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As countries progress towards universal health coverage (UHC), they frequently develop explicit packages of health services compatible with UHC goals. As part of the Disease Control Initiative 3 Country Translation project, a systematic survey instrument was developed and used to review the experience of five low-income and lower-middle-income countries—Afghanistan, Ethiopia, Pakistan, Somalia and Sudan—in estimating the cost of their proposed packages. The paper highlights the main results of the survey, providing information about how costing exercises were conducted and used and what country teams perceived to be the main challenges. Key messages are identified to facilitate similar exercises and improve their usefulness. Critical challenges to be addressed include inconsistent application of costing methods, measurement errors and data reliability issues, the lack of adequate capacity building, and the lack of integration between costing and budgeting. The paper formulates four recommendations to address these challenges: (1) developing more systematic guidance and standard ways to implement costing methodologies, particularly regarding the treatment of health systems-related common costs, (2) acknowledging ranges of uncertainty of costing results and integrating sensitivity analysis, (3) building long-term capacity at the local level and institutionalising the costing process in order to improve both reliability and policy relevance, and (4) closely linking costing exercises to public budgeting.

Objectives Testing and treatment for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are highly effective, high-impact interventions. This article aims to estimate the cost-effectiveness of scaling up these interventions by scenarios, regions, and income groups. Methods We modeled costs and impacts of hepatitis elimination in 67 low- and middle-income countries from 2016 to 2030. Costs included testing and treatment commodities, healthcare consultations, and future savings from cirrhosis and hepatocellular carcinomas averted. We modeled disease progression to estimate disability-adjusted life-years (DALYs) averted. We estimated incremental cost-effectiveness ratios (ICERs) by regions and World Bank income groups, according to 3 scenarios: flatline (status quo), progress (testing/treatment according to World Health Organization guidelines), and ambitious (elimination). Results Compared with no action, current levels of testing and treatment had an ICER of $807/DALY for HBV and –$62/DALY (cost-saving) for HCV. Scaling up to progress scenario, both interventions had ICERs less than the average gross domestic product/capita of countries (HBV: $532/DALY; HCV: $613/DALY). Scaling up from flatline to elimination led to higher ICERs across countries (HBV: $927/DALY; HCV: $2528/DALY, respectively) that remained lower than the average gross domestic product/capita. Sensitivity analysis indicated discount rates and commodity costs were main factors driving results. Conclusions Scaling up testing and treatment for HBV and HCV infection as per World Health Organization guidelines is a cost-effective intervention. Elimination leads to a much larger impact though ICERs are higher. Price reduction strategies are needed to achieve elimination given the substantial budget impact at current commodity prices.

The COVID-19 pandemic has brought the need for well-functioning primary health care (PHC) into sharp focus. PHC is the best platform for providing basic health interventions (including effective management of non-communicable diseases) and essential public health functions. PHC is widely recognised as a key component of all high-performing health systems and is an essential foundation of universal health coverage. PHC was famously set as a global priority in the 1978 Alma-Ata Declaration. More recently, the 2018 Astana Declaration on PHC made a similar call for universal coverage of basic health care across the life cycle, as well as essential public health functions, community engagement, and a multisectoral approach to health. Yet in most low-income and middle-income countries (LMICs), PHC is not delivering on the promises of these declarations. In many places across the globe, PHC does not meet the needs of the people—including both users and providers—who should be at its centre. Public funding for PHC is insufficient, access to PHC services remains inequitable, and patients often have to pay out of pocket to use them. A vicious cycle has undermined PHC: underfunded services are unreliable, of poor quality, and not accountable to users. Therefore, many people bypass primary health-care facilities to seek out higher-level specialist care. This action deprives PHC of funding, and the lack of resources further exacerbates the problems that have driven patients elsewhere.

Background Cost effectiveness was a criterion used to revise Ethiopia’s essential health service package (EHSP) in 2019. However, there are few cost-effectiveness studies from Ethiopia or directly transferable evidence from other low-income countries to inform a comprehensive revision of the Ethiopian EHSP. Therefore, this paper reports average cost-effectiveness ratios (ACERs) of 159 health interventions used in the revision of Ethiopia’s EHSP. Methods In this study, we estimate ACERs for 77 interventions on reproductive maternal neonatal and child health (RMNCH), infectious diseases and water sanitation and hygiene as well as for 82 interventions on non-communicable diseases. We used the standardised World Health Organization (WHO) CHOosing Interventions that are cost effective methodology (CHOICE) for generalised cost-effectiveness analysis. The health benefits of interventions were determined using a population state-transition model, which simulates the Ethiopian population, accounting for births, deaths and disease epidemiology. Healthy life years (HLYs) gained was employed as a measure of health benefits. We estimated the economic costs of interventions from the health system perspective, including programme overhead and training costs. We used the Spectrum generalised cost-effectiveness analysis tool for data analysis. We did not explicitly apply cost-effectiveness thresholds, but we used US$100 and $1000 as references to summarise and present the ACER results. Results We found ACERs ranging from less than US$1 per HLY gained (for family planning) to about US$48,000 per HLY gained (for treatment of stage 4 colorectal cancer). In general, 75% of the interventions evaluated had ACERs of less than US$1000 per HLY gained. The vast majority (95%) of RMNCH and infectious disease interventions had an ACER of less than US$1000 per HLY while almost half (44%) of non-communicable disease interventions had an ACER greater than US$1000 per HLY. Conclusion The present study shows that several potential cost-effective interventions are available that could substantially reduce Ethiopia’s disease burden if scaled up. The use of the World Health Organization’s generalised cost-effectiveness analysis tool allowed us to rapidly calculate country-specific cost-effectiveness analysis values for 159 health interventions under consideration for Ethiopia’s EHSP.

Summary Investment in the capabilities of the world's 1·2 billion adolescents is vital to the UN's Sustainable Development Agenda. We examined investments in countries of low income, lower-middle income, and upper-middle income covering the majority of these adolescents globally to derive estimates of investment returns given existing knowledge. The costs and effects of the interventions were estimated by adapting existing models and by extending methods to create new modelling tools. Benefits were valued in terms of increased gross domestic product and averted social costs. The initial analysis showed high returns for the modelled interventions, with substantial variation between countries and with returns generally higher in low-income countries than in countries of lower-middle and upper-middle income. For interventions targeting physical, mental, and sexual health (including a human papilloma virus programme), an investment of US$4·6 per capita each year from 2015 to 2030 had an unweighted mean benefit to cost ratio (BCR) of more than 10·0, whereas, for interventions targeting road traffic injuries, a BCR of 5·9 (95% CI 5·8–6·0) was achieved on investment of $0·6 per capita each year. Interventions to reduce child marriage ($3·8 per capita each year) had a mean BCR of 5·7 (95% CI 5·3–6·1), with the effect high in low-income countries. Investment to increase the extent and quality of secondary schooling is vital but will be more expensive than other interventions—investment of $22·6 per capita each year from 2015 to 2030 generated a mean BCR of 11·8 (95% CI 11·6–12·0). Investments in health and education will not only transform the lives of adolescents in resource-poor settings, but will also generate high economic and social returns. These returns were robust to substantial variation in assumptions. Although the knowledge base on the impacts of interventions is limited in many areas, and a major research effort is needed to build a more complete investment framework, these analyses suggest that comprehensive investments in adolescent health and wellbeing should be given high priority in national and international policy.

To make progress toward universal health coverage, countries should define the type and mix of health services that respond to their populations’ needs. Ethiopia revised its essential health services package (EHSP) in 2019. This paper describes the process, methodology and key features of the new EHSP. A total of 35 consultative workshops were convened with experts and the public to define the scope of the revision, develop a list of health interventions, agree on the prioritization criteria, gather evidence and compare health interventions. Seven prioritization criteria were employed: disease burden, cost effectiveness, equity, financial risk protection, budget impact, public acceptability and political acceptability. In the first phase, 1,749 interventions were identified, including existing and new interventions, which were regrouped and reorganized to identify 1,442 interventions as relevant. The second phase removed interventions that did not match the burden of disease or were not relevant in the Ethiopian setting, reducing the number of interventions to 1,018. These were evaluated further and ranked by the other criteria. Finally, 594 interventions were classified as high priority (58%), 213 as medium priorities (21%) and 211 as low priority interventions (21%). The current policy is to provide 570 interventions (56%) free of charge while guaranteeing the availability of the remaining services with cost-sharing (38%) and cost-recovery (6%) mechanisms in place. In conclusion, the revision of Ethiopia’s EHSP followed a participatory, inclusive and evidence-based prioritization process. The interventions included in the EHSP were comprehensive and were assigned to health care delivery platforms and linked to financing mechanisms. publishedVersion

The World Health Organization’s (WHO’s) Choosing Interventions that are Cost-Effective (CHOICE) programme has been a global leader in the field of economic evaluation, specifically cost-effectiveness analysis for almost 20 years. WHO-CHOICE takes a "generalized" approach to cost-effectiveness analysis that can be seen as a quantitative assessment of current and future efficiency within a health system. This supports priority setting processes, ensuring that health stewards know how to spend resources in order to achieve the highest health gain as one consideration in strategic planning. This approach is unique in the global health landscape. This paper provides an overview of the methodological approach, updates to analytic framework over the past 10 years, and the added value of the WHO-CHOICE approach in supporting decision makers as they aim to use limited health resources to achieve the Sustainable Development Goals (SDGs) by 2030.

Executive summaryDespite dramatic improvements in survival, nutrition, and education over recent decades, today’s children face an uncertain future. Climate change, ecological degradation, migrating populations, conflict, pervasive inequalities, and predatory commercial practices threaten the health and future of children in every country. In 2015, the world’s countries agreed on the Sustainable Development Goals (SDGs), yet nearly 5 years later, few countries have recorded much progress towards achieving them. This Commission presents the case for placing children, aged 0–18 years, at the centre of the SDGs: at the heart of the concept of sustainability and our shared human endeavour. Governments must harness coalitions across sectors to overcome ecological and commercial pressures to ensure children receive their rights and entitlements now and a liveable planet in the years to come.

Summary Background Primary health care (PHC) is a driving force for advancing towards universal health coverage (UHC). PHC-oriented health systems bring enormous benefits but require substantial financial investments. Here, we aim to present measures for PHC investments and project the associated resource needs. Methods This modelling study analysed data from 67 low-income and middle-income countries (LMICs). Recognising the variation in PHC services among countries, we propose three measures for PHC, with different scope for included interventions and system strengthening. Measure 1 is centred on public health interventions and outpatient care; measure 2 adds general inpatient care; and measure 3 further adds cross-sectoral activities. Cost components included in each measure were based on the Declaration of Astana, informed by work delineating PHC within health accounts, and finalised through an expert and country validation meeting. We extracted the subset of PHC costs for each measure from WHO's Sustainable Development Goal (SDG) price tag for the 67 LMICs, and projected the associated health impact. Estimates of financial resource need, health workforce, and outpatient visits are presented as PHC investment guide posts for LMICs. Findings An estimated additional US$200–328 billion per year is required for the various measures of PHC from 2020 to 2030. For measure 1, an additional $32 is needed per capita across the countries. Needs are greatest in low-income countries where PHC spending per capita needs to increase from $25 to $65. Overall health workforces would need to increase from 5·6 workers per 1000 population to 6·7 per 1000 population, delivering an average of 5·9 outpatient visits per capita per year. Increasing coverage of PHC interventions would avert an estimated 60·1 million deaths and increase average life expectancy by 3·7 years. By 2030, these incremental PHC costs would be about 3·3% of projected gross domestic product (GDP; median 1·7%, range 0·1–20·2). In a business-as-usual financing scenario, 25 of 67 countries will have funding gaps in 2030. If funding for PHC was increased by 1–2% of GDP across all countries, as few as 16 countries would see a funding gap by 2030. Interpretation The resources required to strengthen PHC vary across countries, depending on demographic trends, disease burden, and health system capacity. The proposed PHC investment guide posts advance discussions around the budgetary implications of strengthening PHC, including relevant system investment needs and achievable health outcomes. Preliminary findings suggest that low-income and lower-middle-income countries would need to at least double current spending on PHC to strengthen their systems and universally provide essential PHC services. Investing in PHC will bring substantial health benefits and build human capital. At country level, PHC interventions need to be explicitly identified, and plans should be made for how to most appropriately reorient the health system towards PHC as a key lever towards achieving UHC and the health-related SDGs. Funding The Bill & Melinda Gates Foundation.

Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3.

A new Global Investment Framework for Women's and Children's Health demonstrates how investment in women's and children's health will secure high health, social, and economic returns. We costed health systems strengthening and six investment packages for: maternal and newborn health, child health, immunisation, family planning, HIV/AIDS, and malaria. Nutrition is a cross-cutting theme. We then used simulation modelling to estimate the health and socioeconomic returns of these investments. Increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits. These returns include greater gross domestic product (GDP) growth through improved productivity, and prevention of the needless deaths of 147 million children, 32 million stillbirths, and 5 million women by 2035. These gains could be achieved by an additional investment of $30 billion per year, equivalent to a 2% increase above current spending.

BACKGROUND: Treatment of childhood pneumonia is a key priority in low-income countries, with substantial resource implications. WHO revised their guidelines for the management of childhood pneumonia in 2013. We estimated and compared the resource requirements, total direct medical cost and cost-effectiveness of childhood pneumonia management in 74 countries with high burden of child mortality (Countdown countries) using the 2005 and 2013 revised WHO guidelines.METHODS: We constructed a cost model using a bottom up approach to estimate the cost of childhood pneumonia management using the 2005 and 2013 WHO guidelines from a public provider perspective in 74 Countdown countries. The cost of pneumonia treatment was estimated, by country, for year 2013, including costs of medicines and service delivery at three different management levels. We also assessed country-specific lives saved and disability adjusted life years (DALYs) averted due to pneumonia treated in children aged below five years. The cost-effectiveness of pneumonia treatment was estimated in terms of cost per DALY averted by fully implementing WHO treatment guidelines relative to no treatment intervention for pneumonia.RESULTS: Achieving full treatment coverage with the 2005 WHO guidelines was estimated to cost US$ 2.9 (1.9-4.2) billion compared to an estimated US$ 1.8 (0.8-3.0) billion for the revised 2013 WHO guidelines in these countries. Pneumonia management in young children following WHO treatment guidelines could save up to 39.8 million DALYs compared to a zero coverage scenario in the year 2013 in the 74 Countdown countries. The median cost-effectiveness ratio per DALY averted in 74 countries was substantially lower for the 2013 guidelines: US$ 26.6 (interquartile range IQR: 17.7-45.9) vs US$ 38.3 (IQR: US$ 26.2-86.9) per DALY averted for the 2005 guideline respectively.CONCLUSIONS: Child pneumonia management as detailed in standard WHO guidelines is a very cost-effective intervention. Implementation of the 2013 WHO guidelines is expected to result in a 39.5% reduction in treatment costs compared to the 2005 guidelines which could save up to US$ 1.16 (0.68-1.23) billion in the 74 Countdown countries, with potential savings greatest in low HIV burden countries which can implement effective community case management of pneumonia.

Summary Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.

The continuum of care for reproductive, maternal, newborn, and child health (RMNCH) addresses three key dimensions of service delivery across time, space, and type of care (Kerber and others 2007): Access to needed services throughout the life cycle, including adolescence, pregnancy, childbirth, the postnatal period, and childhood Access to interventions with functional linkages among levels of care in the health system provided by families and communities, outpatient and outreach services, and health facilities Access to different types of health services and activities, including prevention, promotion, and curative and palliative care (World Health Assembly 2009). Assessing the returns on investments in the continuum of care for RMNCH requires specification of a package of interventions and an estimate of the full costs incurred in the health system to deliver those interventions. On the benefits side, the outcome of the continuum of care is evidenced in the many dimensions of the health benefits arising from an integrated care program. These benefits are not only lives saved; they also include the improved health and welfare of mothers and children, and the benefits that arise from expanding the ability of women to plan their pregnancies. These diverse health gains will have a wide range of economic and social benefits. Thus, assessing the returns on investment in the continuum of care for RMNCH also requires a comprehensive attempt to measure the various benefits that accrue to communities, at different stages of the life-cycle, as a result of the interventions. The overall analysis compares costs and benefits, taking into consideration their varying patterns over time, to generate benefit-cost ratios and rates of return on investment.This chapter assesses the costs and benefits of delivering a set of integrated RMNCH interventions across the continuum of care in countries with high child and maternal mortality. The purpose is twofold: To demonstrate that very high returns can be achieved by strengthening investments in the delivery of a suite of high-impact interventions To underscore the importance of an accurate assessment of those returns, including the full range of costs involved in delivering integrated care across the continuum and the full range of benefits that flow from the interventions. This chapter is based on the first attempt, to our knowledge, to undertake such a comprehensive analysis of the returns on investment in the continuum of care for RMNCH (Stenberg and others 2014).

OBJECTIVE: To cross-validate the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. METHODS: After the main cost categories for each country were identified, validation questionnaires were sent to 32 countries with high child mortality. Publicly available estimates for disease incidence, intervention coverage, prices and resources for individual-level and programme-level activities were validated against local data. Nine updates to the 2007 WHO model were generated using revised assumptions. Finally, estimates were extrapolated to 75 countries and combined with cost estimates for immunization and malaria programmes and for programmes for the prevention of mother-to-child transmission of the human immunodeficiency virus (HIV). FINDINGS: Twenty-six countries responded. Adjustments were largest for system- and programme-level data and smallest for patient data. Country-level validation caused a 53% increase in original cost estimates (i.e. 9 billion 2004 United States dollars [US$]) for 26 countries owing to revised system and programme assumptions, especially surrounding community health worker costs. The additional effect of updated population figures was small; updated epidemiologic figures increased costs by US$ 4 billion (+15%). New unit prices in the 26 countries that provided data increased estimates by US$ 4.3 billion (+16%). Extrapolation to 75 countries increased the original price estimate by US$ 33 billion (+80%) for 2010-2015. CONCLUSION: Country-level validation had a significant effect on the cost estimate. Price adaptations and programme-related assumptions contributed substantially. An additional 74 billion US$ 2005 (representing a 12% increase in total health expenditure) would be needed between 2010 and 2015. Given resource constraints, countries will need to prioritize health activities within their national resource envelope.

To do resource and cost projections for the entire Cambodian health sector using the OneHealth tool, during the development of the third national health strategic plan 2016-2020.Through a consultative process, the health ministry estimated the needed and available resources to implement the strategic plan. The health ministry used the OneHealth Tool to estimate costs of expanding public sector service provision and compared these to estimates of projected available financing. Cost estimates covered implementation of health programmes including commodities and programme management costs, and six cross-cutting health system strengthening components. The tool is populated with local demographic, epidemiological, programmatic and unit cost data. We present costs in constant 2015 United States dollars (US$).We estimated the five-year cost of the strategic plan to be US$ 2973.8 million. Costs are split between health systems strengthening components (US$ 1516.3 million) and investments in individual disease or public health programmes (US$ 1457.5 million). Health programmes for maternal and neonatal health (US$ 367 million), child health and immunization (US$ 197 million) and noncommunicable disease (US$ 157 million) have the highest costs. Although projected resource needs increase over time, a financial space analysis with ambitious projected increases in government funding indicates that government and donor funding jointly could be sufficient to cover the cost of the strategic plan from 2018 to 2020.The results both informed development of the strategic plan, and contributed to the evidence base for improved budgeting, resource mobilization strategies and stronger overall public sector financial planning.Effectuer des projections des ressources et des coûts pour l'ensemble du secteur de la santé au Cambodge à l'aide de l'outil OneHealth, dans le cadre de l'élaboration du troisième plan stratégique national de santé 2016-2020.Par le biais d'un processus consultatif, le ministère de la Santé a estimé les ressources nécessaires et disponibles pour mettre en œuvre le plan stratégique. Le ministère de la Santé a utilisé l'outil OneHealth pour estimer les coûts liés au développement de la fourniture de services du secteur public, puis comparé ces coûts aux estimations du financement disponible prévu. Les estimations de coûts couvraient la mise en œuvre de programmes de santé, et notamment les coûts des produits de base et de gestion des programmes, et six composantes transversales du renforcement du système de santé. L'outil est alimenté par des données locales relatives à la démographie, à l'épidémiologie, aux programmes et au coût unitaire. Nous présentons les coûts en dollars des États-Unis constants de 2015.Selon nos estimations, le coût pour cinq ans du plan stratégique s'élève à 2973.8 millions de dollars des États-Unis. Les coûts sont divisés entre les composantes du renforcement des systèmes de santé (1516.3 millions de dollars des États-Unis) et les investissements dans différentes maladies ou des programmes de santé publique (1457.5 millions de dollars des États-Unis). Les programmes pour la santé de la mère et du nouveau-né (367 millions de dollars des États-Unis), la santé et la vaccination des enfants (197 millions de dollars des États-Unis) et les maladies non transmissibles (157 millions de dollars des États-Unis) représentent les coûts les plus élevés. Bien que les besoins projetés en ressources augmentent avec le temps, une analyse financière incluant des hausses prévues ambitieuses du financement gouvernemental indique que, pris ensemble, le financement gouvernemental et le financement des donateurs pourraient suffire à couvrir le coût du plan stratégique de 2018 à 2020.Les résultats ont servi de base à l'élaboration du plan stratégique et enrichi le corpus de données pour une meilleure budgétisation, des stratégies de mobilisation de ressources et un renforcement de la planification financière du secteur public général.Realizar estimaciones de recursos y costes del sector de la salud de Camboya utilizando la herramienta OneHealth, durante el desarrollo del tercer plan estratégico nacional de salud 2016-2020.A través de un proceso de consulta, el Ministerio de Salud estimó los recursos necesarios y disponibles para implementar el plan estratégico. El Ministerio de Salud utilizó la Herramienta OneHealth para estimar los costes de la ampliación de la prestación de servicios del sector público y los comparó con las estimaciones de la financiación prevista disponible. Las estimaciones de costes abarcaron la implementación de programas de salud, incluidos los gastos de gestión de productos básicos y programas, y seis componentes transversales de consolidación del sistema de salud. La herramienta cuenta con datos demográficos, epidemiológicos, programáticos y de costes unitarios locales. Presentamos los costes en dólares estadounidenses constantes de 2015 (USD).Calculamos que el coste a cinco años del plan estratégico sería de 2973.8 millones de USD. Los costes se dividen entre los componentes de consolidación de los sistemas de salud (1516.3 millones de USD) y las inversiones en enfermedades específicas o en programas de salud pública (1457.5 millones de USD). Los programas de salud para la salud materna y neonatal (367 millones de USD), la salud e inmunización infantil (197 millones de USD) y las enfermedades no transmisibles (157 millones de USD) suponen los costes más altos. Aunque las necesidades de recursos estimados aumentan con el tiempo, un análisis de espacio financiero con aumentos ambiciosos previstos en la financiación del gobierno, indica que el financiamiento del gobierno y de los donantes en conjunto podría ser suficiente para cubrir el coste del plan estratégico de 2018 a 2020.Los resultados informaron sobre el desarrollo del plan estratégico y contribuyeron a la base empírica para un mejor presupuesto, estrategias de movilización de recursos y una planificación financiera general más sólida del sector público.وضع تقديرات للموارد والتكاليف لقطاع الصحة في كمبوديا بالكامل، وذلك باستخدام أداة OneHealth، أثناء وضع الخطة الاستراتيجية الوطنية الثالثة للصحة خلال الفترة من 2016 إلى 2020.من خلال عملية تشاورية، قدرت وزارة الصحة الموارد اللازمة والمتاحة لتنفيذ الخطة الاستراتيجية. استخدمت وزارة الصحة أداة OneHealth لتقدير تكاليف التوسع في توفير خدمات القطاع العام، ومقارنتها بتقديرات التمويل المتاح المتوقع. وغطت تقديرات التكاليف تنفيذ البرامج الصحية بما في ذلك تكاليف السلع وتكاليف إدارة البرنامج، وستة مكونات شاملة لتعزيز النظام الصحي. يتم تغذية الأداة بالبيانات الديموغرافية المحلية، والبيانات الخاصة بالأوبئة، والبيانات البرمجية وتكاليف الوحدات. نحن نقدم التكاليف بالقيمة الثابتة لدولار الولايات المتحدة الأمريكية لعام 2015 (الدولار الأمريكي).كان تقديرنا لتكلفة الخطة الاستراتيجية لمدة خمس سنوات بقيمة تبلغ 2973.8 مليون دولار أمريكي. يتم تقسيم التكاليف بين مكونات تعزيز الأنظمة الصحية (1516.3 مليون دولار أمريكي)، والاستثمارات في البرامج الفردية للأمراض أو برامج الصحة العامة (1457.5 مليون دولار أمريكي). وكانت البرامج الصحية للأمهات والأطفال حديثي الولادة (367 مليون دولار أمريكي)، وصحة الأطفال وعمليات التمنيع (197 مليون دولار أمريكي)، وتكاليف الأمراض غير المعدية (157 مليون دولار أمريكي)، هي الأعلى من حيث التكاليف. على الرغم من أن الاحتياجات المتوقعة من الموارد تتزايد مع مرور الوقت، فإن التحليل المالي للوضع الاستراتيجي وتقييم الإجراءات، إلى جانب الزيادات المتوقعة الطموحة في التمويل الحكومي، تشير جميعها إلى أن التمويل من الحكومة والجهات المانحة معاً يمكن أن يكون كافياً لتغطية تكلفة الخطة الاستراتيجية من عام 2018 إلى عام 2020.كشفت النتائج عن تطوير في الخطة الاستراتيجية، كما ساهمت في قاعدة الأدلة على تحسين الميزانية، واستراتيجيات تعبئة الموارد، وكذلك التخطيط المالي الأقوى بشكل إجمالي للقطاع العام.在 2016 至 2020 年第三个国家健康战略规划发展期间，通过使用同一健康 (OneHealth) 方法为整个柬埔寨卫生部门进行资源和成本预测。.通过协商过程，卫生部估算了实施该战略规划的必需和可用资源。卫生部使用同一健康 (OneHealth) 方法估算了扩大公共部门服务供应的成本并与预计可用财政预算进行比较。成本预算覆盖健康规划的实施，包括商品和规划管理成本以及六个交叉的健康系统强化组成部分。该工具多用于当地人口统计学、流行病学、程序和单位成本数据。我们以固定的 2015 年美元 (US$) 来展示成本费用。.我们估算实施五年战略规划的成本为 2973.8亿美元。成本分为健康系统强化组成部分（1516.3亿美元）以及个人疾病或公共健康规划投资（1457.5亿美元）。针对孕产妇和新生儿健康（367 亿美元）、儿童健康和免疫接种（197 亿美元）和非传染性疾病（1.57 亿美元）的健康规划成本最高。尽管预计所需资源会随着时间的推移不断增加，但一项对政府资金投入充满雄心壮志的预算增加财务空间分析表明，政府和捐助者的共同资金能够充分覆盖 2018 至 2020 年间的战略规划成本。.以上结果均通报了该战略规划的发展，并为改进预算、资源调动战略和更强大的整体公共部门财务规划提供了证据基础。.Составить прогнозы ресурсов и расходов для всего сектора здравоохранения Камбоджи, используя инструмент OneHealth, в ходе разработки третьего национального стратегического плана в области здравоохранения на 2016–2020 годы.В ходе совещания Министерство здравоохранения провело оценку необходимых и доступных ресурсов для реализации стратегического плана. Министерство здравоохранения использовало инструмент OneHealth для оценки расходов на расширение предоставления услуг в государственном секторе и сравнило их с оценками прогнозируемого финансирования. Оценка расходов охватывала реализацию программ в области здравоохранения, включая расходы на товары и услуги коммерческого характера и руководство программами, а также шесть межотраслевых компонентов укрепления системы здравоохранения. Инструмент учитывает местные демографические и эпидемиологические данные, расходы на реализацию программ, а также удельные расходы. Величина расходов представлена в постоянных ценах 2015 года в долларах США (долл. США).Авторы подсчитали, что величина расходов на реализацию стратегического плана, рассчитанную на 5 лет, составит 2973.8 млн долл. США. Расходы распределены между компонентами укрепления систем здравоохранения (1516.3 млн долл. США) и инвестициями в программы по борьбе с отдельными заболеваниями или программы в области общественного здравоохранения (1457.5 млн долл. США). Наибольшие расходы связаны с программами по охране здоровья матерей и новорожденных (367 млн долл. США), охране здоровья детей и иммунизации (197 млн долл. США) и борьбе с неинфекционными заболеваниями (157 млн долл. США). Хотя прогнозируемые потребности в ресурсах с течением времени возрастают, анализ финансового пространства со значительным плановым увеличением государственного финансирования показывает, что совместного государственного и спонсорского финансирования может быть достаточно для покрытия расходов на реализацию стратегического плана с 2018 по 2020 год.Полученные результаты послужили основой для разработки стратегического плана и способствовали созданию доказательной базы для совершенствования составления бюджета, стратегий мобилизации ресурсов и укрепления финансового планирования в государственном секторе.

BackgroundIn order to achieve Millennium Development Goals 4, 5 and 6, it is essential to address adolescents' health.ObjectiveTo estimate the additional resources required to scale up adolescent friendly health service interventions with the objective to reduce mortality and morbidity among individuals aged 10 to 19 years in 74 low- and middle- income countries.MethodsA costing model was developed to estimate the financial resources needed to scale-up delivery of a set of interventions including contraception, maternity care, management of sexually transmitted infections, HIV testing and counseling, safe abortion services, HIV harm reduction, HIV care and treatment and care of injuries due to intimate partner physical and sexual violence. Financial costs were estimated for each intervention, country and year using a bottom-up ingredients approach, defining costs at different levels of delivery (i.e., community, health centre, and hospital level). Programme activity costs to improve quality of care were also estimated, including activities undertaken at national-, district- and facility level in order to improve adolescents' use of health services (i.e., to render health services adolescent friendly).ResultsCosts of achieving universal coverage are estimated at an additional US$ 15.41 billion for the period 2011-2015, increasing from US$ 1.86 billion in 2011 to US$ 4,31 billion in 2015. This corresponds to approximately US$ 1.02 per adolescent in 2011, increasing to 4.70 in 2015. On average, for all 74 countries, an annual additional expenditure per capita ranging from of US$ 0.38 in 2011 to US$ 0.82 in 2015, would be required to support the scale-up of key adolescent friendly health services.ConclusionThe estimated costs show a substantial investment gap and are indicative of the additional investments required to scale up health service delivery to adolescents towards universal coverage by 2015.

Low and middle income countries are faced with a range of challenges related to providing efficient and affordable health care. With non-communicable diseases (NCD) on the rise, there is a growing need to be able to estimate resource requirements, costs and expected impact associated with various investment strategies related to prevention and control of NCD. In this article, recently developed costing and health impact models for non-communicable disease are reviewed, with a view to drawing out their main findings as well as methodological limitations. A key shortcoming is that earlier modelling efforts have taken a vertical approach to costing, when in reality a more integrated, horizontal approach is needed in order to effectively plan for scaled-up investment and system development. We subsequently describe how the integration of an NCD module into the joint United Nations OneHealth tool will enable low- and middle-income countries to bring NCD into an integrated process for national strategic health planning.

As the deadline for the millennium development goals approaches, it has become clear that the goals linked to maternal and newborn health are the least likely to be achieved by 2015. It is therefore critical to ensure that all possible data, tools and methods are fully exploited to help address this gap. Among the methods that are under-used, mapping has always represented a powerful way to ‘tell the story’ of a health problem in an easily understood way. In addition to this, the advanced analytical methods and models now being embedded into Geographic Information Systems allow a more in-depth analysis of the causes behind adverse maternal and newborn health (MNH) outcomes. This paper examines the current state of the art in mapping the geography of MNH as a starting point to unleashing the potential of these under-used approaches. Using a rapid literature review and the description of the work currently in progress, this paper allows the identification of methods in use and describes a framework for methodological approaches to inform improved decision-making. The paper is aimed at health metrics and geography of health specialists, the MNH community, as well as policy-makers in developing countries and international donor agencies.