Unit cost repositories for health program planning and evaluation: a report on research in practice with lessons learned

Abstract

Background: Most low- and middle-income countries have limited access to cost data that meets the needs of health policy-makers and researchers in health intervention areas including HIV, tuberculosis, and immunization. Unit cost repositories (UCRs)-searchable databases that systematically codify evidence from costing studies-have been developed to reduce the effort required to access and use existing costing information. These repositories serve as public resources and standard references, which can improve the consistency and quality of resource needs projections used for strategic planning and resource mobilization. UCRs also enable analysis of cost determinants and more informed imputation of missing cost data. This report examines our experiences developing and using seven UCRs (two global, five country-level) for cost projection and research purposes.

Discussion: We identify advances, challenges, enablers, and lessons learned that might inform future work related to UCRs. Our lessons learned include: (1) UCRs do not replace the need for costing expertise; (2) tradeoffs are required between the degree of data complexity and the useability of the UCR; (3) streamlining data extraction makes populating the UCR with new data easier; (4) immediate reporting and planning needs often drive stakeholder interest in cost data; (5) developing and maintaining UCRs requires dedicated staff time; (6) matching decision-maker needs with appropriate cost data can be challenging; (7) UCRs must have data quality control systems; (8) data in UCRs can become obsolete; and (9) there is often a time lag between the identification of a cost and its inclusion in UCRs.

Conclusions: UCRs have the potential to be a valuable public good if kept up-to-date with active quality control and adequate support available to end-users. Global UCR collaboration networks and greater control by local stakeholders over global UCRs may increase active, sustained use of global repositories and yield higher quality results for strategic planning and resource mobilization.

Keywords: Costs; Developing countries; Health financing; Knowledge; Resource allocation.

Fig. 1

Core steps followed by UCRs and potential innovations for improved usability and sustainability. In this diagram, the boxes describe current actions and attributes for global UCRs (in blue) and for country-specific UCRs (in green). The box in orange describes potential innovations that could apply to global and country-specific UCRs. Source: The maps included in this figure are taken from the GHCC’s Unit Cost Study Repository (https://ghcosting.org/pages/data/ucsr/app/, version 6.0, updated September 30, 2021). Darker shading within the maps indicates a higher quantity of unit cost estimates included in the GHCC’s Unit Cost Study Repository. Permission to reproduce these maps in this report was granted by Avenir Health