Value for Money and Health Partnerships

International development donors, such as DFID, are increasingly asking us to demonstrate and explain the impact of our work in value for money terms. Here we introduce the topic and share the case studies we commissioned to explore the ways in which health partnerships demonstrate value for money.

Value for money is a phrase in everyday use. To describe a loaf of bread as “good value for money” is to say that it’s good quality for little cost compared with other loaves of bread that are available. So “value for money” is a comparative statement about quality and cost.

The complexity of health partnerships makes quality and cost harder to assess than a sliced white loaf. A good VFM assessment begins with a careful description of resources, activities, processes and results – based on monitoring and evaluation data – and then adds cost data, and looks for alternative ways to achieve those results. The characteristics of health partnerships – the capacity-building approach founded on long-term, peer relationships between health workers – make results particularly difficult to measure.

As we all know, cheap does not always mean good value. Carefully tailored, high quality health partnership activities, in hard to reach places, can be effective but comparatively expensive; but this does not mean they are poor VFM.  A cost comparison may be helpful where health partnerships are undertaking similar activities in similar contexts, but this is rarely the case.

International development donors, such as DFID, are increasingly asking us to demonstrate and explain the impact of our work in value for money terms. By becoming familiar with VFM principles, health partnerships can engage effectively with donors; and VFM data collection and analysis encourages good practice in project management, monitoring and evaluation – and therefore in the health workforce strengthening activities undertaken by health partnerships.

DFID uses the “4 Es” framework, which can help us structure evidence for a VFM assessment.

• Economy means keeping project costs low, for instance with good procurement practices or by getting donations of time or equipment;
• Efficiency means getting the most activity out of every pound, for instance by gradually reducing course running costs as local trainers take responsibility from international volunteers;
• Effectiveness means maximising the change achieved, for instance by strengthening management capacity to support improvements in health worker performance after training or beyond the lifetime of the project;
• Equity means addressing the greatest needs.

THET presents health partnership VFM in these terms, and in 2015 we commissioned detailed case studies of three health partnerships, two of which you can view here:

Value for Money of Health Partnerships: Case Study of the partnership between East London NHS Foundation Trust and Butabika Hospital, Uganda – Gillian Eva, consultant.  Download it as a summary or in full.

Value for Money of Health Partnerships: Case Study of the COSECSA Oxford Orthopaedic Link – Judy Gold, PhD, consultant.  Download it as a summary or in full.

The third case study is by health economist Michael Thiede of Scenarium Group, Assessing the Value for Money of Health Partnerships. Multi-Country Partnership working in partnership to achieve MDG4 in East Africa: Improving the Quality and Safety of Hospital Care for Sick Infants and Children through ETAT+.  This case study is the subject of further work to develop the concept of VFM and health partnerships.

The case studies draw on quantitative and qualitative data to describe the health partnerships in VFM terms, as well as suggesting ways to improve VFM measurement. Overall, these case studies should reassure the reader that you do not need to be a health economist to talk about the value of your health partnership. The growing emphasis on VFM is an opportunity for health partnerships to show their strengths and achievements.

THET is working on more comprehensive VFM assessment in health partnerships and in our management of the HPS, to improve our performance and make the case for continued funding. The approach is likely to include:

• More detailed questions about VFM during grant selection and reporting;
• Improved financial reporting templates that facilitate analysis of activity costs;
• More case studies on the ways in which health partnerships demonstrate value for money, including those written by health partnerships themselves;
• Seeking further expert advice on the ways in which we can accurately and usefully map the 4Es to health partnerships’ work.