Our Approach to Economics and Costing

Avenir Health performs a range of assessments using data for decisionmaking. This includes primary data collection and analysis, as well as secondary analysis of existing data, costing of national and decentralized health programs, analysis of markets and approximation of potential markets, and estimation of complex indicators. Results of the analyses are used by multinational organizations, international and national non-government organizations, donors, policy makers in developing countries, and individuals in a variety of public health fields.

Economics and Costing Projects

USAID’s Efficiency and Accountability Technical Assistance Project II (EATAP-II) contract provides technical assistance to support PEPFAR financial monitoring and other data processes; provides technical expertise to strengthen and streamline data use through the development of program planning and budgeting tools, analytics, and rapid data collection; and supports analytics and capacity-building activities to increase technical knowledge and strengthen use of data for efficiency and accountability, including program planning and budgeting. Analyses and tools developed support activities as varied as a tool to help design differentiated care model programs for ART; a tool to display aligned resources across PEPFAR, Global Fund, Domestic governments, and other funders in HIV; the costing module in PrEP-it, a tool for PrEP implementation planning, monitoring and evaluation; and analyses using cost, expenditure and beneficiary data for key population and general population outreach programs.

Avenir Health contributes expertise in costing, economics and financing to the USAID-funded Health Policy Plus (HP+). Team members support USG and host country governments in developing and using economic and financial data for decision making, as well as training counterparts on these topics. As part of costing and financing work under HP+, Avenir Health has completed cost and cost-effectiveness studies of male circumcision, PMTCT, and antiretroviral therapy, and analyzed resource allocation decisions for HIV funding. In Tanzania, Avenir Health assessed the costs of treatment support services, an area which has received only limited attention in terms of identifying costs. Avenir Health is currently providing senior leadership to the analysis of activity-based costing and management (ABC/M) in Tanzania, Uganda and Kenya, with plans to continue this work in Mozambique and Zambia. The project also performed capacity building activities around costing and modeling in several countries and regions, including Lesotho, Mozambique, East Africa, South Asia, Southeast Asia, West Africa, Latin America and the Caribbean.

Breakthrough RESEARCH catalyzes social and behavior change (SBC) by conducting state-of-the-art research and evaluation and promoting evidence-based solutions to improve health and development programs around the world. Under this project, Avenir Health has developed a cost study repository, SBC costing guidelines, and applied the guidelines in several settings. In addition, the project developed business cases, and underlying models, to evaluate the cost-effectiveness of family planning and malaria SBC in various countries.

Avenir Health is a partner of the Momentum Private Healthcare Delivery project, exploring variations in cost structures and cost drivers of publicly provided and privately provided MNCH/FP/RH services for the purpose of improving allocation of resources and advocating for greater integration of private providers into the wider health system. This analysis will focus on private (for profit and NGO providers) and public service providers in three countries (Bangladesh, DRC and Tanzania). By understanding the costs and cost-drivers, recommendations will be made regarding ways in which services can be offered more cost-effectively through the private sector.

Avenir Health is part of the Global Health Cost Consortium (GHCC), www.ghcosting.org, which aims to improve resources to estimate the costs of TB and HIV programs, as well as other health areas. The Center led the development of the web site and Unit Cost Study Repository, which contains detailed information on a few hundred studies containing costs for HIV, TB, Social and Behavior Change and family planning in developing countries. The web site serves as a central store of information about costing, including the original Reference Case for Estimating the Costs of Global Health Services and Interventions, a guide that helps ensure that the process of cost estimation is clearly conveyed and reflects best practices. Links to other resources, including other costing guidelines and databases of primary costing data, are also on the web site.

Avenir Health, as a partner of Project SOAR, was able to focus on a range of operational research studies focused on costing and modelling. Project SOAR performed costing and target modelling estimates of male circumcision in a range of countries, including eSwatini, Mozambique, Namibia, Kenya, Lesotho, South Africa, Tanzania, Uganda and Zimbabwe. Avenir Health costed circumcision services for both the public and the private sectors in South Africa (as well as evaluating the costs to clients), illustrating how costs vary and assessing how resources should be allocated to maximize HIV prevention. Project SOAR also assessed treatment costs in Namibia, identifying the ways in which treatment costs changed in Namibia with the introduction of “Treat All”.

Avenir Health has conducted Investment Case studies in a range of countries, including Bolivia, Costa Rica, Cote d’Ivoire, the Dominican Republic, DRC, El Salvador, Guatemala, Honduras, Kenya, Mali, Mozambique, Namibia, Nicaragua, Nigeria, Panama, Suriname, Tanzania, Togo and Uganda. Avenir Health has recently agreed to conduct five additional Investment Case studies, evaluating the costs and cost-effectiveness of alternative approaches to allocating resources. The Center also contributes to the costing portion of the UNAIDS Global Resource Needs Estimates that occurs every few years.