Scaling Up Child Survival Interventions in Cambodia: The Cost of National Programme Resource Needs
The purpose of this study was to develop estimates of the cost of the scaled-up scorecard interventions. Based on the action plans developed by the programmes, the interventions would require resources costing $79.9 million from 2007 through 2010 to achieve the targeted coverage levels. This cost estimate reflects the activities and commodities identified by the national programmes for the scaled-up scorecard interventions, and represents the total cost of implementing all the necessary activities for maintaining current coverage and for increasing coverage. The costs are spread fairly evenly over the four years, ranging from $19.0 million to $20.8 million per year. Costs include national programme activities for all interventions, commodities for all interventions, and service delivery staffing costs for some interventions. The estimates exclude most of the costs of daily service delivery activities carried out at community level and at health facilities, including salaries of health workers and operating costs such as transport, utilities and repairs. The reason for excluding the operational costs from this study is that plans were not sufficiently developed to assess delivery costs. Moreover, costing the service delivery will require further work at district and facility levels to determine credible assumptions for projecting resource availability and need.
For the interventions that directly address the top three causes of child mortality listed above, the skilled birth attendance intervention aimed at reducing neonatal mortality could not be costed, the pneumonia treatment intervention would require $11.1 million and the ORT intervention would require $13.8 million. It should be noted that costs should not be compared across interventions as they do not include all service delivery costs and because the coverage targets are different.
The total of $79.9 million includes $38.4 million (48%) for commodities, with the highest components being ITNs ($10.2 million), dengue vector spray materials ($8.5 million) and ORT supplies ($7.2 million). The balance of $41.5 million (52%) reflects the cost of activities identified by the national programmes to support implementation (e.g., IEC, surveillance and capacity building), and, in some cases, costs to support service delivery (equipment, salaries, transport and per diems).
Of the total estimated cost of $79.9 million, $62.0 million is for intervention-specific activities (activities that are exclusively identified as relevant for the child survival scorecard interventions). The balance of $17.9 million represents a scorecard interventions’ portion of the cost of shared activities which was estimated at $37.0 million in total. If the remainder of these shared costs ($19.1 million) is not sufficiently funded under non-scorecard interventions, then the scorecard interventions will have to bear a larger burden of the shared costs - or they may not be successfully implemented.
Clearly, assumptions used in the costing on how to allocate shared costs affect the results presented here. For example, the cost of the ITN intervention is high partly because the full cost of providing households with nets has been allocated to the child survival scorecard intervention on the assumption that a full set of nets must be provided to a family to ensure that the under-5 children are protected. Similarly the cost of the dengue vector control intervention is high partly because the total cost of all the spraying has been allocated to the scorecard intervention on the assumption that a full spraying programme has to be carried out in order to protect the under-5 children.
The results of this report should be regarded as preliminary for the following reasons:
Further work is needed on some of the programme action plans including reviewing activities
and targets and analyzing for constraints, feasibility and possible cost-savings.
The estimate of $79.9 million excludes the cost of the skilled birth attendance intervention,
which is directed at the neonatal problems that are the leading cause of child mortality in Cambodia today. This missing component needs to be incorporated in order to arrive at a cost estimate for all 12 interventions.
The study excludes most of the costs of daily service delivery activities carried out at community level and at health facilities, as well as activities related to overall strengthening of the service delivery system. Once operational plans for delivery options have been identified, a follow-up study is recommended to assess the human resource requirements and associated costs as well as the need for other delivery inputs such as transport. For some interventions, the scaling up will require significant increases in health service delivery and health promotion activities at community and health centre level. Costs associated with the service delivery platform are essential in order to reach the intended scorecard coverage levels.