08. Costing Essential Services Package An Issue Paper

Costing Essential Services Package: An Issue Paper 5
The relative share of non-ESP components of HPSP to ESP expenditure varies by nature and
purpose of the specific components (discussed later).
Since the purpose is costing ESP, an understanding about the detailed classification of HPSP
components is necessary. The HPSP, as shown in Figure 2, can be divided into 8 broad
Components; each component is further divided into major areas (e.g.; there are 5 major
areas under the ESP component); each of the specific major areas are further divided into subareas
(e.g. the major area – reproductive health care is divided into 8 sub-areas); each subarea
is divided into sub-sub-areas (e.g., sub area – Safe motherhood is divided into 3 major
sub-sub-areas – ANC, Safe birth practices and PNC); each sub-sub-area is divided into
disease/treatment conditions (e.g., sub-sub-area – Safe birth practices is divided into two
conditions, namely normal delivery and complicated delivery); each such condition is further
divided into sub-conditions (e.g., condition – complicated delivery is divided into subconditions
such as postpartum haemmorhage, obstructed labour, perineal tear, etc). Thus,
ideally speaking, costing ESP, should include cost from components to sub-conditions via the
major areas, sub-areas, sub-sub-areas and conditions. This iteration is true not only for the
direct ESP component of HPSP, but also for all other seven components to the extent they are
related (directly or indirectly) to ESP (discussed later and shown in Figure 10). Costing ESP
should also take care of costing by activity, sub activity and coverage, as well as by type of
service delivery facilities (Figure 3).
At this stage, it would be useful to note the following:
1. Costing is the activity that estimates the costs of an action either in the future or in the past.
2. There are three major points in the planning spiral at which costing is necessary – the option
appraisal stage, budgeting, and evaluation.
3. Costs involved should be well defined and sufficiently accurate.
4. Within the public sector the real costs to society, and not just to the health sector, should be
assessed.
5. Cost need to be estimated as a prerequisite to setting budgets.
6. In determining the costs of any action, it is important to identify all the costs arising, and on
whom they fall. For example, providing an antenatal service, may incur costs for:
� the health service, for example, in the form of drugs or personnel;
� the individual, in the form of charges, transport costs, or time away from home or work;
and
� the individual’s employer or family, in covering for her absence (Green 1997: 188-189).