The United Nations MDG Strategy

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UNDP RBA MDG Based National Development
Planning Workshop MDG Needs Assessments
Adapting other models Chandrika Bahadur UN
Millennium Project February 27-March 3, 2006
2
Agenda

• Review of needs assessment tools
• Adapting tools to assess MDG needs
• Country examples

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Alternative needs assessment tools

• Education for All (UNESCO)
• Cape Town model for HIV/AIDS
• Mother Baby package (WHO)
• Marginal Budgeting for Bottlenecks
  (WB/UNICEF/WHO)
• Planning frameworks developed by governments

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Education for All (UNESCO)

• Created for assessing resource needs for EFA (and
  especially Fast Track Initiative)
• Focused on all EFA goals
• Early childhood development
• Universal completion
• Appropriate learning
• Adult literacy
• Gender parity
• Quality education
• Typically used by line ministries
• Calculates annual, incremental costs covering
  both capital and recurrent expenditures

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Cape Town Model

• Developed to cost ARV treatment by estimating the
  number of people in need of antiretroviral
  therapy each year
• Required inputs
• epidemiological data
• antiretroviral drug regimens
• laboratory testing schedules
• cost of antiretroviral drugs
• cost of laboratory tests
• cost of primary care
• Tool can be adapted to countries needs, but
  requires modification
• Tool does not estimate investment needs for
  prevention or human resource development

6
WHO Mother-Baby package

• Original WHO model has been adapted for MDGs by
  UN Millennium Project (available on website)
• Detailed interventions-based costing tool for
  maternal health and antenatal care interventions
• Calculates the cost of all inputs
  (infrastructure, drugs, equipment) needed to
  reach specified coverage targets
• Part of broader set of needs assessment tools to
  support the scaling up of health systems

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Marginal Budgeting for Bottlenecks (MBB)

• MBB was developed by UNICEF and World Bank
• MBB takes an incremental approach rather than a
  goal-based approach and assesses how best to
  spend additional increases in health funding
  (based on cost-effectiveness of interventions)
• MBB calculates how much it would take to
  overcome barriers or bottlenecks to service
  delivery (in the areas of availability,
  accessibility, utilization, continuity, and
  quality)
• MBB uses three levels of service delivery
  community/family, outreach, and clinical
  care--always beginning with the lowest level of
  service

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Marginal Budgeting for Bottlenecks (MBB)

• MBB can be made to calculate the costs of
  reaching goals, but assumptions (on coverage,
  service package, etc.) have to be carefully
  reviewed
• MBB requires several weeks/months of
  on-the-ground work to estimate the costs of
  overcoming barriers

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Agenda

• Review of needs assessment tools
• Adapting tools to assess MDG needs
• Country examples

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Adapting Tools to Quantify MDG Needs

YES
Can the costing methodology be used for MDG-based
planning?

• YES

• NO

Select a new costing methodology
Are the interventions and coverage targets
ambitious enough to achieve the MDGs?

• NO

• YES

Revise the model to build in the intervention and
coverage target assumptions necessary to achieve
the MDGs

Use the costing methodology
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Making Tools MDG Consistent

• Tools that use methodologies that can be used to
  estimate MDG resource needs share common
  characteristics
• Intervention based approach
• Cost estimation done annually
• Capital and recurrent costs included
• Outcome targets explicitly specified and linked
  to input coverage targets
• Results can be compared to other sector results
  and aggregated accordingly

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Making Tools MDG Consistent (3)

• Revise assumptions to make the tools MDG
  consistent
• Ambition Ensure that long term and intermediate
  targets in line with the MDG goals
• Scope Ensure that all of the relevant sectors
  are covered in the analysis
• Rigor Base all costs on interventions based,
  outcome driven needs assessment
• Timeframe Extend the analysis to 2015
• Financing Add a consolidated financing framework
  to the tool

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Agenda

• Review of needs assessment tools
• Adapting tools to assess MDG needs
• Country examples

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Some country examples

• EFA model from Yemen
• Education sector costing from Ethiopia
• Marginal Budgeting for Bottlenecks