Agenda  Motivation and Overview (using Education as an example)  Discussion by Selected Intervention Area  Energy Services  Hunger (multi-sector)  Gender  Health

Key Assumptions for Health Needs Assessment  Interventions: Comprehensive set of interventions to comprise minimum package of health services  Targets: Coverage targets should aim at meeting MDGs for entire population  Synergies: Benefits of prevention and non-health interventions should be factored into needs assessment  Investment model: Service delivery models should reflect local needs and health system structure; unit costs should reflect costs for reaching hard-to-reach populations.  Financing: User fees should be eliminated for basic health package.

Summary of Health Interventions Infectious Disease New infrastructure and O&M of existing infrastructure Health personnel salaries Pre- and in- Service training Community demand interventions Management and monitoring & evaluation Research and development Health System Child and Maternal Health IMCI package Immunization Neonatal package Antenatal care Skilled attendance and clean delivery Emergency obstetric care (EmOC) Abortions and care of complications of abortion Antiretroviral therapy UNAIDS prevention and care package ACT for malaria Insecticide treated nets DOTS

Child Health and Maternal Health Interventions

HIV/AIDS Interventions

TB, Malaria, Access to Medicines, and Health Systems Interventions

Proposed Health Coverage Targets 1/2 Maternal Health Coverage Current 2015 % of women receiving antenatal care 17% 99% % of women with access to EmOC 3% 90% % skilled attendance 6% 99% contraceptive prevalence rate (CPR) 5% 41% Child Health Coverage Current 2015 percent of sick children receiving care 15% 99% percent of sick infants receiving care 16% 99% TB Coverage Current 2015 case detection 26% 70% cure rates 61% 85%

Proposed Health Coverage Targets 2/2 HIV/AIDS coverage Current 2015 antiretroviral therapy 1.5% 100% condom distribution N/A 100% PMTCT N/A 90% voluntary counseling & testing N/A 100% Malaria coverage Current ITNs/IRS 0% 80% effective therapy within 24h 1.4% 80%

Estimating Costs for Direct Service Provision NO. OF CASES COST PER CASE Country epidemiological data Country demographic data Target coverage rates Intervention components and quantities Unit costs of components Drugs Hospital bed and food Laboratory costs Other supplies TOTAL COSTS

Assessing Need for Infrastructure Based on scale-up plan of Federal Ministry of Health (2004). “Draft Proposal for an Accelerated Expansion of Primary Health Care Facilities in Ethiopia ( )”  Scale-up of health centres and health posts from Draft Proposal until 2008  Scale-up of hospitals based on targets outlined in the Draft Proposal 1 zonal hospital per one million people, 1 district hospital per 250,000  Include costs of construction, upgrading, operations, and maintenance

Estimating Needed Health Workers  Target staffing ratios can be obtained from Federal Ministry of Health (2004). “Draft Proposal for an Accelerated Expansion of Primary Health Care Facilities in Ethiopia ( )”  Consider appropriate physician and nurse ratios for health centers and hospitals  Include training costs associated with increasing health workers; consider need for revision of training curricula  Consider increase in health worker salaries (by how much?) to improve recruitment and retention, particularly in rural areas

Investing in Health Systems In addition to disease specific activities, human resources, and infrastructure, need to invest in strengthening health systems. This includes:  Enhancing community demand (community education, awareness raising)  Improving management (planning, supervision, supply management, accounting, financial management at the Ministry of Health and district health center levels)  Enhancing monitoring and evaluation (data gathering, vital registries, epidemiological surveillance, regulation of service delivery, formulation of policy guidelines, and implementation of quality-assurance schemes)  Building R&D capability (clinical and operational research)

Adding Up the Components Direct costs of all interventions + Infrastructure and HRH costs Costs of health system strengthening + Total health costs

Way Forward  It is important to agree on key assumptions for three health needs assessment scenarios: ambitious scenario (maximum coverage targets, full intervention package) middle scenario (lower coverage targets, key low-cost interventions) business-as-usual scenario (incremental increases over current service provision)  Work with existing data and models to understand range of health inputs required to meet the MDGs