Using Time Driven Activity Based Costing (TDABC) for Defining and Integrating essential NCD interventions in Nepal
Universal Health Coverage (UHC), a key target of SDG 3, is vital not only for improving access to care but also for reducing mortality. Countries like Nepal face major challenges in achieving UHC, particularly in delivering services for non-communicable diseases (NCDs). The NCD Poverty Network and the Bergen Centre for Ethics and Priority Setting in Health (BCEPS) are supporting national efforts, including in Nepal, to define health priorities and develop UHC benefit packages. To achieve UHC efficiently, it is essential to assess and reorganize high-priority clinical services. Using Time-Driven Activity-Based Costing (TDABC) allows for accurate facility-level cost data, supporting better resource allocation, service delivery, and monitoring.
Kathmandu Institute of Child Health (KIOCH), the implementing partner with the funding from Centre for Integration Science in Global Health Equity is conducting the project from September 29, 2023 with involvement from government stakeholders, ensuring that it aligns with national priorities.
Time-Driven Activity-Based Costing (TDABC) project is micro- costing research designed to accurately capture the real cost of healthcare service delivery in Nepal. It focuses on the actual resources utilized by patients—such as human resources, equipment, consumables, and physical spaces—during their visits along with the associated indirect costs to healthcare facilities. By tracking the time spent at each step of the care process, this project offers a detailed, patient-centered understanding of the cost incurred per visit.
This research specifically evaluates and aims to improve the delivery of care for twelve priority non-communicable diseases (NCDs) in Nepal. These include sickle cell anemia, hypertension, ischemic heart disease, rheumatic and congenital heart diseases, heart failure, stroke, chronic obstructive pulmonary disease (COPD), asthma, diabetes, breast cancer, and cervical cancer. Aligned with the Universal Health Coverage (UHC) Compendium, this project analyzes the disease as per the interventions such as prevention, longitudinal management, screening and diagnosis, acute care management, etc. For instance, when a patient visits a health facility for diabetes screening, they may follow multiple care pathways—registration, consultation, laboratory or imaging services, and pharmacy—utilizing various resources over specific periods of time. TDABC captures these interactions at a micro level to determine the actual cost of care delivery with consideration of indirect costs.
With a vision to assess service delivery and cost across all three tiers of Nepal’s health system—primary, secondary, and referral— this project has been implemented across twelve health facilities chosen for their wide geographic coverage and diverse representation within the healthcare system. These include referral hospitals such as Koshi, Dhulikhel, Lumbini Provincial, and Bheri; district hospitals such as Damak, Dolakha, Gulmi, and Bardiya; and primary care facilities such as Chulachuli Health Post, Kiratechhap Urban Health Center, Jubhung Health Post, and Sorahawa Primary Health Center. This project targets individuals of all age groups and is being implemented in two phases: the first phase focuses on the adult population, while the second phase will cover the pediatric population.
The project supports the effective implementation of the PEN-Plus program, which focuses on the integrated management of severe chronic NCDs. Through this project, the healthcare system can gain vital insights into how resources are used, how services can be optimized, and how quality, efficiency, and equity in NCD care can be meaningfully improved for patients across Nepal. By informing smarter resource allocation, supporting standardized care protocols, and guiding strategic planning, this project presents a robust and scalable methodology for expanding and strengthening NCD services throughout Nepal.