Summary of funding available for both areas:
Applications are invited for funding to support work on the specific topic of (a) ‘Development of methods to assess resource requirements to achieve universal health coverage in high TB burden countries’, or (b) to support work on any other area of TB modelling (ie an ‘open’ call).
The total funds available for all work in (a) and (b) is US$130,000. This is likely to be shared between two awards of around US65k per award. Funds will be allocated to applications, based on application quality as assessed by external reviewers using the assessment criteria below.
Details for this research topic: (a) Development of methods to assess resource requirements to achieve universal health coverage in high TB burden countries
Reference: TB MAC RFA 4a
Duration: 6 months
Total funds available : up to US$130,000
Funds available for this topic : up to US$130,000, but preference for applications around US$65k
Submission opening date: 11th June 2015
Submission closing date: 3rd July 2015
Decisions announced: 16th July 2015
Contact: Christina.Albertsen@lshtm.ac.uk (admin) or Richard.White@lshtm.ac.uk (technical)
BACKGROUND
The World Health Organization (WHO) has developed a post-2015 global TB strategy for the period 2016−2035, known as the End TB Strategy. The strategy includes ambitious targets for 2030 and 2035, and milestones for 2020 and 25. The 2035 targets are to reduce the absolute number of tuberculosis deaths by 95% and the tuberculosis incidence rate by 90% compared with 2015 levels, corresponding to the goal of ending the global tuberculosis epidemic. The 2025 milestones are reductions of 75% and 50%, respectively. A milestone specifically linked to progress towards universal health coverage (UHC) was also agreed: that no tuberculosis patients and their households experience catastrophic costs as a result of their disease by 2020.
UHC has been defined by WHO and the World Bank as “all people who need health services (promotion, prevention, treatment, rehabilitation and palliation) receive them, without undue financial hardship. It has two interrelated components: the full spectrum of good-quality essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services.” Reaching the 2025 milestones of the End TB Strategy requires that UHC is in place by 2025. This is because the 2025 milestones require that the case fatality ratio (TB deaths divided by the number of new cases) is lowered to 6.5% (the current level in high-income countries) by 2025, which is only possible if all people with TB have access to high-quality treatment. A recent review of the direct and indirect costs associated with accessing TB diagnosis and treatment remain high relative to household income in many countries.
TB-MAC contributed to the modelling work that informed the definition of post-2015 global TB targets and has subsequently undertaken analytical work (epidemiological modelling and economics) on how targets can be reached, and associated resource requirements, in 3 high TB burden countries: China, India and South Africa. One of the major limitations affecting the costing work is that it has so far not been possible to adequately incorporate the resource requirements for the broader strengthening of health services (e.g. staffing, infrastructure) required to achieve UHC. There is work on-going on how unit costs for TB interventions services and at the programme level will change as coverage increase have been made (examining the impact of linear and non-linear cost functions on overall resource requirements estimates). However to date the costs of health systems strengthening more broadly have not been considered.
Although it is recognized that investments to reach UHC are not made for specific diseases, if resource requirements could be estimated it would be possible to allocate a share to TB, or alternatively to place TB-specific costs in a wider context and show what is required alongside TB-specific efforts to reach post-2015 TB targets. This is a challenge that also affects costing for other priorities such as HIV/AIDS, malaria and maternal and child health.
OBJECTIVES
Identify any recent (last five years) costing work, or work that is currently underway, that is directly or closely related to costing of UHC in low and/or middle-income countries, and provide a critical review of the strengths and weaknesses/gaps of the methods used.
Develop/propose methods that could be used to assess the resources required to achieve UHC in high TB burden countries, either overall or for TB specifically.
Develop 1−2 illustrative examples of how the methods described in 2 could be applied in high TB burden countries, working closely with the team working closely on the TB Targets exercise.
TASKS
Literature review and interviews with individuals/groups working on costing of health care interventions and service delivery, to identify recent or ongoing efforts to assess the costs of achieving UHC in low and/or middle-income countries.
Preparation of a written document that summarizes recent costing efforts related to UHC and assesses their methodological strengths/limitations/gaps.
Development and documentation of proposals for method(s) that could be used to assess the resources required to achieve UHC in high TB burden countries, either overall or for TB specifically, including illustrative examples.
Deliverables
A presentation (15-30 slides) summarising the literature and a draft critical review of methods to be prepared for the TB-MAC meeting in October 2015
A draft paper (can have appendices) that a) summarizes recent costing efforts related to UHC and their methodological strengths/weaknesses/gaps b) describes and explains proposals for methods that could be used to assess resources required to achieve UHC in high TB burden countries and provides illustrative examples of how the described methods could be applied by the end of 2015.
PROFILE OF INDIVIDUAL/TEAM REQUIRED
Essential qualifications and experience
Health economist (s) with extensive (more than 10 years) of experience in costing of health care interventions.
Experience in working in low and middle income countries
Excellent written and spoken English.
Desirable qualifications and experience
Costing experience related to TB prevention, diagnosis and treatment.
Experience in health systems research, analysis and/or development
Experience of working with infectious disease modellers
Assessment criteria
All applications will be reviewed by expert external reviewers. All applications to this research question will be scored against the following criteria:
Is the research question and plan well-described
Is the research team qualified to conduct this research and meet the profile above
Is the budget and timeline appropriate for the proposed activity
Is the proposal likely to meet the aim, objectives and deliverables
Is the dissemination and policy impact maximisation plan adequate
Does the proposal explain how models/data will be shared for maximum public utility
Does the proposal show a clear understanding of the limitations of research
Mechanism
A contract will be issued from LSHTM either to an institution or to an applicant personally in the form of consultancy fees.
Eligible costs
This call will pay Direct Costs and Indirect Costs only. Our ultimate funder is the Bill & Melinda Gates Foundation and we would comply with the same Indirect Costs rule as they grant to us, which is up to 15%.
Eligibility
Members of the TB MAC Secretariat and Advisory Panel are not eligible for this award.
Format
Applications should include a proposal limited to three pages (excluding references, and with a minimum of 11 point font size). Proposals should include: (i) an introduction to the topic; (ii) description of previous work in the area by the applicants; (iii) description and justification of the intended approach; (iv) timeline for the proposed work; (v) budget and its justification. In addition, the principal applicant should provide a separate short bio-sketch (one page summary of qualifications, research interests, key funding publications and major sources of research support).
