Costing of Health Services

MSH has developed and used several costing tools throughout Asia, Africa, and Latin America to help ministries of health, nongovernmental organizations, and donors develop financing strategies for health service delivery, advocate for future funding, and conduct cost-effectiveness analyses. Many of MSH's tools are designed to determine the cost of integrated health service packages, while others are used to cost programs for specific health areas such as such as tuberculosis, malaria, diarrhea, pneumonia, and family planning. MSH produces guidelines to accompany its tools, and users are able to adapt them for developing country contexts. When feasible, MSH can provide assistance and training to help users apply the costing tools more effectively.

  • Through a two-year investment from the Bill & Melinda Gates Foundation, MSH is developing and piloting the Primary Health Care Costing, Analysis, and Planning (PHC-CAP) Tool and approach. This open-source tool will be available as a public good and will allow users to estimate the cost of current and required resources for primary health care services and systems at the community, facility, and district levels. Designed for health program implementers, policymakers, and funders, the PHC-CAP Tool will generate much-needed evidence to support decision making for improved PHC resource mobilization and allocation and system performance in low- and middle-income countries.

  • The Community Health Planning and Costing Tool was developed with UNICEF to cost packages of community health services and produce results to help evaluate performance, plan future services, and prepare investment cases. The tool is user-friendly, open-source, and spreadsheet-based and, based on inputs provided by the user, calculates key results on the costs and required financing for the introduction, maintenance, or scale-up of community programs at the national or subnational levels.

  • MSH's Integrated Community Case Management (iCCM) Costing and Financing Tool estimates the cost of introducing or scaling up community case management services for childhood malaria, diarrhea, and pneumonia. Results are used to inform decisions on the implementation and scale-up of iCCM activities. MSH recently used the tool to develop investment cases for scaling up iCCM in Nigeria and Burkina Faso with funding from the Bill and Melinda Gates Foundation. MSH is currently adapting this tool to study the costs of scaling up family planning services in Zambia for the USAID EVIDENCE project, nutrition services in Afghanistan for Save the Children Canada, and seasonal malaria chemoprevention in the Sahel region of Africa through the UNITAID-funded ACCESS-SMC Project.


  • MSH's Cost Revenue Analysis (CORE Plus) and HOSPICAL tools are used by managers at public and private health centers and hospitals to cost health service packages. In Rwanda, MSH expanded these tools to produce diagnosis-related group costs for public and private facilities to provide a basis for the government to restructure its health provider reimbursement system under the national health insurance scheme. In Afghanistan, the Ministry of Public Health's Economics and Financing Department used the tools to assess the cost of health services and used the results to improve health facilities' performance and efficacy.

  • Through the USAID-funded TB CARE I project, MSH developed the TB Services Costing Tool, the MDR-TB Cost-Effectiveness Analysis Tool, and the TB Economic Burden Analysis Tool to help governments and NGOs develop service delivery and financing strategies and advocate for funding. In Indonesia, the government is using these tools to project the economic burden of tuberculosis and related service delivery costs.

  • MSH has also developed the Planning, Costing, and Budgeting Framework, a tool that helps governments and NGOs improve the quality of their health system plans and budgets.