A Financing Strategy to Expand Surgical Health Care

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FIGURE 1
Steps of the Surgical Health Care Financing Strategy
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FIGURE 2
Stakeholder Analysis and Mapping^a
^aAdapted from Mendelow.⁶¹
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FIGURE 3
Aligning the Surgical Health Care Financing Strategy With the NSOAP Process
Abbreviation: NSOAP, national surgical, obstetric, and anesthesia plan.

TABLE 1.

Comparative Costing of NSOAPs in Low- and Middle-Income Countries^a

Country	ImplementationTime, Years	NSOAP TotalCost, US$	Current Health ExpenditurePer Capita, US$	NSOAP Cost/YearPer Capita, US$
Zambia	5	314 million	1509.80	3.62
Tanzania	7	597 million	936.33	1.51
Rwanda	6	69 million	748.39	0.94
Nigeria	5	16 billion	1968.56	17.12

Abbreviations: NSOAP, national surgical, obstetric, and anesthesia plan; US$, U.S. dollars.
↵^aAdapted from Jumbam et al.³¹

TABLE 2.

Indicators to Formulate a Surgical Health Care Investment Case

Components of an Investment Case	Indicators	Potential Data Sources
Cost	All costed activities needed to deliver the proposed reform to improve surgical health care	NSOAP
Health systems	Percentage of population with 2-hour access to timely SOA care SOA providers per 100,000 population Hospital bed density ICU bed density	MOH World Bank WHO Primary data collection Research studies
Impact	Life expectancy Maternal mortality Mortality of children aged younger than 5 years Post-cesarean section mortality rate Post-operative mortality rate Percentage of population at risk of catastrophic expenditure Percentage of population at risk of impoverishing expenditure from SOA health care	MOH Hospital registries World Bank Data World Development Indicators
Broader government goals and spillover effects	Promote economic growth Reduce inequality and poverty Promote social cohesion Attain universal health coverage Achieve regional geopolitical dominance Promote national glory Reduce fossil fuel dependence	Country statistical office Country development plan UNDP WHO World Bank IMF

Abbreviations: ICU, intensive care unit; IMF, International Monetary Fund; MOH, Ministry of Health; NSOAP, national surgical, obstetric, and anesthesia plan; SOA, surgical, obstetric, and anesthesia; UNDP, United Nations Development Programme; WHO, World Health Organization.

TABLE 3.

Fiscal Space Metrics

Fiscal Space	Measurement
Macroeconomic conditions	Projected economic growth Tax collection capabilities Level of inflation (consumer price index) Unemployment rate Balance of payments Debt: gross domestic product ratio Government taxes on externalities influencing population health
Reprioritization of government budget	Health budget as proportion of total government budget Annualized rate of change in health budget
Reprioritization of health sector–specific resources to cost-effective interventions	Health disparities by region and income level Population coverage with primary health care services
Efficiency in the application of existing health resources	Control of corruption index Health outcomes for health spending per capita Surgical volume of 1,000 per 100,000 population
External funding sources	Development assistance for health: total health expenditure ratio Development assistance for health: government health expenditure ratio
Innovative financing	Innovative financing: total health expenditure ratio Innovative financing: government health expenditure ratio