Transcript Price tag

A Price Tag for Newborn
and Child Survival
Dr. Joy Lawn BM BS MRCP (Paeds) MPH
Saving Newborn Lives/Save the Children-USA
and MRC, Cape Town South Africa
and Institute of Child Health London
The Team
THE LANCET
Can the world
afford to save
6 million
children?
Child series costing
Neff Walker
Jennifer Bryce
Joy Lawn
Zulfiqar Bhutta
Saul Morris
Bob Black
Newborn series costing
Neff Walker
Joy Lawn
Simon Cousins
Zulfiqar Bhutta
Luc de Bernis
Gary Darmstadt
Combining the newborn and child costings
All the above plus Saul Morris and Gareth Jones
Outline
1. Countdown context
2. Combining The Lancet Price Tags for
newborn & child survival
3. Costs for lives saved – the bottom line
4. Comparison with other costings
5. Consequences
Countdown context
• The majority of newborn, child and maternal deaths are
preventable with existing interventions
• Some countries or some single interventions have been
successful in rapid scaling up, but overall we need to
accelerate progress
$ Accelerated progress will require investment – how much
will the essential interventions cost?
$ Donor investment in child health has increased but seems
to be most focussed on “vertical” programmes
$ What is the financial gap? Where will the money come from
for MNCH health systems and how will it get to where it is
needed most in countries? How can the poor be protected?
LIVES
Full coverage (99%) with 23 proven interventions
could reduce under-five mortality by 66%,
saving 6 million child deaths/year
COST
The Lancet Child Survival series: Key findings
Additional cost of providing these interventions is
US$ 5.1 billion annually
or $1.23 per capita
COST
LIVES
The Lancet Neonatal Survival series: Key findings
Coverage (90%) with 16 proven interventions delivered
through packages could reduce neonatal mortality by up
to 67% equivalent to 2.7 million deaths/year
Additional cost of providing these interventions is
US$ 4.1 billion annually
or $0.96 per capita
70% of the costs also benefit mothers and older children
Combining newborn and child survival costing
Methods & assumptions
Bellagio series
Countries
Interventions
Neonatal series
Countdown
combined
42
75
60
23
8 neonatal
16
7 of the 8 neonatal
in Bellagio series
32
Current
coverage
2000
2000 Updated with
Countdown data
Target
coverage
99%
90%
99%
Combined costing
Objective
To estimate the running costs at 99%
coverage for selected essential
interventions for newborn and child
health in the 60 priority countries
• Current running costs based on current
coverage (updated from Countdown report)
• Additional cost to provide these interventions
to those currently unreached
Combined costing
Methods & assumptions
• Intervention-specific cost
– Cost of commodities (ORS, antibiotics, vaccines)
– Cost of service delivery (community health worker time, staff
time and clinic's running costs, theatre time)
• Programme cost associated
– Staff and support inputs
(training, supervision, monitoring and evaluation etc)
Current
running costs
– Amortised
costs
for buildings, equipment and transport
• Incorporates the increasing costs required to reach
the unreached at higher levels of coverage based
on assumptions from the WHO CHOICE model
Does NOT include costs to
expand infrastructure (new hospitals)
produce new human resources (pre-service training of new midwives)
Integrated service delivery timetable for preventive child survival
interventions included (adaptation needed for countries)
Birth
Before
birth
Weeks
1-2
2 4 6
Approximate child age in months
9
15
21
27
33
39
45
51
Antimalarial intermittent
preventive treatment
Preventive interventions
Tetanus Toxoid
Nevirapine &
replacement feeding
Contact with trained health care worker
Birth
Neonatal
interventions*
Breastfeeding
antenatal steroids
Insecticide-treated
materials
Hib vaccine
Zinc
Water & sanitation
Complementary
feeding
Vitamin A
Measles vaccine
Includes clean delivery with skilled attendant, temperature management, antibiotics for premature rupture of
57
Lancet Neonatal Survival series
Skilled obstetric and immediate newborn care
(hygiene, warmth, breastfeeding) & resuscitation
Familycommunity
Outreach/outpatient
services
Clinical
care
Emergency obstetric care to manage
complications eg obstruction, hemorrhage
Emergency newborn care for
illness, especially sepsis
management and care of very low
birth weight babies including
Kangaroo Mother Care
Clean delivery and neonatal resuscitation
Folic
acid #
Antibiotics for preterm rupture of membranes#
Corticosteroids for preterm labour#
Neonatal sepsis treatment
Focused
4-visit antenatal
Tetanus toxoid
package
immunization
•Intermittent
tetanus immunisation,
presumptive
• management of syphilis/STIs
therapy
for
malaria
pre-eclampsia, etc
Postnatal care to support healthy
practices
Early detection and referral of
complications
Malaria intermittent
presumptive therapy*
Detection and treatment
of bacteriuria#
Counseling and preparation
for newborn care and
breastfeeding, emergency
preparedness
Pre- pregnancy
Clean delivery by
traditional birth
attendant (if no
skilled attendant is
available)
Healthy home care
including
Breastfeeding
promotion,
breastfeeding promotion, hygienic
cord/skin
care, thermal
care,
Case
management
for pneumonia
promoting demand for quality care
Extra care of low birth weight babies
Simple early
newborn care
Pregnancy
# For health systems with higher coverage and capacity
Birth
Case management for pneumonia
Neonatal period
Infancy
Combined costing results
Lives saved in the 60 countries
All under 5 child
deaths
Proportion of
deaths averted at
99% coverage
Number of lives that
could be saved in the 60
countries
67%
6.6 million
Two thirds of newborn and child deaths
are preventable with existing interventions
6.6 million lives a year
Combined costing results
Cost in 60 countries

US$ 7 billion annually in new resources
or US$ 1.62 per capita in the 60
countries

US$ 4.3 billion is already being spent

US$ 25 per child under 5 per year for
the total cost all the essential
interventions
Combined costing results
Cost in 60 countries
Sensitivity analysis was performed
by varying the following inputs:
• Coverage estimates
• Drug costs
• Community worker costs
Results in a range of
US$ 4.6 to 10.7 billion
Combined costing results
Costs by service delivery approach
Costs (US$billions) per year
4
Costs for current coverage
Costs for expanded coverage
3
2
1
0
Water & sanitation
Family & community
Outreach/outpatients
Clinical care
Combined costing results
Costs saved in treatment by preventive care
Estimated annual running costs of delivering treatment
interventions at current (2004) coverage levels, with and without
savings from expanded prevention, in millions of 2004 US$
6
Billions of 2004 US$
5
Savings: US$ 700 million
4
3
2
1
0
Without prevention effects
With prevention effects
Combined costing results
Costs saved by integrated delivery
Estimated annual cost per child life saved comparing integrated and
parallel delivery of preventive interventions in millions of 2004 US$
Millions of 2004 US$
1,500
1,406
1,051
1,000
656
414
500
0
Hib Vaccine
Exclusive Breastfeeding
Integrated
Parallel
Economical policy choices
1.
Cost-effective packages within the
continuum of care
2.
Delivery at all levels through outreach,
family-community care, and facility-based
clinical care – synergistic effect
3.
Initial focus on outreach and health
education to families and communities which
is feasible even in weak health systems and
gives economic benefits through prevention
in reducing treatment costs
Comparison with other relevant costings
World Health Report 2005 reaching MDGs 4 & 5
– Inputs:
• 75 countries with similar interventions
– Results:
• $52 billion over 10 years
• $7.8 billion per year once at coverage of 95%
• Per capita cost of $1.50
Commission for Macroeconomics and Health
– Inputs:
• Includes the cost of new infrastructure and
human resources and running costs related to
malaria, maternal and child health components of
the total CMH costing
– Results:
• $21.8 billion (14 to 25.5) out of total of $46 billion
• Specific MNCH per capita costs of $4.5
Less than 10% of what was
spent on tobacco products in
the US in 2003
Less than the annual
subsidisation of
the Japanese cow
Is US$ 7 billion/year
to save 6.6 million
children and newborns
“affordable”?
Only a little more than the US$4 billion lost to poor countries
in migrating skilled professionals
Less than 10% global
About half of the US$12 to
Overseas Development Aid
US$20 billion committed
estimated total
annually to the fight against
of US$78 billion
HIV/AIDs
Commitments…. few poor countries deliver
Tanzania
Zambia
Ethiopia
Low income countries must spend more and prioritise reaching the
poor as per Abuja target of 15% of government spending on health
Commitments…. few donor countries deliver
Donor countries must meet their commitment of 0.7% of GDP
Not just more money – spending better
and reaching the poor
Some low income countries halved their
neonatal mortality rates in the 1990s
(Sri Lanka, Nicaragua, Honduras, Peru, Indonesia)
Source: Martines J et al Lancet 2005
Costing – the future

Move to MNCH – incorporate costs for further
maternal interventions

Approaches to identify the financing gap at country
level and simplification of current tools

More long term efforts to improve the input data:

Disability outcomes (eg by preventing birth asphyxia) not
included

Coverage data for specific interventions not routinely
available

Almost no data on societal and opportunity costs
Conclusion
Commitment and leadership
• US $ 7 billion or $1.64 per capita per year would save
6.6 million babies and children and also reduce
maternal deaths
• Current spending is not enough - limited information
on resource flows suggests donor inputs for most
MNCH essential interventions is a very low proportion
• More investment is required alongside strategic,
phased planning - rapid gains can be made and many
lives saved especially by starting at community level
• The leaders of both rich and poor countries have a
responsibility to the mothers and children of the world
WHO, Rivers of life
Thank you!
Comparison with WHO cost estimates
Model
element/
Approach
Lancet
Child/ Neonatal
Survival
Combined
WHO
World
Health
Report
Running costs
Scale-up &
running costs
Countries
60
75
Interventions
32
16 “sets”
99%
95%
What is costed?
Target coverage
Delivery strategy
Some
Integrated
vertical; some
delivery timetable
combined.
Relative to
Bryce et al,
WHO estimate
is likely to be: