Policy expertise

Demonstrating Value for Money in health: A framework for African countries.

Policy Area
African Development Bank (AfDB)
Aug 2013 - March 2014
OPM contact

This project has provided a framework for completing robust value for money (VfM) assessments of health sector initiatives in different African countries. Despite their increasing importance as accountability measures, fit-for-purpose VfM assessments may be held back by a number of capacity and data constraints. The African Development Bank (AfDB) approached OPM to summarise best practice VfM approaches and investigate their applicability to health sector initiatives within AfDB member countries. Our team conducted desk-based reviews and synthesised evidence from the literature. We used this evidence to develop recommendations for the most appropriate set of tools and indicators to provide the AfDB with a basis for its VfM support to African countries.

With increasing calls for greater accountability around public service delivery, being able to demonstrate the value-for-money (VfM) of investments is critical. Completing useful VfM evaluations relies on a whole host of factors: from identifying appropriate indicators and collecting representative data to robust analysis and effectively feeding findings into decision-making processes.

Despite being extremely diverse - politically, economically and socially - many African countries share similar barriers to conducting effective health sector VfM assessments. These include: a lack of consistent and reliable socio-economic and health information, a lack of local capacity, legal and institutional frameworks and minimal stakeholder involvement.

This project was established to address these barriers by providing a framework to support effective VfM assessments across the AfDB member states.

We conducted comprehensive literature and documentation reviews and summarised best practice approaches to VfM. Our research highlighted the opportunities and challenges presented by three key approaches in the area: a purist economic evaluation approach which equates VfM with full economic evaluations; a more ‘balanced’ approach which argues for economic evaluations to be integrated in a broader evidence spectrum; and the WHO’s analysis of inefficiencies within health systems blocks.

Drawing on the strengths of each approach, we integrated the approaches into a common VfM framework that can be applied to health sector initiatives across the AfDB member states.

The framework incorporates measures of efficiency, effectiveness, and sustainability based on in-depth stakeholder interviews with representatives from the AfDB and member states. The framework has been published as a paper by the AfDB and is being disseminated across the member states.

This project has provided a practical framework for completing health sector value for money assessments that can be applied in a number of different contexts. By drawing together elements of the current best practice approaches in the field, our framework provides a comprehensive overview of the factors that practitioners and policy-makers alike need to consider in order to completed robust assessments of public service interventions.

Over the longer-term, as the AfDB and others begin to use this framework, the findings from VfM assessments will help support more evidence-based decision-making within the sector. By identifying areas for improvement, governments will be better able to address inefficiencies in expenditure and resource allocations and ultimately, strengthen the impact of health sector initiatives within their countries.

Senior Consultant and Portfolio Leader
Director, Social Policy