Enhance access to health care and nutrition services MDG 1: Reduce protein-energy malnutrition Reduce Poverty by half of 1990 levels. MDG 4: Reducing child mortality by MDG 5: Reducing maternal mortality by Intensify prevention and control of communicable diseases such as HIV and AIDS Malaria Tuberculosis MDG 6: Halting and reversing the spread of HIV and AIDS, TB and malaria Bridging Access, and Social Welfare through: Equity Strengthened efficiency Strengthened response to medical emergencies All health-related MDGs, including MDG 7: Sustainable access to safe drinking water Reduce Poverty by half of 1990 levels. Ensure sustainable financing arrangements that protect the poor MDG 8: Increase access to essential and affordable drugs Non-MDGs Strengthen institutional care and Mental Health service delivery Intensify prevention and control of Non-MDGs Governance, strengthen efficiency Objectives of the HSMTDP Costing Exercise The objectives of the HSMTDP costing exercise were as follows: Preparation: Locate sources of information for obtaining costs on all inputs to the health sector covering recurrent costs (staff, infrastructure, drugs etc) and capital investments (new buildings and equipment). Cost the strategic plan as a whole: Use the four year strategic plan to estimate the total cost of full implementation, covering projected staff increases, infrastructure investments, and costs associated with expanding the essential package of services to reach the entire population, as defined by program targets. Estimate current shortfalls in financing the health sector as a whole, and how this could be addressed over time. Link the final cost estimates to the preparation of the budgets for the subsequent years, showing how investment will need to increase over the 3 years for the strategic plan to be fully implemented.
Identify recurrent and capital components of the plan: Cost the services expected to be provided at each level of the health system at desired levels of coverage, together with the investments in human resources, infrastructure, and system strengthening investments required to deliver those services; Estimate the recurrent costs associated with delivering the services (personnel, consumables, overhead) Indicate the costs by year Estimate the potential health impacts the plan could deliver, if implemented properly. Data type Most common source Baseline coverage of key health and nutrition interventions DHS 2008, updated with newer data from program reports where applicable New health sector strategies HSMTDP draft 12 August, 2010; Ghana Child Health Strategy; GHS Strategic Plan, individual program plans 2010-2015 Service coverage targets for 2013 Same as above Epidemiology DHS 2008, UNICEF, WHO and UNFPA data; expert opinion Demography DHS and Ghana Statistical Service Macroeconomics IMF and Ghana Ministry of Finance and Economic Planning (MOFEP) Unit prices: infrastructure and vehicles Ghana health sector Capital Investment Plan (CIP); revised by MOH Unit prices: drugs and basic commodities UNICEF global supply data (occasionally updated where relevant) Infrastructure development targets Ghana health sector CIP, revised by MOH Funding sources and projected funding flows MOH Table 2: Data sources used in the HSMTDP costing exercise (details in Annex 6) Methods Overview The costing exercise was conducted by a working group assembled under the direction of the Ministry of Health/PPME and complemented by representatives from the World Bank, UNICEF and Danida. The group agreed upon a mix of methods developed and refined through similar exercises in other countries and further adapted to suit Ghana’s specific context and goals. The exercise involved five steps: a) an assessment of the structure of the health system and current coverage of high-priority interventions; b) specification of new coverage targets associated with the planned strategies (including facility construction and HR targets); c) calculation of the marginal costs of implementing the HSMTDP; d) integration of the marginal cost estimates with the baseline (2010) budget; e) assessment of the available resources or fiscal space for implementing the plan and identification of funding gaps. Each of these steps is described in detail below. Assessment of the structure of the current health system and current coverage of high-priority interventions
Construction/rehabilitation of logistical base/store National 2,000,000 West and Central Africa Average (UNICEF) Maintenance Per year 400,000 Percentage of new construction costs (see below) Cost of building a medical school Per unit 150,000 West and Central Africa Average (UNICEF) Maintenance medical school Per year 15,000 Percentage of new construction costs (see below) Equipment Radio 1 per 50 households Per 50 households 200 West and Central Africa Average (UNICEF) Equipment for health post Per unit 6,000 West and Central Africa Average (UNICEF) Maintenance of health post equipment Per year 300 Percentage of new equipment costs (see below) Equipment for health center Per unit 80,000 West and Central Africa Average (UNICEF) Maintenance of health center equipment Per year Percentage of new equipment costs (see below) Material for resuscitation (ambu- bag) Per unit West and Central Africa Average (UNICEF) Equipment for first level referral care facility Per unit 8,000,000 West and Central Africa Average (UNICEF) Maintenance of equipment first level referral care facility Per year Percentage of new equipment costs (see below) Equipment for second level referral care facility Per unit 15,000,000 West and Central Africa Average (UNICEF) Equipment for surgery and obstetrics Per unit West and Central Africa Average (UNICEF) Maintenance of equipment for second level referral care facility Per year Percentage of new equipment costs (see below) Equipment for medical school Per unit 50,000 West and Central Africa Average (UNICEF) Maintenance (as share of capital cost) Maintenance of building (as share of construction cost) % 10.0% Ghana estimate 2010 Rehabilitation of building (as share of new construction cost) % 30.0% Ghana estimate 2010 Maintenance of equipment (as share of equipment cost) % 5.0% Ghana estimate 2010 Water / electricty recurent costs (as share of new construction) % 15.0% Ghana estimate 2010 Water installation (as share of new construction cost) % 1.0% Ghana estimate 2010 Electricity installation (as share of new construction cost) % 2.0% [Ghana estimate 2010 Annual salaries (total compensation not including benefits) Parameter name Unit Ghana Value (US$) Reference [Source] Community health volunteers Per year unpaid National policy