency syndrome. Am. J. Trop. Med. Hyg. 2004; 71(Suppl 2):
    147-155

4.  World Health Organization, Regional Office for Africa: *Integrated
    Disease Surveillance and Response: A Regional Strategy for
    Communicable Diseases* 1999-2003 (AFR/RC/48.8). Harare: WHO; 1999
    \[http://www.afro.who.int/csr/ids/publications/ids.pdf\]

5.  Perry NH, McDonnell MS, Alemu W. et al. Planning an integrated
    disease surveillance and response system: a matrix of skills and
    activities. BMC Medicine, 2007, 5:24
    (<http://www.biomedcentral.com/1741-7015/5/24>).

6.  World Health Organization, Regional Office for Africa: *Technical
    Guidelines for Integrated Disease Surveillance and Response in the
    African Region*. Harare: WHO; 2002.
    \[http://www.cdc.gov/idsr/focus/surv_sys_strengthening/tech_guidelines-integrated-diseaseENG.pdf\].

**APPENDIX**

**Appendix 1**: **Tool for Planning for Collection of Data for Economic
Analysis**

In this assessment, we will look at the costs associated with
implementing IDSR in an African country. To conduct the assessment, we
will need to collect and analyze data on costs for specific categories:
IDSR personnel, offices, advocacy, medicines and vaccines; laboratory
supplies and reagents; and transportation.

Since the sources of data may be located in different Ministry offices
and levels of the health system, we would like your help in identifying
the appropriate sources of data (and contact persons, if possible) at
your local health system level that will be able to provide the
requested data for this area. We recognize that the persons who are
responsible for the data sources may need some advance notice about the
need to provide cost data for specific sources, and we hope this tool
will be useful to you in locating the relevant contact person and
advising them as to what kind of data will be requested and when the
assessment team will be visiting them.

The table below is organized into five sections: 1) personnel, 2) office
space, furniture, equipment, materials, and supplies, 3) advertising,
media and broadcasting, 4) medications and vaccines, and 5)
transportation. For each major section, we have provided general
guidance about the type of information that will be needed to complete
the costing tool. You will see there is also a space for noting the most
relevant data source. There is also another space for making note of who
needs to be contacted in advance of the evaluation exercise so they will
be able to access and provide the data for data entry into the tool when
the team begins the evaluation.

+--------------+---+-------------------------+------------+---------------+
| *            |   |                         |            |               |
| *Personnel** |   |                         |            |               |
+--------------+---+-------------------------+------------+---------------+
|              | * |                         | **Data     | **Contact     |
|              | * |                         | s          | person(s)**   |
|              | I |                         | ource(s)** |               |
|              | n |                         |            |               |
|              | f |                         |            |               |
|              | o |                         |            |               |
|              | r |                         |            |               |
|              | m |                         |            |               |
|              | a |                         |            |               |
|              | t |                         |            |               |
|              | i |                         |            |               |
|              | o |                         |            |               |
|              | n |                         |            |               |
|              | n |                         |            |               |
|              | e |                         |            |               |
|              | e |                         |            |               |
|              | d |                         |            |               |
|              | e |                         |            |               |
|              | d |                         |            |               |
|              | * |                         |            |               |
|              | * |                         |            |               |
+--------------+---+-------------------------+------------+---------------+
| >            | C |                         |            |               |
|  **Full-time | h |                         |            |               |
| >            | a |                         |            |               |
|  employees** | r |                         |            |               |
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| **Office     |   |                         |            |               |
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+--------------+---+-------------------------+------------+---------------+
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+--------------+---+-------------------------+------------+---------------+
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+--------------+---+-------------------------+------------+---------------+
| **           |   |                         |            |               |
| Advertising, |   |                         |            |               |
| media, and   |   |                         |            |               |
| br           |   |                         |            |               |
| oadcasting** |   |                         |            |               |
+--------------+---+-------------------------+------------+---------------+
| > **Advocacy |   | **Information needed**  | **Data     | **Contacts**  |
| > or social  |   |                         | s          |               |
| >            |   |                         | ource(s)** |               |
| mobilization |   |                         |            |               |
| > costs**    |   |                         |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Airtime on radio and    |            |               |
|              |   | television              |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Number, length, and     |            |               |
|              |   | cost of articles or     |            |               |
|              |   | advertisements in       |            |               |
|              |   | newspapers              |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Funding sources         |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Proportion time or      |            |               |
|              |   | space allotted for IDSR |            |               |
|              |   | activities              |            |               |
+--------------+---+-------------------------+------------+---------------+
| **Tran       |   |                         |            |               |
| sportation** |   |                         |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | **Information needed**  | **Data     | *             |
|              |   |                         | s          | *Contact(s)** |
|              |   |                         | ource(s)** |               |
+--------------+---+-------------------------+------------+---------------+
| >            |   | Characteristics of      |            |               |
|  **Vehicles, |   | owned vehicles, motor   |            |               |
| > motor      |   | bikes, and other means  |            |               |
| > bikes, and |   | of transportation (e.g. |            |               |
| > other      |   | model, make, year)      |            |               |
| > means of   |   |                         |            |               |
| > tran       |   |                         |            |               |
| sportation** |   |                         |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Characteristics of      |            |               |
|              |   | rental vehicles (e.g.   |            |               |
|              |   | model, make, year)      |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Purchase price of       |            |               |
|              |   | vehicle, motor bikes or |            |               |
|              |   | other means of          |            |               |
|              |   | transportation *or*     |            |               |
|              |   | value, if donated       |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Rental costs            |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Insurance and taxes     |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Source of funding to    |            |               |
|              |   | pay for vehicles        |            |               |
+--------------+---+-------------------------+------------+---------------+
| > *          |   | Cost of maintenance and |            |               |
| *Operation** |   | repairs                 |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Cost of gasoline/oil    |            |               |
|              |   | used, *or* value, if    |            |               |
|              |   | donated                 |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Distance traveled per   |            |               |
|              |   | year                    |            |               |
+--------------+---+-------------------------+------------+---------------+
| **Laboratory |   |                         |            |               |
| Supplies and |   |                         |            |               |
| Reagents;    |   |                         |            |               |
| Vaccines and |   |                         |            |               |
| M            |   |                         |            |               |
| edications** |   |                         |            |               |
+--------------+---+-------------------------+------------+---------------+
| **Vaccines   |   | **Information needed**  | **Data     | *             |
| and          |   |                         | s          | *Contact(s)** |
| M            |   |                         | ource(s)** |               |
| edications** |   |                         |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Number and type of      |            |               |
|              |   | medications             |            |               |
|              |   | administered;           |            |               |
|              |   |                         |            |               |
|              |   | Number and types of     |            |               |
|              |   | vaccines administered   |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Sources of funding for  |            |               |
|              |   | medicines and vaccines  |            |               |
|              |   | (purchased; donated;    |            |               |
|              |   | etc.)                   |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   | Information about       |            |               |
|              |   | adverse reactions and   |            |               |
|              |   | their costs             |            |               |
+--------------+---+-------------------------+------------+---------------+
| **Laboratory |   | Number of units of lab  |            |               |
| Supplies and |   | supplies and reagents   |            |               |
| reagents for |   | (e.g., 1 vial);         |            |               |
| confirming   |   | quantities purchased    |            |               |
| IDSR         |   | during the year,        |            |               |
| diseases**   |   | quantities used,        |            |               |
|              |   | purchasing price        |            |               |
+--------------+---+-------------------------+------------+---------------+
|              |   |                         |            |               |
+--------------+---+-------------------------+------------+---------------+

**Appendix 2: Description of Resources Used to Operate the Surveillance
and Response System**

The methods cover resources required to operate the IDSR system. These
resources include the personnel and financial resources expended in
operating the system. The following checklist is given to guide the
documentation of these resources.

> ![](media/image66.wmf){width="5.999305555555556in" height="3.33125in"}

Selection criteria for specific categories of costs will be based on
their appropriateness for IDSR activities, their relevance to economic
analysis, and the feasibility for data collection. The cost items
ultimately selected will be grouped by health structure level and
organized into a review checklist.

In describing these resources the following will be considered:

-   *Funding source(s)*: Specify the source of funding for the
    surveillance system

-   *Personnel requirements*: Estimate the time it takes to operate the
    program, including the collection, analysis, and dissemination of
    data (e.g., person-time expended per month of operation). These
    measures will be converted to dollar estimates by multiplying the
    person-time by appropriate salary and benefit costs.

-   *Other resources*: Determine the costs of other resources, including
    travel, training, supplies, computer and other equipment, and
    related services (e.g., mail, telephone, computer support, Internet
    connections, laboratory support, and hardware and software
    maintenance.

When appropriate, the description of the program's resources should
consider all levels of the public health system, from the local
health-facility to district, province/region, and central levels,
including the following categories:

-   *Buildings and Civil Works*: New construction under the IDSR
    program, renovation and repair of existing structures or extension
    of facilities

-   *Goods*: Procurement of goods (laboratory equipment, office
    equipment, computer hardware, application and system software,
    furniture/fixtures and materials & supplies)

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-   *Laboratory equipment*: binocular microscopes, table top centrifuge,
    refrigerator, deep freezer, incubator, autoclave, ELISA reader, etc.
    Quantity of each item by various laboratories will be worked out by
    the program authorities and by undertaking facility survey

-   *Office equipment*: To implement the program all surveillance units
    (peripheral/district/province/central) are to be equipped with
    office equipment such as photocopier, fax machine, overhead
    projector, air conditioner and telephone, etc.

-   *Computer hardware and operating system*: Connecting peripheral,
    district, province, and central surveillance units is the major
    activity of the IDSR program. Computer server, router, modem,
    printer, UPS, etc. are required for networking. Operating system for
    Server, RDBMS, Website Tool and GIS Software is required for
    carrying out various functions (data entry, data analysis,
    transmission of information and reporting).

-   *Furniture and fixtures*: Furniture and Fixtures which includes
    tables, chairs, laboratory platforms, washbasins, etc. are required
    for laboratories and surveillance units.

-   *Materials and Supplies*: Laboratory consumable goods and supplies
    are required continuously for the purpose of various diagnostic
    tests. These include slides, gloves, test tubes, cotton wool swabs,
    blood culture bottles, aluminum foil, typhoid rapid diagnostic kit,
    faecal contamination rapid test kits, HIV diagnostic kit ELISA, etc.

    -   *Services*: Procurement of services including the following

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-   *Information, Education and Communication (IEC)*: IEC activities
    includes organization of sensitization workshops, review meetings,
    publication of advertisement in newspapers to make public aware
    about the preventive action to be taken, printing of
    pamphlets/leaflets/brochures/manuals/formats for reporting, street
    plays, puppet shows, counseling and motivation of public through
    inter-personal communication, IEC activities at the national level
    like development and publication of advertisements in national
    newspapers for public awareness, printing of manuals, guidelines,
    training modules, production and telecast/broadcast of TV/Radio spot

-   *Studies*: Quality Assurance of laboratory services, survey on risk
    factors, evaluation of training activities, effectiveness of
    information

-   *Training*: The raining at various levels in the laboratories and
    surveillance units includes:

    -   training of multi-purpose health workers and laboratory
        assistants undertaken in-house at selected community health
        centers

    -   training of medical officers of primary and community health
        centers undertaken in-house at district surveillance units

    -   training of laboratory technicians, data mangers, district and
        province surveillance teams organized in professional
        institutions

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-   *Consultancy services*:

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-   *Miscellaneous (Incremental Operating Cost):* This involves
    operational expenses for all the components of the program and would
    include office expenses, office stationary, travel costs, hiring and
    maintenance of vehicles, maintenance of equipment/computers, salary
    of incremental staff and consumable, and individual consultants
    hired for specialized services to serve in the district and province
    surveillance units.