Budgeting for Environmental Health Services in Healthcare Facilities: A Ten-Step Model for Planning and Costing

Abstract

Environmental health services (EHS) in healthcare facilities (HCFs) are critical for safe care provision, yet their availability in low- and middle-income countries is low. A poor understanding of costs hinders progress towards adequate provision. Methods are inconsistent and poorly documented in costing literature, suggesting opportunities to improve evidence. The goal of this research was to develop a model to guide budgeting for EHS in HCFs. Based on 47 studies selected through a systematic review, we identified discrete budgeting steps, developed codes to define each step, and ordered steps into a model. We identified good practices based on a review of additional selected guidelines for costing EHS and HCFs. Our model comprises ten steps in three phases: planning, data collection, and synthesis. Costing-stakeholders define the costing purpose, relevant EHS, and cost scope; assess the EHS delivery context; develop a costing plan; and identify data sources (planning). Stakeholders then execute their costing plan and evaluate the data quality (data collection). Finally, stakeholders calculate costs and disseminate findings (synthesis). We present three hypothetical costing examples and discuss good practices, including using costing frameworks, selecting appropriate indicators to measure the quantity and quality of EHS, and iterating planning and data collection to select appropriate costing approaches and identify data gaps.

Development and Application of Tools to Cost Delivery of Environmental Health Services in Healthcare Facilities: A Financial Analysis in Urban Malawi

“…We followed a ten-step process model described by Anderson et al [5]. Brie y, the model comprises three phases: Planning to de ne scope of relevant services and costs, to understand the facility context, and to develop a data collection plan; Data collection to execute the data collection plan and evaluate data quality; and Synthesis to calculate costs and disseminate ndings.…”

“…To assess accuracy and representativity of cost data, we used the iterative process described by Anderson et al [5]. In brief, following completion of Step 7, we aggregated data across all records and compared to our cost frameworks.…”

“…Environmental health services (EHS) in healthcare facilities (HCFs) reduce risk of HAIs by reducing transmission of contamination from person-toperson, and person-to-environment and vice versa [4,5]. EHS protect patients and providers, other workers in the HCF (e.g.…”

“…EHS protect patients and providers, other workers in the HCF (e.g. waste handlers and cleaners), patient caregivers, and people living in the surrounding communities who may be exposed to waste outputs [5]. Inadequate EHS reduces patient careseeking [6] and adversely affects healthcare worker satisfaction with the work environment [7].…”

“…We describe the rst application of a model designed speci cally for costing EHS in HCFs in LMICs [5]. We extended the model by developing frameworks of essential outputs and inputs for each EHS, which we used to identify expenses essential for EHS delivery and evaluate the completeness of costs data.…”