Costing mhealth Strategies: Total Cost Ownership Model

Transcription

1 Costing mhealth Strategies: Total Cost Ownership Model December 11, 2013 Youngji Jo Doctoral Student Johns Hopkins Bloomberg School of Public Health & JHU Global mhealth Initiative Scholar

2 Outline Costing for mhealth Total Cost Ownership (TCO) Model Case study : Dimagi-Save the Children-IHAT Assessment: TCO as a costing tool for mhealth evaluation Looking forward

3 Why mhealth Costing Analysis? Health Programs Increasing Demand VS. Scarce Resources Cost benefit analysis as guidance of decision making mhealth Programs Increasing interest and investment VS. Little existing evidence, few economic evaluations Any guidance or tools? mhealth costing strategies aim to build an evidence base through country case studies and economic studies and provide a preliminary framework of research questions to pursue in evaluating the economic benefits of mhealth.

4 Cost matters from various points of view mhealth impact evaluation? Academy Developers Cost for protocol/prototype/pilot development NGOs Setting up vs. Incurrent cost? Efficiency gained while scale-up? Donors COST Government Cost savings? Scale-up cost estimation? Cost for lives saved? Cost-effectiveness analysis? Private Sectors Buy-in cost? Break-even point? Return of Investment?

5 Total Cost Ownership Model Research question/program goal: How much cost occur to implement the program? Cost estimation Cost structure Cost type Cost item Cost forecasting Cost saving Source of financing Development stages Fixed costs vs Variable costs Categorization Reference case Comparison group Total Cost Ownership Model As a measurement and evaluation framework in mhealth costing strategies

6 TCO Conceptual Framework: Dimagi-Save the Children-IHAT

7 Total Cost Ownership Model Template Introduction Deployment Maintenance Cost item Organization Unit price Fixed cost Quantit y Total cost Unit price Fixed cost Quantit y Variable cost Unite price Quantit y Total cost Unit price Fixed cost Quantit y Variable cost Unit price Quanti ty Total cost Assump tion Grad Total mhealth Dimagi Health Infor mation Syste Dimagi ms Personals IHAT Training activities IHAT Supplies IHAT M&E Transportati on Incentive program Save the Chil dren IHAT IHAT Facilities Governmant Marketing Partnership Save the Chil dren Save the Chil dren Grand Total (Note: This template is a simplified version)

8 How to use TCO model 1. Identify key ingredients Operational model/scope: Geographical areas; Population coverage; Institutional setting; Organizational structure; Numbers/types of workers; Time period Cost : Itemizing costs investigating each costs analyzing the costs Outcome: Geographical/institutional setting, # of CHWs/services, coverage of beneficiaries 2. Build assumptions Ratio CHW vs. Managers and a time point of its change Payment cycle (e.g. server maintenance fee, telecommunication bills, electricity charge) Service bundling 3. Develop scenarios Cost saving (before vs. after, compared to another program) Cost sharing through partnership Cost forecasting: Scale up (replication, expansion, integration)

9 Dimagi-Save the Children-India Health Action Trust (IHAT) IHAT Dimagi Save the Children Development (Protocoldevelopment) 1 month Prototype (3 ASHAs: Testing) 2 weeks Pilot (10 ASHAs) Customization 6 months Deployment (70 ASHAs) Training 5 months Maintenance (70 ASHAs) Follow-up 3 months 2011 June 2012 September CommCare (Open Source Platform) 70 ASHAs Mothers & Children Community Supporting Tool = A Job Aid for ASHAs 5 PHCs in Silora/Kishangarh Blocks in Rajasthan State in India, (120 villages and 319,543 population)

10 Findings : Deployment and Pilot stages take the first and second highest costs across the development stages Training and Human Resources are the major cost drivers in each development stages

11 Findings : Key determinants of total costs are : 1) Health domain; 2) Development stage; 3) Partnership structure ; and 4) Specialized incentive programs Particular characteristics and context of the project - Local government covers ASHAs salary - NOKIA s CSR for mobile phone - Free Commcare basic application

12 Cost-relevant Evidences and Strategies I. Cost saving scenario : Standardization If Dimagi would develop CommCare standard packages, up to 51% of total set up costs or 24% of total cost can be saved. (Assumption: introduction costs) II Cost sharing scenario : Partnership If a Rajasthan State Government would incorporate the mhealth training to the existing public training modules, 37% of total cost can be saved. (Assumption: partnership) III. Cost forecasting scenario : Scale up If the same program is scaled up in an entire Ajmer district, approximately $254,000 total costs would be required. (Assumption: ratio of # of beneficiaries/population in a catchment area)

13 Assessment: TCO as a costing tool for mhealth evaluation Deliverables Total cost Average costs (e.g. Cost/CHW, Cost/Child who received an intervention) Cost structure/profile/trend Cost saving strategies A set of baseline reference Contributions Matrix platform: transparent, systematic, and validated approaches Generalizable approach across various mhealth programs Quantifiable evidence based claims Considerations Various stakeholders: data collection process Historical approach : lack of available data mhealth attributions : inclusion vs. exclusion Benefits : greater negotiation power at larger scale, standardization, network effect Constraints : hidden costs, political uncertainties, external factor etc.

14 Looking forward Methodological considerations for cost comparison and forecasting mhealth Benefit Matrix for value demonstration? Efficiency: Compress process time through one-time registration Economy: Reduce (resources and administration) costs compared to paper based systems Impact : Increase number of lives saved through increasing coverage of an intervention more rapidly and greatly Quality : Deliver complete packages to target population in a timely way through Helpline call or SMS reminder services Equity: Promote universal coverage through increase access to health services in rural areas By considering and quantifying the full range of financial costs and benefits, a method like TCO can provide useful data for informed decision making on investments in mhealth.

15 Acknowledgements Dr. Garrett Mehl, World Health Organization Dr. Alain Labrique, Johns Hopkins University Bloomberg School of Public Health Dr. Neal Lesh and Mr. Matt Theis, Mr. Carter Power, Ms. Mohini Bhavsar, Dimagi Mr. Prabhat Kumar, Save the Children Dr. Priyamvada Singh and Mr. Devki Nandan, India Health Action Trust (IHAT) Dr. Subodh Kandamuthan, Administrative Staff College of India (ASCI) Funding kindly provided by the UN IWG mhealth catalytic grant mechanism through the World Health Organization Department of Reproductive Health and Research and the mhealth Alliance.

16 References Jeannine Lemaire. Scaling Up Mobile Health Elements Necessary For the Successful Scale Up of mhealth in Developing Countries. December Julian Schweitzer and Christina Synowiec, The Economics of ehealth and mhealth, Journal of Health Communication, Johns and Tan Torress. Costs of scaling up health interventions: a systematic review Health Policy and Planning Neil S. Fleming et al. The Financial And Nonfinancial Costs Of Implementing Electronic Health Records In Primary Care Practices Health Affairs, 30, no.3 (2011): Wang SJ et al. A cost-benefit analysis of electronic medical records in primary care, American Journal of Medicine, April The 4th Common Review Mission of the National Rural Health Mission: Report from Rajasthan, ution/221.pdf

17 Thank you! Youngji Jo