Costing Methodology
The PhilPACT costing tool was developed to estimate the financing requirements of the medium-term TB control strategy. The costing tool is aligned to the PhilPACT planning horizon and computes the associated annual costs for all activities listed under the eight strategies of PhilPACT. To encompass the breadth of the PhilPACT planning horizon, annual costs are estimated for the period 2010 to 2016.
In addition to the estimation of financing requirements, the costing tool also allows for the incorporation of identified funding commitments from the following stakeholders: national government (NG), local government units (LGUs), foreign assisted projects (FAPs), PhilHealth (PHIC), and out-of-pocket expenses (OOP). Available information on financing commitments however provides less detail compared to estimates of financing requirements; consequently more aggregated estimates of financing commitments are presented in the costing tool. The incorporation of financing commitments allows for the subsequent estimation of potential funding gaps.
To enhance alignment with financial tools on TB care expenditures particularly those employed by international organizations, the costing tool draws heavily from the WHO costing templates for national TB control programs. This is evident in the costing tool’s use of cost structures similar to the budgeting tool developed by WHO for NTPs in other countries.
This alignment also encompasses the consistency of the costing tool with cost estimates employed by the DOH, partner organizations like the Global Fund and WHO. The alignment is assured through the incorporation of cost parameters from DOH planning documents in the costing tool.
The cost calculations involve computing cost per activity given the item list per activity and the associated unit cost, e.g., unit cost of meetings multiplied by number of meetings per L GU multiplied by number of LGUs. The phasing of
activities also follows the timeline specified in the planning matrix, e.g., number of warehouses to be upgraded increases or decreases depending on the phasing of warehouse upgrading.
The unit cost parameters used in the calculations were obtained from the following sources: national government agency reports, FAPS records, project data, and key informants. They were agreed upon by the TF members for standardization. To simplify calculations, financing requirements are cast in 2010 prices.
Aside from unit costs, estimates of the prospective number of TB patients were derived from TB incidence parameters which were derived from WHO and NTP reports.
To obtain estimates of financing commitments in the costing model, information from DOH budget documents, RCC, and other FAPS documents were reviewed. Since the identification of potential financing at the activity level is not always possible for future periods, aggregate financing commitments are estimated at the strategy level.
The costing tool thus incorporates financing commitments per strategy for each year of PhilPACT.
The funding gap is computed as financing requirements less financing commitments. This is done per strategy and aggregated across all eight strategies and for all years of PhilPACT planning.
Summary of Financing Requirements and Funding Gaps
The total financing requirement for PhilPACT implementation is PhP23 billion. The breakdown by strategy and year is shown in Table 5.
TABLE 5: PhilPACT Financing Requirements by Strategy and Year in Philippine Pesos
Strategy 2010 2011 2012 2013 2014 2015 2016 Total
1.Localize TB control program
implementation 244,339,691 228,658,174 235,045,176 181,940,003 179,654,329 62,681,057 58,613,557 1,190,931,988 2.Monitor health
system
performance 65,392,583 111,323,271 11,828,600 14,811,600 52,060,000 2,060,000 12,060,000 269,536,054 3.Engage both
public and private TB care
providers 458,167,126 462,142,900 433,152,517 384,588,984 387,497,597 376,161,909 372,526,909 2,874,237,942 4.Promote and
strengthen positive behavior
of communities 415,087,013 485,016,758 523,858,854 471,234,466 461,965,200 397,437,030 278,030,340 3,032,629,660 5.Address MDR-TB,
TB/HIV, and needs of vulnerable
populations 1,237,744,018 1,633,756,763 1,343,670,417 1,389,579,293 1,511,543,932 1,465,978,706 1,112,225,280 9,694,498,410 6.Regulate and
make available quality TB diagnostic
tests and drugs 734,399,721 535,597,718 677,869,266 609,091,917 771,401,868 569,982,025 712,545,745 4,610,888,260 7.Certify and
accredit TB
care providers 53,860,644 77,050,144 71,652,580 68,689,083 62,843,483 50,643,483 51,676,483 438,415,897 8.Secure adequate
funding and improve allocation and efficiency of
fund utilization 22,446,000 127,201,000 136,737,000 146,978,500 157,478,500 165,922,000 165,911,000 922,674,000
TOTAL 3,231,436,796 3,660,746,728 3,433,814,410 3,266,913,845 3,584,444,908 3,090,866,211 2,763,589,315 23,031,812,212
Annual costs vary from PhP3.2 billion in 2010 to PhP2.7 billion in 2016. Frontloading of activities occurs mostly during the first two years.
Strategy 5 and strategy 6 account for most of the financing requirements at around 62% of the total.
FIGURE 6
Distribution of Estimated PhilPACT Cost by Major Strategy
The national government accounts for the lion’s share of prospective PhilPACT funding (38 %), followed by FAPs (33%) and LGUs (14%). Projected out-of-pocket expenditures for TB-DOTS, however, remains significant at 14% due to the payments to private providers as well as the transportation costs incurred.
FIGURE 7
Share of PhilPACT Financing by Stakeholder/Source
Despite known commitments by FAPS and expected national government funding, funding gaps are expected to persist due to out-of-pocket expenditures and programmed LGU expenditures that have yet to be secured. The funding gap is expected to increase in 2015 due to the end of Global Fund support. The total funding gap is estimated to be PhP6.9 billion. The earlier discussion on strategy 8 presents steps to address the situation.
FIGURE 5
Estimated Annual Financing Requirements of PhilPACT from 2010-2015 in Philippine Pesos
Implementing Arrangements
The following principles will guide the effective and efficient implementation and monitoring of PhilPACT:
There should be unified and coordinated management of TB control efforts in the Philippines with clear descriptions of the roles and relationships of implementing structures.
Existing structures are maximized and implementing arrangements must ensure efficiency and prevent duplication.
Linkages with the Health Sector Reform implementing arrangements should be made.
The importance of support of key stakeholders, both public and private, including the LGUs who are the main implementers of TB control under a
decentralized system, must be recognized.
The implementing arrangement is described below.
National Level
The Department of Health, through the National Center for Disease Prevention and Control, will be responsible and accountable for the implementation of PhilPACT. It shall ensure that activities of various stakeholders are consistent with PhilPACT. NCDPC will be supported by the NCC
based on the expanded National Coordinating Committee for PPMD that was created under AO No. 154 s. 2004, which includes some provisions of the CUP. It will coordinate with the Sectoral Management Committee that is responsible for the overall development, monitoring, and coordination of policies, mechanisms, and guidelines for the health sector.
The functions of the NCC are:
oversee the implementation of PhilPACT,
ensure that plan is disseminated to various stakeholders,
review and approve the annual operational plan of PhilPACT,
monitor plan implementation,
assist in mobilizing resources, and
discuss and resolve strategic issues.
The NCC will also have technical advisers consisting of both local and international experts who will be non-voting members. The Infectious Disease Office of NCDPC will be the secretariat of the NCC.
To assist the NCC for PhilPACT in the organizational and technical preparations, a Technical Working Group will be created. This shall be headed by the NTP Manager with members coming from DOH agencies as well as private and other public partners. The NTP will function as secretariat of the TWG.
FIGURE 8
Estimated Funding Gap, 2010-2016 (in Million Pesos)
COMPOSITION
Chairperson Director IV, NCDPC Alternate
Chairperson Director III, NCDPC-IDO Co-Chairperson Director, Health Sector,
Social Development Committee, NEDA Vice Chairperson President, Philippine
Coalition Against TB (PHILCAT)
MEMBERS
National TB Program Manager- DOH Senior Vice-President, Health Finance Policy Sector, PhilHealth
Hospital Representative
League of provinces of the Philippines League of Cities of the Philippines NGO Representative
Health Policy Development and Planning Bureau
Regional level
The Center for Health Development, led by the CHD Director, in coordination with the Regional Development Council (RDC) and the Regional Implementation and Coordination Team, will be the main regional implementing body for PhilPACT. It will be supported by the Regional Coordinating Committee that will be organized based on the expanded Regional Coordinating Committee for PPMD that was created by AO No. 154 s. 2004 as well. It will be chaired by the CHD Director, co-chaired by the Regional Social Development Committee of NEDA and its members will be composed of representatives from CUP agencies, PhilHealth, private sector, local TB coalition, NGOs, and the regional TB Program Coordinator. The regional TB team will be the technical secretariat.
Provincial/HUC level
The provincial/city health officer, under the governor/city mayor, will be responsible for the
overall implementation of the PhilPACT in the province or city. S /he will be supported by a multisectoral body that is composed of representatives from other government agencies, private sector including the NGOs, people’s organization/civil society, and TB patients. The province will have an option of selecting a PP coordinating body that is best suited for its situation and needs. It can be any of the existing functional coordinating bodies:
provincial health board;
provincial CUP;
provincial coordinating committee being established jointly with PhilCAT; and
local implementation and coordination team (LICT), a body that coordinates health sector reforms in the province/city.
Municipality
The Municipal Health Officer of the Rural Health Unit, under the municipal mayor, will be responsible for PhilPACT implementation in the municipality. S/
he will be supported by the municipal health board that will also mobilize participation from the private sector. The DOTS facilities including RHUs/HCs, PPMDs, and TB laboratories will be the service delivery points for PhilPACT.
Barangay
The barangay health station will provide TB services to the communities to be supported by the barangay health workers and in some areas by the Barangay TB Task Force or any community/faith-based organizations.