Landscape Study — The Cost, Impact, and Efficiency of Above Service Delivery Activities in HIV and Other Global Health Programs

Costs incurred by health programs for activities conducted above the front-line facility or community setting, referred to in this report as costs above the point of service delivery (ASD), constitute a substantial share of health program spending. ASD activities include procurement and supply chain activities, in which critical commodities and equipment are supplied to service providers, and demand generation activities like mass media campaigns at the district, regional, or national level, which seek to maximize the numbers of patients who visit service providers. Some ASD activities are systemic, such as activities that support the laboratory system or health information infrastructure, while other ASD activities are programmatic and take place at district, regional, national, or above-national level. Such programmatic activities are designed to ensure the proper operation of the program and the quality of front-line services, and include program management, monitoring and evaluation, supervision, and surveillance.

However, despite the important of ASD activities in the delivery of major health services, and despite the vast sums spent above the point of service delivery, far less is known about ASD costs than costs at the point of service delivery. This report— informed by stakeholder feedback from a consultation meeting convened in April 2016, and by interviews with key partners—provides a robust landscape analysis of above service delivery activities and technical efficiency associated with major health programs in HIV, immunization, TB, malaria, family planning, and nutrition. The report aims to provide researchers, policymakers, and global health program managers with a useful resource summarizing the current state of knowledge and avenues for future inquiry and development.

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