Costing Module

[sakshimohan]

This PR adds a costing module to the TLO model.

The current costing method is as follows -

[sakshimohan]

Questions:

1. Interpretation of Frac_Time_Used_By_OfficerType in the healthsystem logger. I've currently assumed that the values give the total number of staff used in the simulation.
2. Is it correct to ignore the squeeze factor because the actual capability used is costed? The same costing formula should work for modes 1 and 2.
3. How is Frac_Time_Used_By_OfficerType recorded when capabilities_coefficient > 1 --> should costs use capabilities_today?
4. The costing is currently disaggregated by Facility_Level and Officer_Type. For the calculation of intervention ICERs, we will need to calculate cost by Treatment_ID. Does the healthsystem logger capture health worker time by Treatment_ID?

[sakshimohan]

Draft figures for HR salary cost by cadre and level =-

[sakshimohan]

I have now created two categories of costs - 1. Financial Cost and 2. Economic Cost. Here is how I envison HR costs will look under the two categories -

Currently the financial cost of HR does not match well with the 2018 salary budget -

[sakshimohan]

Options for costing equipment (following Walker & Kumaranayake (2002)) -

[sakshimohan]

Updated Real versus model cost

[sakshimohan]

Human Resource costing
Is there a need to account for attrition when costing health workers?
Rationale: Because the TLO model does not model pre-service training but only the resource available at a given point in time, it is important to account for costs beyond salary in the Costing module.

Total cost of maintaining the size of the current health workforce = Salaries for current workforce + Cost of regular in-service training + Cost of replacing attrited workforce

Cost of replacing attrited workforce = Cost of pre-service training per student X (1 - % of health workforce recruited from abroad) X (1 + absorption rate of students into health worker posts) X Number of health workers attrited

Number of health workers attrited = Attrition rate X Size of current workforce

References:

1. Lopes et al (2017) - Rapid review - Overall, the total annual attrition rate varied between 3 and 44% while the voluntary annual attrition rate varied between 0.3 to 28%. In the SoWMy analysis, 49 countries provided some data on voluntary attrition rates of their SRMNH cadres. The average annual voluntary attrition rate was 6.8% across all cadres.
2. Berman et al (2022) - Reliable and complete data on health worker attrition was not available to calculate health worker outflow. Through comparison of MoH analyses, analysis conducted in Malawi and other low-income countries (LICs) which suggested attrition of 14% for nurses and 15% for doctors, and MoH and stakeholder consultation, a 7% attrition rate for the non-intervention scenario was selected [Lopes et al (2017)]. This includes 1% from retirement based on birthdate data in staff returns, 2% involuntary attrition, 3% voluntary attrition, and 1% study leave
3. Beniol et al (2022)
   

HRH Costing in the HSSP-III

• Pipeline model - The objective of a health worker training pipeline model is to estimate the number of health workers expected to be available in the future workforce based on current training, recruitment, and retention trends, and under various intervention scenarios. Practically, the model provides the pace of scale up required – at each program/training institution level – to meet national workforce targets.
  

• Pre-service training costs - infrastructure, faculty development, scholarship, equipment

Other resources -
1. High attrition among CHWs
2. Need for inter-sectoral action for health worker retention

[sakshimohan]

Current status of cost estimation:

Validation:

[sakshimohan]

Margherita's suggestion on HR costing

it would be good to have a 'timeline' of costs for each worker along the lines of what I attached, as it would allow us to estimate what the costs past/present/and future are associated with having minutes of patient-facing time from that cadre at any given time, incorporating probabilities of dropping out at any point - due to failed graduation, attrition etc.