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Financing and Sustainability Postabortion Care Services March 2002
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Financial Sustainability What does it take? Not about numbers only But numbers do count Not “business as usual”
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Not About Numbers Only Sustainability plan included in strategic plan Business plans also for NGOs? Change of attitude Efficiency in service delivery Awareness of cost implications of quality Costs of high vs. poor quality
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Numbers Do Count How much does it cost to provide services: current level and at scale? What price to charge for PAC services If no cost recovery, who pays for any subsidies offered? Budgetary recognition and allocation by ministries of health
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Not Business As Usual Organizational sustainability Need business-like approach Leadership Strategic partnerships/collaboration External relations – creatively managed
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Business-like Approach “Not-For-Profit is not a management style, but a tax status” (P. Drucker) Relevant business-type principles: Use of financial management information Cost analysis Synergy through integration Customer/patient/client focus
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Leadership Born or taught? Need for champions to promote Political will creates enabling environment
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Partnerships Training – who has comparative advantage? Logistics for MVA and other supplies Procurement of supplies
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External Relations These need to be managed well Costs/burden of donor support Weaning out of donor dependence – is this in the sustainability plan?
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Cost of PAC Services Availability of information on cost Some studies on cost effectiveness of MVA vs. D&C Little information on the costs involved in scaling up of PAC services What cost information is relevant?
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Scaling Up: What Costs Are Relevant? Incremental costs only: MVA or D&C supplies Additional staff time costs Other supplies and equipment required
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Relevant Costs (cont) Opportunity costs of scaling up PAC services What happens to funding for other RH services Scaling up FP reduces need for PAC; Unwanted pregnancy implies failure in FP
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Cost Estimation Step 1: Strategic mapping to identify what exists and service delivery gaps Step 2: Estimation of demand. Step 3: Incremental resources needed over time. Step 4: Cost of additional resources
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Costing Tools CORE (Cost and Revenue analysis tool developed by MSH) Cost Estimate Strategy (developed by MSH) Cost Analysis Tool (developed by EngenderHealth) A Guide to Assessing Resource Use for the Treatment of Incomplete Abortion (Developed by Ipas)
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Scaling Up: Cost Determinants Capital costs – Buildings, equipment, initial training Takes into account existing infrastructure Projected demand for services Treatment protocols Ease of replication of pilot
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Cost Drivers The key cost drivers include: Treatment protocols, e.g. The re-use of canulla Length of stay/Discharge from hospital Drugs and medical supplies and staff time are the most significant costs Need to control the key cost drivers.
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Financing PAC Services User fees Community health funds Health insurance Cost savings through: Lower hospital stay Use of MVA where possible as this has been proven to be more cost effective than D&C Public funds (taxation) External assistance
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Policy Considerations Financing issues Service sustainability Staff capacity Continued availability of supplies Support for PAC at policy level Budgetary support Clarity on legal issues to enhance use Classification of PAC services as “emergency” care?
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Conclusions Importance of financing and sustainability in PAC Complex subject Cost effectiveness of MVA vs. D&C Need to do more research on issues of financing and sustainability in scaling up PAC
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