Cost analysis of the essential package of health services (EPHS) in Somalia

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This cost study of the EPHS in the three zones of Somalia provides an important step in establishing the fundamental building blocks for further economic and VfM analysis of EPHS implementation and impact.

The report explores the following economic questions:

  • What are the actual total and unit costs of EPHS implementation in the regions where HCS partners are implementing the EPHS?
  • What are the primary cost components of EPHS implementation, including, but not limited to, infrastructure and equipment, human resources, training and capacity building, drugs and medicines, and recurrent costs?
  • What are the main cost drivers in the implementation of the EPHS due to remoteness (urban/rural), security, or level/type of care?
  • How would the costs of the EPHS vary based on changes to either the scope or scale of EPHS implementation? What are the normative costs of EPHS implementation under various scenarios?
  • How can the HCS improve value for money (VfM)/investment in the EPHS in Somalia, including improved application of the costing model?


The resulting recommendations are as follows:

  1. Resource and financial planning for EPHS scale-up for government and development partners (normative costing)
  2. Capacity building of EPHS implementers – cost-efficiency and normative costing scenarios
  3. Enhancing cost-effectiveness
  4. Expansion of costs included in the assessment, including indirect costs in the Somalia and Nairobi levels
  5. Proposed study to examine variation in costs
  6. Proposed study to examine private sector health service provision and costs
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