Methodology and assumptions used to estimate the cost of scaling up selected child health interventions
Author(s): World Health Organization
Publication date: 2005
Number of pages: 84
The World Health Report 2005 presents the incremental expenditures required to scale up selected child health interventions in 75 countries with 94.2% of the global burden of under-five mortality in year 1992. This paper reports on the methodology and assumptions used to derive these financial cost estimates, incremental to current investments. The costs of delivering selected interventions and services were estimated annually over the period 2006-2015 and per country, based on an ingredients approach. They reflect a continuum of care throughout the health system, with investments at the levels of the community, primary health care facility, and first referral care facility, as well as national policy and legislation. Costs were estimated for 16 priority interventions, selected based on their feasibility of implementation and ability to reduce child mortality and morbidity.
The sum of the additional costs for implementing the scaling-up scenarios is estimated to be US$ 52.4 billion. We estimate the need in 2006 to be US$ 2.2 billion, increasing to US$ 7.8 billion by 2015. Of the total, US$ 25.1 billion (48%) are costs for delivering services, most of which is wages and honorariums. US$20.4 billion (39%) are the estimated costs for drugs, supplies and lab tests, whereas the remaining US$7 billion (13%) are programme and health systems costs. Sub-Saharan Africa (WHO's African region) accounts for 42% of all under-five deaths globally. In this cost estimate, 40 countries from this region were included, together accounting for 32% of estimated costs. WHO's South East Asian region accounts for 29% of global under-five mortality, and here the 6 countries included in the costing contribute to 28% of costs. WHO's Eastern Mediterranean region is estimated to have contributed to 13% of under-five deaths in year 2002/2003: here the 9 countries included from the EMRO region account for 13% of costs. Latin America and the Caribbean account for 4% of under-five mortality and the 8 countries included give rise to 12% of costs. WHO's Western Pacific Region accounts for another 10% of child mortality and 12% of costs (7 countries included). Finally, WHO's European region contributes to 3% of under-five deaths and the five countries included in the costing account for 4% of costs.
On average for all 75 countries an annual additional expenditure per capita ranging from of US$ 0.47 in 2006 to US$ 1.48 in 2015, is required to sustain the scale-up. A comparison of the required incremental cost per country with the current general government health expenditure (GGHE), reveals that the estimated costs required are equivalent to an average increase in general government health expenditure by 8% in 2006, and by 26% in 2015, over current levels. In the group of countries with the weakest health systems, this would correspond to almost a doubling of average general government expenditure on health in 2015, for scaling up child health interventions alone. Although a substantial proportion of the funds required can be mobilized from within countries themselves, for the low-income countries there is a need for continued external financial assistance in order to scale up provision of essential health services.