Health Economist at Living Goods

Project plan

The investment case is for the whole country and not for specific counties, so the consultant is expected to:

• Engage and manage stakeholder engagement to ensure relevant views are represented, and key stakeholders are brought into the process
• Work with the MoH and relevant stakeholders and experts to design the methodology for the investment case consistent with the model created by the Financing Alliance, investment cases done in other countries and the UNICEF Community Health Planning and Costing Tool.
• Collating data sets and information from interviews and secondary data sets to ensure a robust approach of determining ‘value’
• Analyse the data to show the return on investment for community health
• Develop deliverables to communicate and disseminate the findings 

Key activities

• Stakeholder engagement 

Developing an investment case that accurately incorporates the true costs and benefit of community healthcare requires a deep engagement with the relevant stakeholders in government, donor and broader healthcare providers, especially to understand the differing impacts in different contexts i.e. urban/ rural, coastal/ inland.

A steering committee and other key stakeholders must be engaged in the process of developing the investment case if it is to really shift perceptions of community health and catalyse a change in how it is funded and for the findings to be accepted by the wider health community.

• Data collection and analysis 

Illustrative Data And Analysis Required (not An Exhaustive List)

Costing of CHW program

• Recruitment
• Training
• Stipends and reimbursements (travel, lunches etc.)
• Supervisor time and costs
• Equipment, supply chain and logistics 

Return on Investment (Value of CHW programs)

• Short-term value for money compared to facility-based care across the following services:

• Vaccinations
• Neonatal care
• Family planning
• Malaria
• Community Management of Acute Malnutrition (CMAM)
• HIV
• Tuberculosis

• Direct savings to the economy

• Saving of child and maternal lives – Impact of ICCM
• Reduction in cost of treating advanced stage diseases
• Savings related to lower total care needs and treatment infrastructure including associated services for the population
• Impact of education on basic hygiene and sanitation, education on childhood disease identification, immunisation nutrition, family planning on reducing disease
• Impact of demand creation for sanitation/ hygiene/ nutrition products which prevent disease?

• Indirect value

• Effect on catastrophic cost for health care resulting from health crises e.g. Ebola/ cholera
• Economic impact of reduced stunting and better educated population (reduced childhood illness)/ economic impact of increased employment
• Increased productivity from a healthier adult population
• Disease elimination – eradication of diseases

• Broader benefits

• Greater female empowerment women
• Reducing patient costs
• Enabling data collection on civil registration and vital statistics (improved policy making, avoidance of disaster e.g. energy and water crises etc.)
• Enabling additional service delivery

• Differences in costs, savings, broader benefits of community healthcare in different regions, community healthcare delivery systems, urban/rural contexts and different regulations and policies in different counties. 

Qualitative insights

Collate qualitative insights for key stakeholders including how to prioritize different types of data, how to best build the case and the impact of different contexts on different value levers. A qualitative narrative will be expected alongside the numbers to explain where things could not be costed but value still exists.

Scenarios

The investment case should not be an absolute number but needs to show how different coverage levels, suites of activities and slightly different staffing structures result in different return on investment. Therefore, it is expected that the analysis will provide different investment scenarios to show the investment case for example for, full CHW coverage such as in the current policy versus partial coverage in just the highest need areas.

• Report development and dissemination 

The consultant will collate the data and insights from stakeholders and analysis into a user-friendly report that can be used by stakeholders to advocate for increased investment. There will be opportunities to engage key stakeholders to review draft documents and feedback into the final set of deliverables. The report will also need to include a literature review of relevant investment cases previously done and other relevant studies.

Deliverables and timeline

Deliverables

• Methodology – to be approved by internal panel and relevant credible external reviewers
• Report including but not limited to:

• Publishable and finalized Word document organized in a logical flow with necessary graphs and text addressing above questions, including executive summary, table of contents, sources/references, and appendices in a format that can easily be pulled into other documents
• A policy brief

• Condensed PowerPoint presentation with key slides summarizing the narrative from the publishable report
• Reusable investment case tool and raw data. Investment case tool
• Synthesis from key informant interviews describing motivations and constraints for community health (should be included in publishable report and PowerPoint slides)
• Attendance at a workshop with key stakeholders to disseminate and explain this research 

Interim deliverables to include

• Draft report
• Draft Excel investment case tool

Timeline

• Final Deliverables will be due end of November 2017
• Interim deliverables will be due in September