Costing Mobile Service Models in Tanzania - the RESPOND Project!

Costing Mobile Service
Models in Tanzania
Presentation to LA/PM Community of
Practice
Mobile Services Working Group
May 23, 2011

Why worry about costs?
Resource constraints are real
Access, quality and costs are
inter-related
Goal of health system: to
maximize “health” subject to
underlying resource constraint
Cost information helps inform
decisions – resource allocation,
scale-up, affordability, efficiency,
etc.

Production Model for FP Acceptors
INPUTS
PROCESSES
OUTPUTS
OUTCOMES
• Provider time
• Support staff time
• Consumables
• Capital (facilities,
vehicles)
Delivery System
•clinic
•commun -based
organization
•mobile services
Services provided thru:
•clinic visits
•community health
workers
•mobile outreach
events
• Higher contraceptive
use
• Fewer unplanned
pregnancies
Efficiency Cost-Effectiveness

LA/PM Decision Cascade
Should extra
effort be made to
improve access
to LA/PMs ?
• Access,
Equity
How should
LA/PMs be
provided to rural
populations?
• Effectiveness,
Cost-effectiveness
How should
mobile outreach
services be
configured?
• Efficiency

Objectives of Cost Analysis
To measure costs of ongoing mobile service
delivery
– ATP-supported “family planning weeks”
– ATP-supported outreach events
– MST outreach expeditions
To compute average cost per LA/PM acceptor
(overall and by contraceptive method)
To describe components of costs of mobile service
delivery

Program Outputs
Data Requirements
– Acceptors of LA/PMs by outreach event and method
Program Inputs
– Staff (providers, supervisors, drivers)
– Consumables (contraceptives, surgical supplies)
– Lodging, perdiem and fuel
– Capital (vehicles, facilities, equipment)
– Zonal Office overhead
Specification of process whereby inputs are transformed
into outputs

Methodology
Retrospective, focusing on 2010
Perspective: programmatic (site level and zonal office)
Unit of analysis: the outreach event or expedition
Source of data: event narratives and associated expense
reports
Sampling plan (aspirational):
– ATP: one FP week and one outreach event, purposively selected
for each province (n=24)
– MST: 30 expeditions (six teams over five months)

Data Collection
Ongoing, using custom
Excel spreadsheets to
extract and organize
information on salaries,
benefits, per-diems,
contraceptives, medical
supplies, fuel, vehicles,
equipment and facilities

Data Analysis
Total cost per event or expedition (includes site
costs plus zonal office overhead)
Cost per LA/PM acceptor, overall and by method

Challenges
• Information not
organized to enable
simple extraction of
costs of mobile
outreach
• Resources come from
different entities, no
central repository of
cost information

Challenges, cont’
• Uneven data quality (completeness, internal
consistency, legibility)
• Complexity of MoH personnel classification
system
• Unclear how many different outreach models
actually exist
• Staff turnover

Next Steps
ATP: Completion of data
extraction for 12 events in
one zone; receipt of
information on costs of
supplies, vehicles and
overhead
MST: Receipt of
categorized expenditure
data for 30 outreach
expeditions
Analysis and reporting