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Dedicated to
Dr. Duane L. Smith (1939-1992),
Dr. William B. Steeler (1948-1992)
and all other health leaders, managers and workers
who follow their example in the effort to bring quality health
care to all in need.
The Primary Health Care Management Advancement
Programme has been funded by the Aga Khan Foundation
Canada, the Commission of the European Communities,
the Aga Khan Foundation U.S.A., the Aga Khan
Foundation’s head office in Geneva, the Rockefeller Foun
dation, the Canadian International Development Agency,
Alberta Aid, and the United States Agency for Interna
tional Development under two matching grants to AKF
USA. The first of these grants was, "Strengthening the
Management, Monitoring and Evaluation of PHC Pro
grams in Selected Countries of Asia and Africa" (cooper
ative agreement no. OTR-0158-A-00-8161-00, 19881991); and the second was "Strengthening the Effective
ness, Management and Sustainability of PHC/Mother and
Child Survival Programs in Asia and Africa" (cooperative
agreement no. PCD-0158-A-00-1102-00, 1991-1994).
The development of Modules 6 and 7 was partially funded
through in-kind contributions from the Primary Health
Care Operations Research project (PRICOR) of the Center
for Human Services under its cooperative agreement with
USAID (DSPE-6920-A-00-1048-00).
This support is gratefully acknowledged. The views
and opinions expressed in the PHC MAP materials are
those of the authors and do not necessarily reflect those
of the donors.
All PHC MAP material (written and computer files) is
in the public domain and may be freely copied and
distributed to others.
in
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Contents
FOREWORD ............................................................................................................ 1
SESSION 1: INTRODUCTION AND OVERVIEW .............................. 7
Transparencies
8-1-. Workshop objectives.......................................................................... 15
8-2: Cost analysis is...................................................................................... 16
8-3: Cost analysis information ................................................................ 17
8-4: Monitoring ........................................................................................... 18
8-5: Efficiency............................................................................................... 19
8-6: Planning ............................................................................................... 20
8-7: PHC programme costs by line item ............................................. 21
SESSION 2: MAKE DECISIONS (STEPS 1, 2 AND 3)......................23
Transparencies
8-8: Session 2: Objectives.......................................................................... 29
8-9: Steps in cost analysis........................................................................ 30
8-10: Determining the scope...................................................................... 31
SESSION 3: CODE AND ALLOCATE COSTS
(STEPS 4 AND 5) ................................................................................................. 37
Transparencies
8-11: Session 3: Objectives.......................................................................... 43
8-12: Advanced features.............................................................................. 44
8-13; Cost allocation.................................................................................... 45
8-14: Units of measure for allocating costs ........................................... 46
8-15: Retrospective allocation techniques ............................................. 47
Module 8: FG; contents
SESSION 4: ENTER, ANALYSE AND REPORT DATA
(STEPS 6, 7 AND 8) .............................................................................................. 49
Transparency
8-16: Session 4: Objectives ......................................................................... 53
Module 8: FG; contents
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Foreword
What is the purpose of the Facilitator’s guide?
The Facilitator’s guide contains a suggested workshop design for use by
individuals who will help PHC managers and staff learn how to use the
Primary Health Care Management Advancement Programme (PHC MAP)
series. There is a Facilitator’s guide for each module in the PHC MAP series.
What information does it contain?
Each Facilitator’s guide contains instructions for conducting a workshop
on one of the modules in the PHC MAP series using the information
contained in the User’s guide.
The instructions are arranged in one to two hour sessions. The number
of sessions depends on the amount of information and/or the number of
steps contained in the User’s guide. The first page of each session lists
session objectives, major topic headings, time required, and materials and
equipment. The following pages describe the instructional activities in
outline form.
The outline is divided into two columns. The right-hand column
indicates what the facilitator says or does to conduct the session. The
left-hand column lists the handouts, overhead transparencies, or other
materials needed to support the activity. Copies of these materials, suitable
for duplication, appear at the end of the session in which they are first used.
Some transparencies are used in more than one session.
How are the workshops organised?
The first session of each workshop contains activities designed to
introduce the PHC MAP series and explain its importance to PHC
programmes, present an overview of the workshop, explain the purpose of
the module, review specific terms or concepts used in the module, and
Module 8: FG; foreword
2
acquaint the participants with the organisation and content of the User’s
guide.
The final session of each workshop contains activities designed to review
key points of the User’s guide, if appropriate, help participants prepare an
action plan, and brings the workshop to a formal conclusion. The sessions
in between present the steps required to accomplish the purpose of the
module and provide an opportunity for participants to apply those steps
to their own programmes.
Each workshop is designed to be given on consecutive days, uninter
rupted except for breaks, meals, and rest, if the workshop is longer than
one day. It is recognised, however, that situations vary and the PHC MAP
modules will be used singly or in combination by individuals and or
ganisations in the field and on university campuses. Therefore, it is
expected that the workshops described in the Facilitator’s guides will be
adapted to fit a range of circumstances. Indeed, those who facilitate PHC
MAP workshops are encouraged to make adaptations to meet the needs
of participants and/or specific PHC programmes.
Who can be a facilitator?
Ideally, the person who serves as facilitator has training and experience
in the fields of public health, management, planning, and evaluation, as well
as sampling and survey design. It is recommended that this person also be
skilful in working with small groups.
The facilitator should be someone from outside the PHC programme,
perhaps from another agency or a university. As a person with no direct
interest in the programme, the facilitator can be neutral in disagreements
that may arise and help the group members resolve an issue objectively.
Having an outside person as facilitator also allows the programme director,
who usually has a leadership role, to contribute his or her knowledge and
experience as a full participant in the work of the group.
It is also recommended that a facilitator have a full set of PHC MAP
User’s guides and Facilitator’s guides. It is sometimes necessary, in the
course of completing one module, to refer to information in another module.
Who should participate in the workshop?
The primary audience for the PHC MAP series is the team that manages
PHC programmes or other population-based health programmes in either
the public or private sector. An example of a PHC management team in
the public sector is the core staff of a district ranging from 100,000 to
300,000 in size of population served.
Module 8: FG; foreword
3
An example of a PHC management team in the private sector is the
core staff of an NGO that provides PHC services to a specific population
in a given geographic area. The average size of the service population may
range from 40,000 to 60,000, but may be as small as 10,000 or more than
100,000. In either case, the management team should have:
• the knowledge and skills needed to complete the steps in the module
• the time and resources required to collect and analyse the required data
• the authority to plan and implement improvements in management
systems and procedures based on this analysis.
If feasible, teams from several districts or from several PHC programmes
within a given NGO, may work simultaneously with one facilitator to
complete a module. It is recommended that one facilitator work with no
more than four teams or 20 people at one time.
What does the facilitator do?
Understands the needs of participants. If the facilitator is working
with one PHC programme, the most efficient way to gather information
about participants and the programme in which they work is to meet with
the PHC director to determine:
• the nature of the PHC programme (services provided, size and description
of area served, number and type of facilities, number and qualifications
of staff, community involvement, computer capability, strengths, major
problems, etc.)
• if information needs have been clearly identified
• previous staff training in management information systems or related
topics
• resources available for training (time, space, equipment)
• possibility for subsequent technical assistance to workshop participants.
Understands the content of Module 1. Read the User’s guide and
Facilitators guide for Module 1 and consider options for workshop delivery.
• The purpose of Module 1 is to help participants select priority information
needs and to review some basic concepts underlying management
information systems. Depending on participant background, the amount
of time available, and the need to establish priorities among management
information needs, Module 1 can be presented in its entirety, limited to
Level 1: Quick start, limited to the PHC MAP systems framework, or in
Module 8: FG; foreword
4
summary form as contained in the first session of the Facilitator’s guides
for Modules 2 through 9.
• If information needs have not been clearly identified and participants
have no background in systems, then Module 1 should be presented in
full. The selection of the next module will depend upon priorities set by
the participants as they complete the steps in Module 1.
• If information needs have been clearly identified and participants have
no background in systems, then that portion of Module 1 can be added
to the first session of the selected module.
• If information needs have been clearly identified and participants have a
background in systems, then the overview of PHC MAP in the selected
module will be sufficient.
Understands the content of the selected module. Read the User’s
guide and Facilitator’s guide for the selected module and consider options
for workshop delivery.
• Depending upon the length of the module and the availability of staff for
training, the workshop sessions may be presented as described in the
Facilitator’s guide, or workshop sessions may be delivered at intervals (for
example, every morning for a certain number of days, one session per
week, or one day per week for three or four weeks).
• If follow-on technical assistance is available, the content of the module
could be presented in the workshop and the application of the procedure
to the PHC programme could be conducted on the job.
• Participants could plan steps in the workshop, complete them on the job,
and bring the results to the next workshop session. This approach is
particularly applicable to Module 2 which requires development of a
questionnaire, selection of a survey sample, training of data collectors,
and data collection. These steps cannot actually be carried out within the
time limits of the workshop as contained in the Module 2 Facilitator’s
guide.
• Other options are possible depending upon the circumstances of each
situation.
Determines what programme information, if any, is needed for
completion of the module. For example, census data and lists of households
are required to complete some of the steps in Module 3.
Module 8: FG; foreword
5 5
5
Determines the most appropriate people to attend the workshop. For
example, Module 7 is best completed by those responsible for planning,
training, supervision, logistics, and other management services.
Discusses the delivery options and participants with the PHC manager
and make decisions regarding the most appropriate option and participant
selection. Also determines if the needed information is available and if it
is not, the alternatives for obtaining the information.
Notifies participants of the date, time, and purpose of the
workshop and confirms attendance. Initial notice of the meeting may come
from the PHC manager, with follow-up by the facilitator.
Prepares the agenda, using as a model the sample in Session 1 of the
Facilitator’s guide for the selected module.
Inspects the room where the workshop will be held and answers these
questions:
• Is the room large enough to seat all the participants?
• Can chairs and tables be arranged in a variety of ways: all participants
around one table; participants in groups of three or four at smaller tables?
• Is the lighting adequate?
• Can temperature and humidity be controlled?
• Is there an electrical outlet for an overhead projector?
• Is a microphone necessary for everyone to hear and to be heard?
• Are toilets conveniently located?
• Is the site convenient to parking, restaurants and public transportation?
• Are supporting facilities available and convenient: duplication, word
processing, computers?
Prepares notes to conduct the workshop using the session outlines in
the Facilitator’s guide for the selected module, and makes the necessary
adaptations. Refer to the appropriate User’s guide for content.
Duplicates the worksheets and other handouts as indicated in
the Facilitator’s guide and obtains the necessary equipment.
Conducts the workshop as planned.
Provides follow-on assistance, if appropriate.
Module 8: FG; foreword
7
Session 1: Introduction and overview
Objectives:
Participants will be able to:
• Define cost analysis.
• Name three ways managers can use cost
analysis.
• Explain one strength and one limitation of cost
analysis.
Session outline:
I. Introduction (30 minutes)
II. Overview of workshop (10 minutes)
III. Module 8 User’s guide (15 minutes)
IV. Cost analysis (20 minutes)
V. Limits and strengths of cost analysis (15
minutes)
Materials:
Module 8 User’s guide
Handout 8-1:
Agenda
Transparency 8-1: Workshop objective
Transparency 8-2: Cost analysis is...
Transparency 8-3: Cost analysis information
Transparency 8-4: Monitoring
Transparency 8-5: Efficiency
Transparency 8-6: Planning
Transparency 8-7: PHC programme costs by
line item
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 8: FG; session 1
8
Session 1: Introduction and overview
I. Introduction (30 minutes)
Note: Omit Section I if you have presented Mod
ule 1, or some other module, immediately prior to
the presentation of Module 8.
A. OPENING REMARKS
• Introduce self and other staff, as necessary.
• Explain your role in the workshop.
• If you do not know the participants, ask each
one to state his or her name, position title, and
job location.
Name tags
or place cards
Note: If the group is larger than 6 or 8, you may
Flip chart
• Ask each participant to complete this sen
wish to have them wear name tags or place cards
with their names at places where they are sitting.
tence: "As a result of attending this workshop,
I expect..." and write their responses on the
flip chart.
• When all responses have been recorded, say
that you will return to this list after giving an
overview of the workshop.
B. OVERVIEW OF PHC MAP
See the Module 1 User’s
guide for this information
• Explain why information is important for
PHC programmes.
• Summarise PHC MAFJ including:
Purpose of PHC MAP
Title and purpose of each module and other
materials.
• Make the following points about PHC MAP:
Has been field-tested and revised to ensure
usefulness to PHC programme staff.
Modules can be used in any sequence.
Module 8: FG; session 1
9
Session 1: Introduction and overview
Checklists and other materials can be
adapted to fit a particular situation.
The procedures outlined in the modules can
be adopted as routine monitoring activities in
a PHC programme.
• Explain why MAP is being introduced in this
PHC programme.
Note: The remarks here should be tailored to the
specific programme and should provide the an
swers to these questions:
Why are we doing this workshop?
What do we expect to achieve?
It may be appropriate for the PHC manager to
make these remarks.
II. Overview of workshop (10 minutes)
Transparency 8-1:
Workshop objective
Handout 8-1: Agenda
Review the workshop objective.
Distribute and review the workshop agenda,
describing the activities that will take place to
accomplish the workshop objectives.
Review the expectations contributed by par
ticipants at the beginning of the session.
Indicate which ones will be met and which
ones will not and why.
Suggest, if possible, alternatives for meet
ing the expectations that will not be met in
this workshop.
Ask for questions or comments.
III. Module 8 user’s guide (15 minutes)
Module 8 User’s guide
Distribute a User’s guide to each participant.
Module 8: FG, session 1
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10
Session 1: Introduction and overview
• Refer participants to the Table of contents
and point out the major sections of the User’s
guide.
Explain that the Introduction will be dis
cussed in detail in just a moment.
Explain the three levels of detail in cost
analysis:
Level 1: Basic
Level 2: Selective
Level 3: Detailed
Explain that the workshop will focus on
Level 2 and the 8 steps listed under proce
dures.
Briefly highlight the contents of Appen
dices A-F and say that they will be referred
to at appropriate points in the workshop.
Mention Appendices G and H as resources
for the participants at any time during or after
the workshop.
IV.
Cost analysis (20 minutes)
Transparency 8-2:
Cost analysis is...
• Define cost analysis as the examination of
Transparency 8-3;
Cost analysis information
• Explain the kinds of information cost analy
expenditures to determine how resources have
been spent, including analysis of revenue
sources and amounts.
sis provides.
• Discuss the ways cost analysis information
can help a manager.
Transparency 8-4:
Monitoring
Transparency 8-5:
Efficiency
Transparency 8-6
Planning
Monitoring
Efficiency
Planning
Module 8: FG; session 1
=3
Session 1: Introduction and overview
• Present examples of the types of information
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3
3
3
3
3
3
Transparency 8-7:
PHC programme costs
by line item
Module 8: FG; session 1
cost analysis can provide.
Refer participants to Table 1 and Figure 1
on page 5 in the User’s guide for two ways to
display total project costs and expenditures.
Refer participants to Table 2 and Figure 2
for a comparison of actual and budget
amounts for expenditures and revenues.
Ask participants which line item costs the
least according to the table (supplies at $332.)
Refer participants to Figure 3 on page 7
in the User’s guide and ask participants
which type of display they prefer (the table
shown on the transparency or the graph in
Figure 3).
Explain that the Module 8 User’s guide
provides computer programs to produce
graphs such as this for the cost data from
their PHC programme.
Refer participants to Table 4 and Figure 4
on page 8 in the User’s guide for a comparison
of line item costs for two subprojects.
Refer participants to Table 5 and Figure 5A
on page 9 in the User’s guide for a display of
costs by PHC service and activity.
Refer participants to Figure 5B on page 10
for displays of unit costs.
Refer participants to Table 6 and Figure 6
on page 11 for displays showing trends in costs
using data from recent years.
Ask participants which year shows the
greatest change according to the numbers in
Table 6 (1988 shows a large increase over
1987).
Ask participants which line items con
tribute to the increase (personnel, travel, and
equipment).
12
Session 1: Introduction and overview
Explain that Figure 6 displays not only
trends over time for total costs but also a
comparison of trends between total costs and
personnel costs. Similar comparisons can be
made of trends in costs of line items.
Refer participants to Table 7 on page 12 in
the User’s guide which shows a trend analysis
for revenue.
Ask participants which year showed the
greatest increase in revenue (1990).
Ask participants which sources ac
counted for greatest portion of that increase
(federal, service fees, and contributions).
Point out the graph in Figure 7 which
shows an alternate way to display the same
data.
Refer participants to Table 8 and Figure 8
on page 13 of the User’s guide for another type
of trend analysis. This type compares expen
ditures and revenue over time and displays
clearly the point at which the project breaks
even (expenditures and revenues are equal).
• Ask for questions and comments on types of
cost analysis information and display choices.
V.
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Limits and strengths of cost analysis (15 minutes)
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A. LIMITS
Discuss the difficulty of estimating time
costs.
Discuss the difficulty of allocating costs.
B. STRENGTHS
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State that even approximate data con
tribute to better decision-making.
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Module 8: FG; session 1
13
Session 1: Introduction and overview
Point out that as the tables and graphs
demonstrate, simple analysis can yield useful
information to help managers plan and moni
tor programme activities.
Remind participants of the value of finan
cial information especially at times when re
sources are shrinking, demand for services is
rising, and programmes are being pressured by
boards and donors to become self-sustaining.
• Ask participants for questions or comments
on the strengths and limits of cost analysis
based on their experience.
Module 8: FG; session 1
14
SAMPLE AGENDA
MODULE 8*
Session 1
(1 hr, 30 mins)
Introduction and
overview
Session 2
(1 hr, 30 mins)
Making decisions
(Steps 1, 2 and 3)
Session 3
(2 hrs, 15 mins)
Code and allocate
costs
(Steps 4 and 5)
Session 4
(1 hr, 35 mins)
Enter, analyse, and
report data
(Steps 6, 7 and 8)
'For an actual presentation, substitute the appropriate clock hours in the first column.
Module 8: FG; session 1; handout 8-1
15
WORKSHOP OBJECTIVE
Carry out a cost analysis using the
instructions and worksheets contained
in Module 8 Users guide
Module 8: FG; session 1; transparency 8-1
16
COST ANALYSIS IS ...
the examination of expenditures to
determine how resources have been
spent, including an analysis of revenue
sources and amounts
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Module 8: FG; session 1; transparency 8-2
17
COST ANALYSIS
INFORMATION
1. Amounts spent and received
2. Comparison of actual and budget
amounts
3. Costs by line item
4. Costs by facility or location
5. Costs by PHC service or activity
6. Average costs
7. Cost trends over time
Module 8: FG; session 1; transparency 8-3
18
MONITORING
Purposes:
• Ensure that costs are under control
• Identify problems before they become
serious
Type of analysis:
• Compare actual costs (and revenue) to
planned budget
Module 8: FG; session 1; transparency 8-4
19
EFFICIENCY
Purpose:
• Identify areas where savings can be
made or revenues increased
Type of analysis:
• Comparison by site or facility
Module 8: FG; session 1; transparency 8-5
20
Purposes:
• Estimate budget needed to support
programme in the future: at the same
level, at an expanded level, at a reduced
level
• Estimate budget to replicate the
programme at another site
Types of analysis:
• Projection of future costs
• Average costs
Module 8: FG; session 1; transparency 8-6
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PLANNING
21
PHC PROGRAMME
COSTS BY LINE ITEM
Line Item
Personnel
Cost
Percent
of
Total Cost
2,345.00
49.9%
Travel
345.00
7.3%
Equipment
456.00
9.7%
Supplies
332.00
7.1%
Other direct costs
876.00
18.6%
Indirect costs
345.00
7.3%
Total costs
$4,699.00
100.0%
Session 2: Make decisions (Steps 1, 2
and 3)
Objectives:
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Participants will be able to:
• Specify objectives for a cost analysis.
• Decide what to cost.
• Select appropriate tables and graphs.
Session outline:
I. Introduction (10 minutes)
II. Specify cost analysis objectives (30 minutes)
III. Decide what to cost (25 minutes)
IV. Select tables and graphs (20 minutes)
V. Summary (5 minutes)
Materials:
Module 8 User’s guide
Transparency 8-8: Session 2: Objectives
Transparency 8-9: Steps in cost analysis
Transparency 8-10: Determining the scope
Handout 8-2:
Worksheet for specifying
objectives
Handout 8-3:
Worksheet for deciding
what to cost
Handout 8-4:
Worksheet for selecting
types of cost analysis
Handout 8-5;
Worksheet for selecting
tables and graphs needed
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
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Module 8: FG; session 2
24
Session 2: Make decisions (Steps 1, 2 and 3)
I.
Introduction (10 minutes)
Transparency 8-8;
Session 2 Objectives
Transparency 8-9:
Steps in cost analysis
• Review session objectives.
• Review the eight steps in cost analysis.
Explain that the first three steps are the
manager’s responsibility and the decisions
made in these steps establish the scope of the
data collection system.
Explain that the remaining five steps are
carried out by the finance staff.
Explain that although responsibility is
divided among the eight steps, it is important
for the manager to understand the capabilities
of the finance staff and it is important for the
finance staff to understand what the manager
wants to know. By consulting with each other
throughout the entire process, better decisions
will be made and better data collected more
efficiently.
• Say that this session covers the first three
steps.
II.
Specify cost analysis objectives (Step 1) (30 minutes)
Handout 8-2: Worksheet
for specifying objectives
• Distribute the worksheet and direct partic-
ipants’ attention to the three major headings.
The user/audience refers to the people who
will see the results of the cost analysis and use
the information to make decisions that affect
the programme.
The purpose refers to how the information
will be used. Each user may have more than
one purpose and several users may share a
common purpose. A manager may be wise to
consult with potential users at this stage to be
sure the purposes of all users are considered.
Module 8: FG; session 2
25
Session 2: Make decisions (Steps 1, 2 and 3)
Note: Show transparencies 8-4, 8-5, and 8-6 from
Session 1, if necessary, to reuiew monitoring, effi
ciency, and planning.
The scope refers to how broad the cost
analysis will be.
• Review the considerations that influence
decisions on scope.
• Write an example of a cost analysis objective
on the flip chart, for example: A one month
prospective analysis of cost and expenditures
will be carried out for all health and manage
ment services in the area served by the PHC
programme to enable the manager to prepare
an operating budget for the coming fiscal year.
Note: This may be prepared ahead of time.
• Ask participants to prepare another sample
objective which includes the user, the purpose,
and the appropriate elements listed under
scope.
• Direct participants to complete the work
sheet for their programme and then write an
objective for each user.
• Participants work on worksheet and objec
tives for 15 minutes.
Note: Depending on the size and composition of
the group, arrange participants in groups of 4-6.
All participants in a group should be from the
same programme.
• Lead participants in a review of their work.
Ask a person from each group to describe
their choices regarding scope and to explain
the rationale for those choices.
Invite questions and comments from other
participants.
Module 8: FG; session 2
26
Session 2: Make decisions (Steps 1, 2 and 3)
Ask a second person from each group to
read one objective.
Invite questions and comments from other
participants.
III.
Decide what to cost (Step 2) (25 minutes)
Handout 8-3: Worksheet
for deciding what to cost
• Distribute the worksheet and review the
three levels of detail.
Level 1 is the simplest as most PHC pro
grammes keep track of costs by line item as
in the examples on page 22 in the User’s guide.
If a programme has more than one project
or site, the manager may want a separate
analysis for each. This is called Level 2. An
example of Level 2 is shown on page 23.
Level 3 cost analysis can provide informa
tion for each of the health services and man
agement services a PHC programme provides.
Possibilities are shown on page 24.
• Direct participants to complete the work
sheet by listing all the general ledger items
they currently account for in Level 1, all pro
gramme projects in sites in Level 2 and all
health and management services in Level 3.
• Inform participants that this is a preliminary
list and they will have an opportunity to re
consider what they want to cost after complet
ing Step 5.
Module 8: FG; session 2
27
Session 2: Make decisions (Steps 1, 2 and 3)
IV. Select tables and graphs (Step 3) (20 minutes)
Handout 8-4- Worksheet
for selecting types of cost
analysis
• Distribute the worksheet and explain that
this is similar to the list that appears on page
28 of the User’s guide except the items on this
list are sequenced according to the level of
detail of the data that is collected.
A manager who selects Level 1 can obtain
four types of analysis with the cost data he
collects.
A manager who selects Level 2 can obtain
five types of analysis.
A manager who selects Level 3 can obtain
all seven types.
• Direct participants to check all seven types
for now. After completing Step 5 and review
ing the level of detail for collecting cost data,
this list may change.
Handout 8-5: Worksheet
for specifying tables and
graphs needed
• Distribute the worksheet and explain that
this is a checklist of the tables that can be
prepared for the various levels of detail of cost
data.
The six basic tables are designated by a
number and letter (1A, 2B, etc.)
The six basic tables can be modified by
changing labels and headings to serve a num
ber of purposes.
The modifications are designated by number
and explained in the notes at the bottom of
the worksheet.
• Refer participants to Table IB in Appendix D
to illustrate how tables can be modified.
Table IB as it appears in Appendix D dis
plays Level 1 data: total revenues and expen
ditures over five years.
Module 8: FG; session 2
Session 2: Make decisions (Steps 1, 2 and 3)
The same table can be used to display Level
2 data by changing the heading to "Total
revenues and costs by location" and changing
the column labels to the names of the loca
tions.
Refer participants to page 29 in the User’s
guide for another example of how a basic table
can be adapted by changing the title and
labels.
If a programme has the capability to use the
computer programs for data entry and analy
sis that accompany this module, then the data
can be displayed in graphs as well as tables.
• Invite questions and comments.
• Direct participants to study the graphs in
Appendix D and check the tables they will
need consistent with the level of detail of data
collection and the objectives of the cost analy
sis.
V. Summary (5 minutes)
• Point out that participants have completed
the first three steps in the cost analysis proce
dure: specify objectives, decide what to cost,
and select tables.
• Explain that the remaining steps that begin
with Step 4 in the next session are carried out
by the finance staff based on decisions made
in Steps 1-3.
Module 8: FG; session 2
29
SESSION 2: OBJECTIVES
• Specify cost analysis objectives
• Decide what to cost
• Select tables and graphs
Module 8: FG; session 2; transparency 8-8
30
STEPS IN COST ANALYSIS
<
1. Specify the objectives
gp
9L-
2. Decide what to cost
3. Select type(s) of tables and graphs
4. Set up a coding system
8P
lie
E
5. Code income (revenue) and expense
(cost) data
6. Enter data and compute costs
7. Analyse and interpret data
8. Report findings
Module 8: FG; session 2; transparency 8-9
gr
B--
EE'
ft
r
it
31
DETERMINING THE SCOPE
• Country, region, city, rural site?
Multiple sites?
• Total programme, project, service
component?
• Past or future? 6 months, 1 year, 3
years?
• Analyse existing data (retrospective)?
• Analyse future data (prospective)?
© Costs? Revenue? Both?
Module 8: FG; session 2; transparency 8-10
32
WORKSHEET FOR SPECIFYING
OBJECTIVES
ft
User/Audience
Manager
Board of directors
Central directorate
____Donors
S-
Other:
gt
Purpose
Monitoring
r:
Be
.St
St
Efficiency
Planning
Other:
Scope
£
Be
Geographic area
Programme/project/activity
Time/duration
Prospective or retrospective
it
Expenditures and/or revenue
St
Module 8: FG; session 2; handout 8-2
St
33
WORKSHEET FOR DECIDING WHAT
TO COST
Level 1:
PHC programme (total costs)
Level 1: General ledger items
Level 2: Projects, subprojects, locations, sites, etc.
Level 3: PHC service components or management components
Module 8: FG; session 2; handout 8-3
34
WORKSHEET FOR SELECTING
TYPE(S) OF COST ANALYSIS
1. Total amount of resources spent and
received (LI)
2. Revenue and expenditures compared
with budget (LI)
3. Distribution of revenue and costs by
line item (LI)
4. Trends in revenue and costs over time
(LI)
5. Distribution of costs by location or
facility (L2)
6. Distribution of revenue and costs by
PHC service or activity (L3)
7. Average costs (unit costs) (L3)
Module 8: FG. session 2; handout 8-4
35
‘-si
3
WORKSHEET FOR SPECIFYING
TABLES AND GRAPHS NEEDED
3
3
3
Tables
Single
Multiple
period
periods
(Trends)
Level 1 Tables : Analysis by general ledger item
___ 1. The total amount of resources spent and revenues received
1A
___ 2. Total revenues & expendilures compared with budgets 2A
___ 3. Distribution of costs & revenues by general ledger line item
3A
3B
4A1
___ 4. GLI revenues & expenditures compared with budgets 4A
3
3)
3
3
3
1B
2B
Level 2 Tables : Analysis by PHC location or facility
___ 5. Total revenues & costs by location/facility
1B2
___6. Total revenues & expenditures compared with budgets 2B
___ 7. Distribution of costs & revenues by general ledger line item
1B1’2
2BT2
3B2
3B1,2
4A1,3
___ 8. GLI revenues & expenditures compared with budgets 4A
Level 3 Tables : Analysis by PHC service or activity
39
■■3
5A
__ . 10. Average costs (unit costs) of each service/activity
6A
6A1
2B3
2B1'3
___ 12. Distribution of service/activity revenues & costs by GLI
3B3
36^
__ , 13. GLI rev. & expend, of each service/activity compared with budgets
4A4
4A1'4
3B3'5
3B1'3
___ 11. Total service/activity revenues & expend, compared with budgets
3fl
___ 14. Distnbution of revenues & costs by location & service
39
3j
3J
39
3B2
___9. The distribution of costs by PHC service/activity
NOTES:
1. Prepare separate table for each time period.
2. Change headings and labels (e.g., from 'Year 1* to 'Central HC or "ANC).
3. Prepare separate table for each location or facility.
4. Prepare separate table for each PHC service or activity.
5 Change labels in vertical axis to GLI names, change labels in horizontal axis to services/activities
31
Module 8: FG; session 2; handout 8-5
Session 3: Code and allocate costs
(Steps 4 and 5)
Objectives:
Participants will be able to:
• Set up a coding system for the items to be
costed.
• Determine if indirect costs, depreciation, non
monetary costs and foreign exchange are to
be included in the analyses.
• Allocate costs directly or indirectly.
• Allocate indirect costs proportionately accord
ing to appropriate unit of measure (e.g., time,
space, and distance).
• Explain three techniques for allocating costs
retrospectively.
Session outline:
Materials:
Module 8: FG; session 3
1. Introduction (5 minutes)
II. Coding system (30 minutes)
III. Advance features (40 minutes)
IV. Cost allocation (15 minutes)
V. Allocation techniques (15 minutes)
VI. Review of decisions (30 minutes)
Transparency 8-11: Session 3: Objectives
Transparency 8-12: Advanced features
Transparency 8-13: Cost allocation
Transparency 8-14: Units of measure for allo
cating costs
38
Transparency 8-15: Retrospective allocation
techniques
Handout 8-6:
Coding worksheet
Equipment:
ii
Overhead projector, screen
Module 8: FG; session 3
39
udt
ri
Session 3: Code and allocate costs (Steps 4 and 5)
I. Introduction (5 minutes)
Transparency 8-11:
Session 3: Objectives
’
• Review session objectives.
£
.
.. ...
• Give an overview ot session activities.
3
II. Coding system (30 minutes)
• Review general principles for setting up a
coding system.
Use or adapt an existing system, if possible.
Make it easy to remember.
Letters are easier to remember than num
bers.
Use a logical sequence, such as location,
service, general ledger item.
Always use codes in the same sequence as a
letter; it may mean different things depending
upon the order in which it is placed.
• Refer participants to page 30 in the User’s
guide for an example of an actual coding
system.
• Invite questions and comments.
3j
*1
Handout 8-6:
Coding worksheet
3)
30
3)
30
50
38
39
Module 8: FG; session 3
• Distribute the worksheet and direct partic-
ipants working in previously established
groups, to list relevant items for each level and
establish a code for each item.
Note: Depending upon time available, all groups
map not finish the coding process. The objective
is to provide opportunity for sufficient practice so
that they can complete it on their own outside the
workshop.
• Invite questions or comments from all par
ticipant groups.
40
Session 3: Code and allocate costs (Steps 4 and 5)
III. Advanced features (40 minutes)
• Explain that cost analysis can be made more
accurate if certain costs and concepts are
understood.
Transparency 8-12:
Advanced features
• Explain that participants may wish to con
sider these features if they are a factor in their
programmes and if they are planning a Level
2 or Level 3 analysis.
Note: Using the information and examples con
tained in Appendix A, prepare a presentation on
these concepts appropriate to the needs of the
programme and the background of the partici
pants.
IV. Cost allocation (15 minutes)
Transparency 8-13:
Cost allocation
• Introduce key terms.
7b allocate costs means to assign them to
one or more cost categories.
Direct allocation is the term used when costs
are assigned to a single category, e.g., the cost
of vaccines is assigned to immunization.
Indirect allocation is the term used when
costs must be assigned to two or more cate
gories. Examples of these costs are staff time
and vehicles.
Indirect allocation may be done equally
(evenly divided among categories) or propor
tionately according to an appropriate unit of
measure (distance travelled in the case of a
vehicle).
’ Refer participants to page 35 in the User’s
guide for examples of direct allocation for al!
three levels.
Module 8: FG; session 3
41
Session 3: Code and allocate costs (Steps 4 and 5)
• Explain that equal indirect allocation is not
Transparency 8-14:
Units of measure for
allocating costs
recommended because it is not very accurate.
For example, personnel costs might be divided
equally among three health centres, but this
method, though easy, would not account for
the differences among the health centres.
• Explain the units of measure for allocating
costs proportionally.
• Refer participants to page 36 in the Users
guide for examples of proportional allocation
for each item.
• Explain that proportional allocation requires
very good records and, though time consum
ing, will give very good estimates of cost.
• Invite questions or comments on cost alloca
tion.
V. Allocation techniques (15 minutes)
• Explain that if participants are planning to
Transparency 8-15:
Retrospective allocation
do an analysis of costs compiled and coded in
the future (prospective) then they can set up
their system now and the needed data for
proportional allocation will be readily availa
ble. If cost analysis is going to be a routine
part of their management, then this approach
is recommended.
• If the cost analyses are done based on data
already collected (retrospective), then other
allocation techniques must be considered.
• Explain the three techniques and the pros
and cons of each.
» Explain the recommended approach:
Recode major items that are easy to cate
gorise, e.g., contraceptives.
Module 8: FG; session 3
Session 3: Code and allocate costs (Steps 4 and 5)
Get estimates from staff (expert judgement)
on time spent on planned activities and use of
space.
Take a prospective sample of remaining
items, especially ones that account for a large
portion of costs.
• Invite questions and comments on allocation
techniques.
VI.
Review of decisions (30 minutes)
• Refer participants to the worksheets they
completed in Session 2:
Deciding what to cost (Handout 8-3)
Selecting types of cost analysis (Handout
8-4)
Specifying tables and graphs (Handout 8-5)
• Direct participants to work in the groups they
formed to prepare the worksheets in Session
2 and review and modify those worksheets in
light of the information presented in Session
3.
• After 15 minutes, ask one person from each
group to describe any changes that were made
and to explain the reason for the change.
<> Ask for final questions or comments on Ses
sion 3.
Module 8: FG; session 3
43
3
3i
3 SESSION 3: OBJECTIVES
a
• Set up coding system
• Decide on inclusion of indirect costs,
depreciation, non-monetary costs, and
foreign exchange
30 • Allocate costs directly and indirectly
■3
• Allocate indirect costs proportionately
73 o Explain 3 techniques for retrospective
allocation
33
30
3
70
50
30
30
Module 8: FG; session 3; transparency 8-11
IB
44
ADVANCED FEATURES
• Indirect costs
• Capital costs (depreciation)
• Non-monetary costs (in-kind contribu
tions)
0
Foreign exchange
Module 8: FG; session 3; transparency 8-12
45
sa
? COST ALLOCATION
• Direct allocation
• Indirect allocation
-i
• Equal allocation
• Proportional allocation
-I
-J
-I
Ml
81
-a
jC
'jQ
Module 8; FG; session 3; transparency 8-13
46
UNITS OF MEASURE
FOR ALLOCATING
COSTS
Item
Unit of measure
Personnel
Time worked
Supplies
Weight used
Volume used
Units used
Facilities
Space used
Time used
Equipment
Time used
Vehicles
Distance travelled
Time used
Module 8: FG; session 3; transparency 8-14
•ar
47
53
3 RETROSPECTIVE
* ALLOCATION
J TECHNIQUES
® Recode all transactions
ii
xi
• Use expert judgement
© Sample selected costs
aj
50
50
Module 8: FG; session 3; transparency 8-15
48
CODING WORKSHEET
Level 1: PHC programme (total costs)
Level 1: General ledger items
Code
description
Code
description
Level 2: Projects, subprojects, locations, sites, etc.
Code
description
Code
description
Level 3: PHC service components or management components
Code
description
Code
description
Module 8: FG; session 3; handout 8-6
49
Session 4: Enter, analyse, and report
data (Steps 6, 7 and 8)
Objectives:
Participants will be able to:
• Enter data and compute costs.
• Analyse and interpret revenue and cost data.
• Report cost analysis findings.
Session outline:
Materials:
Equipment:
Module 8: FG; session 4
I. Introduction (5 minutes)
II. Enter data (20 minutes)
III. Analyse and interpret data (20 minutes)
IV. Report findings (15 minutes)
V. Next steps (25 minutes)
VI. Conclusion (10 minutes)
Transparency 8-16: Session 4: Objectives
Flip chart, stand, markers, masking tape, over
head projector and screen
50
Session 4: Enter, analyse, and report data (Steps 6, 7 and 8)
Introduction (5 minutes)
I.
Transparency 8-16:
Session 4: Objectives
II.
• Review session objectives.
, Give an overview of session activities.
Enter data (20 minutes)
• Remind participants that in a prospective
cost analysis, coding and data entry will be
done as costs are incurred according to the
system established.
• Explain that for a retrospective cost analysis
there are three ways that data can be taken
from past records and recoded.
Reclassify total costs.
Reclassify monthly or quarterly costs.
Reclassify individual transactions.
• Explain how to reclassify monthly or quar
terly costs using the example on page 32.
o Explain how to reclassify individual transac
tions.
By computer.
Manually.
• Invite questions or comments on data entry.
III.
Analyse and interpret data (20 minutes)
» Explain that the manual production of tables
is easily accomplished by taking the totals
from Step 6 and entering them in the appro
priate tables.
• Refer participants to page 45 and discuss
the questions that should be asked to help
interpret the data displayed on the tables.
Module 8: FG; session 4
51
3
Session 4: Enter, analyse, and report data (Steps 6,7 and 8)
• Invite questions and comments on analysis
-Tj
and interpretation.
IV. Report findings (15 minutes)
L -5^
• Refer participants to page 46 and discuss
•?
u
the guidelines for reporting findings, orally and
in writing.
Note: If possible, circulate a written report that is
a good example of what the participants should
do.
4
• Remind participants that the cost analysis
objectives specified in Session 2 are a good
place to begin when preparing the report.
• Also note that it may be necessary to prepare
more than one report if user objectives are
markedly different.
‘i
• Invite questions and comments on reporting
findings.
V. Next steps (25 minutes)
• Direct participants to work in small groups
$
as assigned in Session 2.
3)
• Ask participants to:
List the steps necessary to implement a cost
analysis in their PHC programme, building on
the decisions made in the workshop.
Arrange the steps in sequence.
Set a tentative completion date for each step
and indicate the name of the responsible person.
*1
%
*1
X)
Ax
/A <
30
:W
t»
>
\
100
Module 8: FG; session 4
(J 6 * '7
TOOT ) r /
' ' '
'V\7a
5
52
Session 4: Enter, analyse, and report data (Steps 6, 7 and 8)
VI. Conclusion (10 minutes)
Transparency 8-1.
Workshop objectives
• Review the workshop objectives.
• Review the list of participant expectations
recorded on a flip chart in Session 1 and ask
participants to indicate the extent to which
they were met.
• Thank participants for their attention and
hard work.
Module 8: FG; session 4
53
-0
5i
'• SESSION 4: OBJECTIVES
47
• Enter data and compute costs
-•5?
£5j • Analyse and interpret data
® Report cost analysis findings
Module 8: FG; session 4; transparency 8-16
PHC MAP MANAGEMENT COMMITTEE
a
Dr. Ronald Wilson • Aga Khan Foundation, Switzerland (Co-Chair)
Dr. Jack Bryant • Aga Khan University, Pakistan (Co-Chair)
Dr. William Steeler • Secretariat of His Highness the Aga Khan, France (Co-Chair)
Dr. Jack Reynolds • Center for Human Services, USA (PHC MAP Director)
Dr. David Nicholas • Center for Human Services, USA
Dr. Duane Smith • Aga Khan Foundation, Switzerland
Dr. Pierre Claquin • Aga Khan Foundation, Switzerland
Mr. Aziz Currimbhoy • Aga Khan Health Service, Pakistan
Mr Kabir Mitha • Aga Khan Health Service, India
Dr. Nizar Verjee • Aga Khan Health Service, Kenya
Ms. Khatidja Husein • Aga Khan University, Pakistan
Dr. Sadia Chowdhury • Aga Khan Community Health Programme, Bangladesh
Dr. Mizan Siddiqi • Aga Khan Community Health Programme, Bangladesh
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Yawarat Porapakkham • ASEAN Institute for Health Development, Thailand
Dr. Jumroon Mikhanorn • Somboon Vacharotai Foundation, Thailand
Dr. Nirmala Murthy • Foundation for Research in Health Systems, India
PHC MAP TECHNICAL ADVISORY COMMITTEE
■i*
Dr. Nirmala Murthy • Foundation for Research in Health Systems, India (Chair)
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Al Henn • African Medical and Research Foundation (AMREF), formerly of
the Harvard Institute for International Development
Dr. Siraj-ul Haque Mahmud • Ministry of Planning, Pakistan
Dr. Peter Tugwell • Faculty of Medicine, University of Ottawa, Canada
Dr. Dan Kaseje • Christian Medical Commission, Switzerland, formerly of the
University of Nairobi, Kenya
KEY PHC MAP STAFF AT THE CENTER FOR HUMAN SERVICES
Dr. Jack Reynolds (PHC MAP Director)
Dr. Paul Richardson
Dr. David Nicholas
Dr. Wayne Stinson
Ms. Maria Francisco
Dr. Neeraj Kak
Ms. Lori DiPrete Brown
Ms. Pam Homan
Dr. Lynne Miller-Franco
Ms. Mary Millar
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