Linking%20Resource%20Needs%20and%20Strategic%20Planning

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Linking Resource Needs and Strategic Planning

• Dominic S. Haazen
• Lead Health Policy Specialist
• The World Bank
• ASAP A Service of UNAIDS

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Why is such a linkage important?

• To ensure that the interventions included in the
  strategic plan are realistic and affordable
• To provide vital information to those managing
  and monitoring implementation of the strategy
• Expected vs. actual program coverage
• Physical resources needed vs. obtained
• Monetary resources needed vs. available

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When are resource needs estimated?

• Estimating resource needs happens at different
  points in the process
• In theory, prioritization should precede the
  estimation of resource needs and the finalization
  of the strategy
• In reality, planning, prioritizing and resource
  estimation are interrelated and often done as
  iterative processes (initial estimates may show
  that too many actions have been prioritized
  relative to the available funds, that coverage
  levels are not feasible, or physical resources
  are no available)

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Process resource needs estimation
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Reviewing two approaches to estimating resource
needs in Swaziland

• Approach 1
• National Strategic Plan
• Activity-based costing
• Small team
• External consultants
• Standardised costs
• Accounting exercise

• Approach 2
• Annual Action Plan
• Participatory
• Large team
• Wide stakeholder involvement
• Costs estimated by implementers

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Approach 1 Activity-Based Costing

• Approach based on
• The Second National Multisectoral HIV and AIDS
  Strategic Plan 2006 2008
• National Program of Action
• Urgent and Priority Agenda
• Dimensions
• 4 components
• 104 sub-thematic areas
• 910 individual actions
• 215 actions in urgent and priority agenda document

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This Approach Included

• Priority setting exercise
• To reduce number of items to be costed
• Based on gut feel that entire plan was not
  affordable/feasible
• Identification and quantification of
• the target groups
• Detailed costing activity
• beginning with the highest priority activities
  (per ratings)
• also included Urgent and Priority Agenda
  activities

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Priority Setting Methodology

• 3 factors (applied at sub-thematic level)
• Available Capacity for carrying out specific
  action (weight 3)
• Immediate Benefit to those at risk, OVC, PLWHA,
  others (weight 2)
• Potential for Long-term Improvement in quality of
  life of PLWHA or their families, or reduction in
  infection rates (weight 1)

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Dimensioning Process

• Similar for all resource needs estimations
• Identify target populations
• Determine number of beneficiaries by year for
  each action area and target population
• Determine timing of any capital requirements and
  number of sites

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Resource estimation process used

1. Develop a chart of accounts
2. Establish standard costs by account category
3. Develop the number of units per recipient/site
4. While costing individual action items, allow
   alternative standard costs, where appropriate
5. Complete detailed description of activities/
   assumptions to document process

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Initial Results

• All priority items including scaling up in ARV
  therapy, PMTCT, nutritional support, education,
  micro-credit, housing and water

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Swaziland Results FTEs
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Approach 2 Participatory

• 3-month process to develop Annual Action Plan
• Consultant team facilitated planning and costing
  meetings with stakeholders
• 14 different implementing agents (e.g., PLWHA
  network, NGO network, business coalition, govt)
• Planning and budgeting workshops 1-2 days each,
  depending on capacity of each implementing
  partner and scale of its operations
• Individual plans then collated into 4 sector
  plans Public, Private, Civil Society,
  Traditional
• Scrutiny, modifications and approval by national
  AIDS co-ordinating body (NERCHA)

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Prioritisation

• Conducted by national AIDS coordinating body
  (NERCHA)
• Analyzed the main drivers of the epidemic (i.e.
  the main factors influencing the spread or
  curtailment of the epidemic)
• Correlated main strategic issues in the National
  Strategic Plan with these drivers
• Identified series of primary goals and objectives
  that address the key drivers
• Result was list of 24 priority objectives to be
  tackled via 35 priority strategies

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Resource needs estimation

• Some costs standardized, but most estimates took
  the form of trend planning
• based on knowledge of costs of similar previous
  activities
• Facilitators assisted participants to generate
  simple formulae
• Total Workshop Costs of participants/facilita
  tors x number of workshop days X workshop venue
  costs per person number of participants x
  average transport cost number of facilitators
  X number of preparation and workshop days X
  facilitation fee budget for stationery and
  materials

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Experiences Lessons Learned

• Unwise to ask people to cost activities when they
  do not have capacity/relevant experience
• Capacity building needs must be addressed
• Participatory approach takes longer but may be
  better at building capacity of broader audience
• Activity-based approach has greater potential to
  pass on high-level skills
• Both approaches require staff and consultants
  with strong capacity

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Experiences Lessons Learned (2)

• Improved tools needed to support Activity-based
  approach
• Standardized costs speed up and simplify
  budgeting and can promote consistency but some
  variations are essential
• Effective prioritization and optimal planning
  require targets/constraints
• without budget or other resource limits, planning
  and resource estimation easily becomes
  wish-listing
• Resource tracking is an integral part of the
  planning, prioritization and costing process

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Overview of New Costing Model

• Need highlighted by Swaziland ( Guyana)
  experience
• Designed specifically to support the ABC approach
• Designed to complement to existing costing tools
• Incorporates key elements of existing models
• concept of target groups/coverage levels - RNM
• functional classification from NASA
• Logical menu-driven sequence of steps
• Level of detail up to the user
• e.g., major drugs, laboratory supplies, other key
  cost items
• selected activities
• or comprehensive all costs/activities

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Overview of the Model (2)

• User can do variance simulations to live within
  resource constraints
• different coverage levels,
• unit cost reductions
• financial and HR implications of task shifting
• various combinations of activities
• Allows expenditure mapping to government
  accounting framework
• Facilitates use as a budgeting and financial
  monitoring tool e.g., variance analysis
• Supports complete cycle of planning, budgeting,
  operations and evaluation

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Model supports all parts of cycle
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Who Should be Involved?
Step Type of Staff
Entering Basic Data ME, Program
Targets and Coverage Levels ME, Program, Management
Chart of Accounts/Mapping Financial
Map Strategic Plan to Functions Program
Costing Standard Interventions Financial, Program, Management
Costing Special Interventions Financial, Program, Management
Review Total Costs Management
Reporting Financial, Program
Management involvement critical to ensure
realism
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Thank you