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Costing of iCCM

A trained community health worker (CHW) counts the breaths of a baby using a respiratory timer

Research Overview

In March 2011, an award was made to Management Sciences for Health (MSH) to develop and test an iCCM cost and financing tool based on research in Malawi, Rwanda, and Senegal. The TRAction-funded costing of iCCM research had the goal of developing and validating a simple tool for program planners and managers to rapidly assess the costs and financing of iCCM introduction and expansion in developing country settings with different levels of iCCM experience.  

Project Location

Malawi, Senegal, and Rwanda

Research Objectives

The aim of this project was to develop and test an iCCM costing and financing tool and accompanying user guide to help program planners and managers plan for and monitor iCCM programs. Specific objectives included: 

  • „Provide users an understanding of the costs and financing of iCCM service delivery, supervision, and management from community to central levels
  • „Facilitate implementation, scale-up, and maintenance of iCCM activities in the future through analysis

To address the challenge, Management Sciences for Health (MSH) completed the following activities:

  • „Developed an iCCM Costing and Financing Tool and an accompanying user’s guide.
  • „Conducted research in three countries to inform, develop, adapt and refine the tool; collect data; and get feedback from key stakeholders.
  • „Field tested the model in one or two additional countries, with only remote technical assistance to ensure the usability of the tool.
  • „Finalized the model, user guide, and data collection instruments.
  • Country reports from Senegal, Rwanda, and Malawi summarized the process and results of applying the costing and financing model in each iCCM program.

Lessons Learned

A cost modeling tool and user guide was tested and developed with the following functions:

  • „Estimating and tracking costs, and the financing required to introduce and expand iCCM and, if appropriate, comparing the overall results from the model to the costs of similar child health programs.
  • Helping guide decisions regarding the feasibility and sustainability of introducing and expanding iCCM programs.
  • Identifying opportunities to increase efficiencies and consider alternative scenarios for expenditures and financing through a comprehensive understanding of programmatic costs, cost drivers, and financing sources.
The main cost-drivers identified were the numbers of services provided by CHWs and supervision and training costs.
 
In testing of the tool, cost-effectiveness emerged as an important theme. In Rwanda, for example, low utilization of iCCM services and high supervision and management costs resulted in high unit costs. Services can only be low-cost if they are well utilized.

Utilization depends largely on the location and numbers of CHWs relative to people served; on the perceived skills, responsiveness and availability of the CHWs; and on the availability of medical supplies and equipment.

Please note that testing indicated success of the tool in Senegal and Rwanda, but the sample size was too small in both countries for the data to be representative of the program as a whole.  As a result, the modeling should be considered as illustrative only. Figures in the tool can be updated as needed, however, and the results can be useful to Ministries of Health and other partners.

Implications and Recommendations

Costing exercises must occur as part of policy-making to set realistic targets and plan for financial sustainability. Using the tool to develop a clear and feasible costing plan allows for a better understanding of the impact of utilization on indirect costs. Further, it allows the user to make cost-effective decisions based on a clear understanding of what constitutes an iCCM service, taking into account the related training and supervision costs, and changes in utilization.

Research into Action

The model and guidelines were published in English and French, and these along with country reports were disseminated through the TRAction website, CCM toolkits, CCM Central, and various presentations to global planners and managers of maternal and child health programs. TRAction and its partners used research findings to develop recommendations that will facilitate successful implementation and scale-up of iCCM programs. These were shared with numerous stakeholders through a variety of channels.

  • Integrated into lessons learned documents shared with representatives from 70 countries at the iCCM Evidence Review Symposium in Accra, Ghana
  • Presented country-level results to the Ministries of Health and other key stakeholders in all countries
  • Shared with implementing partners through participation on the iCCM Task Force
  • Integrated into TRAction iCCM policy briefs providing recommendations for both policy makers and program managers on iCCM implementation and start-up
  • Applied the tool to determine the costs of iCCM projects in several countries outside those tested in the TRAction project.
  • Utilized the tool to develop iCCM investment cases and iCCM proposals for the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

Additional Resources

iCCM Costing Tool

iCCM Costing Tool Demo

iCCM Costing Tool User Guide

Costing of Integrated Community Case Management in Senegal

Costing of Integrated Community Case Management in Malawi

Costing of Integrated Community Case Management in Rwanda

Research Partner

PI: David Collins

Project Status

 

 

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