OneHealth Tool Integrated Strategic Planning and Costing How much does it cost to scale up nutrition specific and sensitive interventions implemented through the health sector? How many lives will be saved?
Why cost nutrition interventions as part of national health plans? In most countries, the majority of interventions are nutrition specific that are implemented through the health sector Many nutrition sensitive interventions are going to be implemented thought the health sector, e.g. health, wat-san Source: SUN Financial Tracking & Resource Mobilization http://scalingupnutrition.org/about/financial-tracking-resource-mobilization 2
Nutrition interventions in the OneHealth Tool All nutrition specific interventions recommended in WHO Essential Nutrition Actions (2013) Nutrition sensitive interventions implemented by the health sector Intervention inputs calculated based on guidance and evidence as published on the WHO e-library of Evidence for Nutrition Actions 3
OneHealth Tool Models cost and impact with a health systems approach Community mobilization, demand generation, programme management National Hospital Health Centre Outreach Community Others Non communicable Child Health Nutrition Reproductive Health Water & Sanitation Immunization Malaria TB HIV Lives saved; healthier populations Infrastructure Health Information Human Resources Governance Supply chain Health Financing Increasing coverage of effective interventions Strengthening Health Systems Financial affordability
What does the OneHealth Tool do? How much will the health plan cost? How much will it cost to scale-up nutrition interventions? Costing as part of the planning process How many lives could be saved? How much could stunting be reduced? Improving population health How many doctors, nurses, CHWs are needed to health and nutrition interventions? Links programme plans to a health systems platform Ensures comparability A standardized costing approach across programmes One health programme Avoid vertical approaches
Costing of nutrition intervention progammes Drugs and supplies (units/treatment case, price/unit) Number of people (target population, incidence, coverage) Estimated staff time (to compare with HR plans) Programme costs (training, advocacy, M&E, supervision, etc.)
Nutrition activities within a health sector plan: Estimating health worker needs Comparing anticipated supply of health workers with the expected demand Estimated time needed for service delivery Available FTE nurses
Nutrition activities within a health sector plan: What will be the demands on the supply chain? Volume of commodities transported in Logistics system, % share by programme Non Communicable disease Nutrition Vaccination HIV/AIDS Malaria TB Child health 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Maternal/newborn and reproductive health
Nutrition activities within a health sector plan: What will be the demands on outpatient care? Predicted number of outpatient visits, by programme area 70,000,000 60,000,000 50,000,000 40,000,000 30,000,000 Nutrition HIV/AIDS Malaria Vaccination 20,000,000 10,000,000 - Child health Maternal/newborn and reproductive health 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Nurses, FTE's Comparing scenarios Summary at 2020 Scenario Cost of Plan (all years) Intervention demand on nurses time (end year) Burkina 50 % coverage 712 million 56% 90 Burkina 70 % coverage 777 million 110% 79 Burkina 90 % coverage 848 million 131% 71 Under five mortality rate (end year) 12,000 10,000 Nurses available 8,000 6,000 4,000 2,000 0 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 FTE's needed Burkina 50 FTE's needed Burkina 70 FTE's needed Burkina 90
Estimating impact LiST (Lives Saved Tool) estimates impact on Mortality Nutritional status Breastfeeding practices 11
Added value of OneHealth Tool for nutrition planning Evidence-based nutrition actions Estimate impact and costs of - Different scaling-up scenarios - Changes in treatment guidelines System-wide approach rather than vertical programmes Accessing domestic resources: assessment of affordability of nutrition interventions within a sectorwide financial space analysis Allow identification of health system bottlenecks for nutrition
Countries that have used/currently using the OneHealth Tool Angola Benin Botswana Burkina Faso Cape Verde Democratic Republic of the Congo Ethiopia Indonesia Kenya Mauritania Morocco Mozambique Papua New Guinea Paraguay Senegal Sierra Leone Sri Lanka South Africa Sudan Tajikistan Turkmenistan Zambia Viet Nam
Disclaimer: the estimates presented in this slide represent work in progress. They are included for illustration purposes only and should not be cited. Country application example (1) Ethiopia MNH Roadmap 2012-2015 Nutrition interventions: IFA to pregnant women Feeding counselling of LBW infants Breastfeeding counselling and promotion Drug and supply costs are attributed to each programme
Country application example (2) Ethiopia MNH Roadmap 2012-2015 Nutrition interventions: IFA to pregnant women Feeding counselling of LBW infants Breastfeeding counselling and promotion 100 90 80 70 60 50 40 30 20 10 0 2011 2012 2013 2014 2015 Not breastfeeding Partial breastfeeding Predominant breastfeeding Exclusive breastfeeding Impact of breastfeeding counselling on breastfeeding in infants <1 month is estimated in LiST Disclaimer: the estimates presented in this slide represent work in progress. They are included for illustration purposes only and should not be cited.
Disclaimer: the estimates presented in this slide represent work in progress. They are included for illustration purposes only and should not be cited. Country application example (3) Sudan National Health Plan 2011-2016 Nutrition interventions: Food fortification IFA to pregnant women Breastfeeding counselling and promotion Management of SAM Management of MAM A share of health systems costs can be attributed to each programme
Disclaimer: the estimates presented in this slide represent work in progress. They are included for illustration purposes only and should not be cited. Country application example (4) Sudan National Health Plan 2011-2016 Nutrition interventions: Food fortification IFA to pregnant women Breastfeeding counselling and promotion Management of SAM Management of MAM Human resources time spent to implement planned activities translated into estimated number of HWs for the nutrition programme
OneHealth Tool OneHealth Tool available in English French Arabic and Spanish versions in pipeline Documents http://www.internationalhealthpartnership.net/en/tools/one-health-tool/ Help screen Life saver function response within 2 working days
For further information email onehealthtool@unfpa.org or contact Kaia Engesveen, WHO Department of Nutrition for Health and Development, engesveenk@who.int Karin Stenberg, WHO Department of Health Systems Financing, stenbergk@who.int