Costing of community health service packages--the Malawi Social Action Fund (MASAF) experience.

Introduction The Malawi Government designed a 12 year project as one of the policy instruments in achieving the Millennium Development Goals. The project is managed by the Malawi Social Action Fund (MASAF). MASAF was designed as a platform for the implementation of multi-sectoral community Driven Development (CDD) interventions in the areas have been placed in five Community Service Packages (CSP) such that community demands to meet local needs must be within these Service Packages in order to get funding from MASAF. Each of the Service Packages has elements that are meant to address specific Millennium Development Goals (MDGs) and the Malawi Growth and Development Strategy (MGDS). The five Service Packages are health, education, water and sanitation, transport and communication and household food security 1,2,3. The design of MASAF was to cost the Service Packages within the first three years so that in the subsequent nine years of implementation, the costs of the various interventions would be predetermined and thereby improve on planning and implementation of the sub projects. The costing of service packages was preceded by establishing baseline data for each of the 12 MDG indicators selected for the MASAF project as impact indicators. The objective of this costing exercise was to estimate the average costs for health service packages to estimate funding requirements to meet local authority health care needs. This paper describes the process that was followed in costing subprojects and service packages and also presents the costs of community health packages by each local authority (LA). This paper follows a previous paper 4 where baseline data for health related MDGs for each LA were reported. The results of this paper could therefore be used to estimate resource requirements that could among other behavioural changes lead to the attainment of the MDG targets at LA level 5. Methodology This study was done in the year 2005 over a six months period. The Malawi Kwacha Exchange rate was MK135 to $1. The projects used to estimate the costs had been under implementation for close to two years. The costing tool had four columns which captured the service package component/item, its unit of measure, cost of its community contribution (if applicable) and cost provided by MASAF. The total cost was then arrived at and converted in dollars. In MASAF 3, communities do preliminary costing of subprojects, which are reviewed and improved at the LA by the District Executive Committee (DEC). …