Boston University School of Public Health, Boston, MA, USA.
UNICEF, New York, NY, USA.
Glob Health Sci Pract. 2023 Oct 30;11(5). doi: 10.9745/GHSP-D-22-00472.
Ensuring access to a package of integrated primary health care services is essential for achieving universal health coverage. In many countries, community health programs are necessary for primary health care service provision, but they are generally underfunded, and countries often lack the necessary evidence on costs and resource requirements. We conducted prospective cost analyses of community health programs in 6 countries in sub-Saharan Africa using the Community Health Planning and Costing Tool.
The Community Health Planning and Costing Tool is a spreadsheet-based tool designed to cost key programmatic elements of community health services packages, including training, equipment, incentives, supervision, and management. In each country, stakeholders defined a package of community health services and corresponding standard treatment guidelines to estimate normative costs, which were applied to program scale-up targets. The data were entered into the tool, and cost models were prepared for different geographical and service utilization scenarios. The results were reviewed and validated with the governments, implementing partners, and expert panels. Additional scale-up scenarios were modeled, taking into account probable constraints to increasing community health service provision and potential funding limitations.
The services and scope of community health service packages varied by country, depending on contextual factors and determined health priorities. The package costs also varied significantly depending on the size and contents of the service package, the service delivery approach, the remuneration of the community health workers, and the cost of medicines and supplies.
Community health programs and service packages are different in every country and change over time as they evolve. They should be routinely costed as an integral part of the planning and budgeting process and to ensure that sufficient resources are allocated for their effective and efficient implementation.
确保获得一整套综合初级卫生保健服务对于实现全民健康覆盖至关重要。在许多国家，社区卫生方案对于提供初级卫生保健服务是必要的，但这些方案往往资金不足，而且各国通常缺乏有关成本和资源需求的必要证据。我们使用社区卫生规划和成本核算工具对撒哈拉以南非洲 6 个国家的社区卫生方案进行了前瞻性成本分析。
社区卫生规划和成本核算工具是一个基于电子表格的工具，旨在对社区卫生服务包的关键方案要素进行成本核算，包括培训、设备、激励、监督和管理。在每个国家，利益攸关方都确定了一整套社区卫生服务和相应的标准治疗指南，以估算规范成本，并将其应用于方案扩大目标。将数据输入该工具，并针对不同的地理和服务利用情况制定成本模型。结果与政府、执行伙伴和专家小组进行了审查和验证。还对额外的扩大规模情况进行了建模，考虑到增加社区卫生服务提供可能存在的限制因素和潜在的资金限制。
社区卫生服务包的服务和范围因国家而异，取决于具体情况和确定的卫生重点。套餐成本也因服务包的规模和内容、服务提供方法、社区卫生工作者的薪酬以及药品和用品的成本而异。
社区卫生方案和服务包在每个国家都不同，随着时间的推移会发生变化，因为它们在不断发展。它们应作为规划和预算编制过程的一个组成部分，定期进行成本核算，以确保为其有效和高效实施分配足够的资源。
