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MedSolve©

Medical Care Development International, as part of its health sector consultancy activities in low income countries worldwide, has pioneered the design and development of an integrated computer software program called MedSolve©. The program consists of a series of modules providing the following functionality:

Program planning and budgeting
Manpower management and planning
Health services pricing and financial planning, and
Pharmaceutical procurement, management, pricing and sales.

MedSolve© is based on the MS Windows® platform which provides a flexible, widely utilized, and user friendly format for all users. To date, MedSolve© has been applied in a wide variety of country settings as a sub-component of health sector projects and studies. Some of these countries include Angola, Burkina Faso, Chad, Guinea, Madagascar, Nigeria, Swaziland, The Gambia, and Togo for health sector projects funded by such donors as The World Bank, African Development Bank, and the U.S. Agency for International Development.
While the nature of the application of MedSolve© varies according to the country and project context, a typical application would include using the various modules in current planning and management activities within the MOH, followed by the installation of the modules on MOH computers at central and local levels, together with intensive training of trainers and relevant MOH staff in its use. MCDI’s technical consultants remain on call following the conclusion of project activities to provide technical support.
The following sections provide brief descriptions of each of the modules contained within MedSolve©, which can be easily adapted to serve specific health sector needs within a country context.

Program Planning and Budget

This module provides health planners with a flexible tool to generate program and/or line item budgets based on a systematic program planning process. The module guides health planners and financial managers through a step-wise process in which they:

Specify sectoral programs or projects;
Define output or objectives for the programs or project and verifiable indicators to evaluate implementation performance;
Specify feasible actions designed to achieve program or project objectives within a specified time frame (e.g., fiscal year);
Produce Gantt charts that lay out the timing of proposed actions in Microsoft Project® and allow users to allocate personnel and other resources to these actions and to track their implementation over time;
Identify and cost inputs or resources for each action, and classify these costs or budgeted expenditures by object of expenditure (budget sub-head), type of funding (taxes, loans, donor grants, etc), and source of financing (government, ADB, UNICEF, etc);
Automatically and rapidly generate annual or multi-annual budgets for some or all of the programs or projects identified as well as financing reports that summarize planned expenditures by source of financing and local and foreign currency component; and,
Easily modify budgets based on amendments to program objectives, actions, inputs or costs.

The module is ideal for preparing and later tracking the implementation of investment packages as identified during a typical health sector pre-investment study. MCDI’s use of this software, the creation of the underlying project and cost databases, plus the transfer of skills in its use permits the MOH to later adjust or modify the investment packages or assign their implementation, and/or funding, to alternative sources. The software is also extremely useful as a tool for conducting cost-effectiveness and cost-containment analyses.
A sample LogFrame produced by the software program for the Swaziland Health Sector Study is reproduced in part below.

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Manpower Management and Planning

The personnel module allows for effective manpower management and costing, evaluations of current manpower composition and distribution, and projections of future manpower supply and costs by occupation, geographic area and numerous other key variables. Historical databases allow detailed occupational and educational histories to be stored and accessed, and the software uses the former to automatically calculate attrition rates by age and occupational cohort.
The software also generates future human resources requirements using alternative forecasting models and compares them with projected supply to produce a gap analysis that it also costs. A sample personnel viewing screen is reproduced below.

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Health Services Pricing and Financial Planning

This module enables financial analysts to rapidly and accurately calculate break-even prices for different services or user groups under alternative price/subsidy scenarios based either on: (1) current account budgets or actual cost databases; and (2) actual or expected levels of utilization. Faced with changing market conditions, the pricing module provides financial analysts with a powerful tool to: (1) Rapidly recalculate price/subsidy levels; (2) Ascertain input combinations and recurrent cost levels that are consistent with changing price/subsidy levels; (3) Identify cost centers that are the best candidates for cost containment. A sample screen from the software program is shown below:

Pharmaceutical Procurement, Management, Pricing and Sales

Enables pharmacists to generate and process orders for drugs and other medical supplies, track vendor-specific price changes, track loss rates during shipment or storage, and manage inventory on hand. A built-in, and easy-to-use, break-even pricing program allows the pharmacists to set sale prices under alternative operating cost and subsidy scenarios. Prices can also be set to achieve either of the following equity objectives:

Cross-subsidize drugs used to treat the most prevalent diseases
Cross-subsidize drugs used to treat the most costly diseases.

The sales module generates and processes invoices and shipping reports while automatically updating inventory files. Sales transactions are posted to input cost databases cross-referenced by health care establishment.
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MedCost©

MedCost©is a health facility and/or service costing module that is part of the MedSolve© series of health sector financial management tools developed by MCDI. As can be seen in the ensuing figures, it provides an interactive spreadsheet environment for calculating total capital, recurrent, fixed and variable cost as well as unit costs by service produced at either the hospital level or at a health center or clinic level. It incorporates a "step-down" costing algorithm that automatically allocates indirect overhead and support service operating costs to a user-defined set of final cost centers or service. Users enter information on the inputs used (or needed) to produce services at the facility level, the cost of these inputs, their current state of repair, and their useful lives. MedCost© uses this information along with actual or projected utilization data and a number of user-defined parameters (e.g. the rate of inflation, currency exchange rates etc) to automatically generate the costs by health facility.
Figure 1: MedCost© Cost Center Definition Sheet

Users define a set of cost centers or service departments that define the production technology employed at each health facility (in this case a district hospital).
Figure 2a: Support Service Production Entry Sheet

Users enter service production statistics for all support service departments for which data are available, and the share of these services produced for each final service department.

Figure 2b: Final Service Production Entry Sheet

Users enter final service production statistics, and MedCost© calculates a number of productivity statistics (e.g. turnover rates etc.).
Figure 3: Input Specification Sheets

Separate input specification sheets are used for overhead, intermediate support and final service departments. Users assign the inputs they enter to their relevant service departments, enter purchase prices, and the useful lives and current state of repair of all assets.
Differential maintenance costs are calculated based on the current state of repair of the input. MedCost© can thus be used not only to generate actual cost based on current production technologies, but also can be used to generate cost estimates under alternative (technically preferred) production technologies.
Based on these data, MedCost© produces three summary cost tables: (1) a total capital and recurrent cost table, (2) a fixed and variable cost table, and (3) a unit cost table.
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