Costing the implementation of public health interventions in resource-limited settings: a conceptual framework

Background Failing to account for the resources required to successfully implement public health interventions can lead to an underestimation of costs and budget impact, optimistic cost-effectiveness estimates, and ultimately a disconnect between published evidence and public health decision-making....

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Vydáno v:Implementation science : IS Ročník 15; číslo 1; s. 86 - 8
Hlavní autoři: Sohn, Hojoon, Tucker, Austin, Ferguson, Olivia, Gomes, Isabella, Dowdy, David
Médium: Journal Article
Jazyk:angličtina
Vydáno: London BioMed Central 29.09.2020
BioMed Central Ltd
Springer Nature B.V
BMC
Témata:
Adaptation
Analysis
Case studies
Commentary
Cost analysis
Costs of implementation
Decision making
Diagnostic tests
Economic evaluation
Estimates
Health Administration
Health care costs
Health Informatics
Health Policy
Health Promotion and Disease Prevention
Health Services Research
HIV
Human immunodeficiency virus
Implementation strategies
Intervention
Medicine
Medicine & Public Health
NGOs
Nongovernmental organizations
Product life cycle
Public Health
Sustainability
Tuberculosis
Costs of implementation
Decision-making
Implementation strategies
Tuberculosis
Economic evaluation
ISSN:1748-5908, 1748-5908
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Shrnutí:Background Failing to account for the resources required to successfully implement public health interventions can lead to an underestimation of costs and budget impact, optimistic cost-effectiveness estimates, and ultimately a disconnect between published evidence and public health decision-making. Methods We developed a conceptual framework for assessing implementation costs. We illustrate the use of this framework with case studies involving interventions for tuberculosis and HIV/AIDS in resource-limited settings. Results Costs of implementing public health interventions may be conceptualized as occurring across three phases: design, initiation, and maintenance. In the design phase, activities include developing intervention components and establishing necessary infrastructure (e.g., technology, standard operating procedures). Initiation phase activities include training, initiation of supply chains and quality assurance procedures, and installation of equipment. Implementation costs in the maintenance phase include ongoing technical support, monitoring and evaluation, and troubleshooting unexpected obstacles. Within each phase, implementation costs can be incurred at the site of delivery (“site-specific” costs) or more centrally (“above-service” or “central” costs). For interventions evaluated in the context of research studies, implementation costs should be classified as programmatic, research-related, or shared research/program costs. Purely research-related costs are often excluded from analysis of programmatic implementation. Conclusions In evaluating public health interventions in resource-limited settings, accounting for implementation costs enables more realistic estimates of budget impact and cost-effectiveness and provides important insights into program feasibility, scale-up, and sustainability. Assessment of implementation costs should be planned prospectively and performed in a standardized manner to ensure generalizability.
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ISSN:1748-5908
1748-5908
DOI:10.1186/s13012-020-01047-2