Business Case and Intervention Summary
ARIES PROJECT 203326
Intervention Summary
Title: Estimating maternal and newborn lives saved using Lives Saved Tool (LiST)
What support will the UK provide?
The UK will provide upto £267,393 for the development, implementation and dissemination of a model
to estimate the number of maternal and newborn lives saved through DFID support.
Why is UK support required?
In December 2010, the Department for International Development published Choices for women:
Planned pregnancies, safe births and healthy newborns. The UK’s Framework for Results for
improving reproductive, maternal and newborn health in the developing world (RMNH FfR).
This framework committed £4.4 billion for women’s and children’s health to:

save the lives of at least 50,000 women during pregnancy and childbirth and 250,000
newborn babies by 2015;

ensure at least 2m safe deliveries;

provide access to modern methods of family planning for 10m additional women; and

prevent more than 5m unintended pregnancies by 2015.
This included a commitment to monitor progress and publish results on an annual basis. UK support is
required to procure the services of an independent Provider to design and implement a model to
measure maternal and newborn lives saved as part of the UK Government’s commitment to
transparency and value for money.
What are the expected results?
Expected results are:

a computerized model to generate lives saved estimates

a detailed methodological note to guide the collation of input data for the model

annual estimates of maternal and newborn lives saved for all countries where DFID has a bilateral
programme – both country level and aggregate results

final cumulative estimates of maternal and newborn lives saved through DFID support during the f
FfR period
Business Case
Strategic Case
A. Context and need for a DFID intervention
Context
The UK government is committed to reduce poverty in poorer countries, in particular through
achieving the Millennium Development Goals (MDGs), including MDG 4 (Reduce child mortality) and
MDG 5 (Improve maternal health).
While progress is being made towards attainment of the MDGs, the rate of progress is insufficient to
attain the MDG targets, with particular challenges in reaching the poorest and most disadvantaged as
described below:
MDG 4: Reduce child mortality
Globally, nearly 19 000 children under five years die every day, amounting to 6.9 million deaths a
year. Although mortality rates for under-fives dropped by 41% between 1990 and 2011, these rates
are still insufficient to achieve MDG 4 by 2015, with only 6 out of 10 regions on track. A large share
of child mortality (40%) is attributable to deaths in the neonatal period with approximately 3 million
newborns dying in the first month of life1.
MDG 5: Improve maternal health
Worldwide, 287 000 women die each year from complications arising during pregnancy and
childbirth, representing a 47% decrease globally between 1990 and 2010. Over 99% of maternal
deaths occurring in developing countries2. For every woman who dies during pregnancy or childbirth
an additional 20 or 30 suffer complications such as such as severe anaemia, incontinence, damage
to the reproductive organs or nervous system, chronic pain, and infertility3.
1
Level and trends in child mortality. Report 2012. Estimates developed by the UN Inter-Agency Group for Child
Mortality Estimation.
2 WHO, UNICEF, UNFPA, World Bank (2012). Trends in Maternal Mortality: 1990 to 2010. Geneva: World Health
Organization.
3 C Murray and A Lopez, eds. Health Dimensions of Sex and Reproduction, Vol. 3, Global Burden of Disease and Injury
Series. Boston: Harvard University Press, 2008.
To support attainment of the MDGs, in 2010 DFID published a Framework for Results for improving
reproductive, maternal and newborn health in the developing world (FfR) setting out how the UK will
support action to:

save the lives of at least 50,000 women during pregnancy and childbirth and 250,000
newborn babies by 2015;

ensure at least 2m safe deliveries, particularly for the poorest 40% by 2015;

provide access to modern methods of family planning for 10m additional women, including 1m
young women aged 15 – 19 by 2015; and

prevent more than 5m unintended pregnancies by 2015.
The Government is committed to making British aid more effective by improving transparency and
value for money4. This includes monitoring and reporting progress made in delivering results
commitments.
In 2011 DFID published a Results Framework outlining four levels of indicators that capture each
main stage through which inputs are transformed into developing country results:5

Level 1 indicators focus on progress against the MDGs, outcomes that cannot be attributed to
DFID alone but result from the collective action of countries and diverse development partners.

Level 2 indicators measure outputs and intermediate outcomes that can be directly linked to DFID
interventions. Level 2 indicators relevant for RMNH include:
a) number of births delivered with the help of a midwife, nurse or doctor through DFID support;
b) number of additional women using a modern method of family planning through DFID
support,
c) number of maternal lives saved through DFID support; and
d) number of newborn lives saved through DFID support.

Level 3 and 4 indicators measure the operational and organisational effectiveness of DFID, to
assess how effectively and efficiently DFID conducts its business.
In June 2012 DFID published its first Annual Report, as the main vehicle for reporting DFID results
and confirmed the commitment of the Government to publish progress against all indicators at all
levels on an annual basis.
In addition to the measurement of results, the RMNH FfR outline 4 additional processes for the
overall monitoring and evaluation of DFID’s contribution towards improving maternal and newborn
4
5
DFID Business Plan 2012 – 15. DFID, May 2012
DFID’s Results Framework. Managing and reporting DFID results. DFID, March 2011.
health:
1. Routine project and programme level evaluation;
2. Mid-term review (2013);
3. Global and partner monitoring and evaluating processes; and
4. Final evaluation (2015-16).
The Level 2 RMNH indicators, reported annually, will feed into and inform the above processes,
providing essential input data for the evaluation of programmes, the mid-term review and final
evaluation of the FfR as a whole.
Need for intervention
DFID has established internal processes to measure and report the number of safe deliveries and
number of additional users of modern methods of family planning through DFID support. Standard
methodology and supporting guidance notes have been developed and disseminated to relevant
cadres within DFID, including results and health advisors with responsibility for DFID programmes.
The first set of results were reported by Country Offices and multilateral programmes accordingly and
published in the 2012 Annual Report.
In contrast, DFID has not yet established methodology to measure maternal and newborn lives
saved. The 2012 Annual Report did not provide results on these indicators, but reported instead that
DFID was working with partners to establish internationally agreed methodology. This Business Case
sets out the rationale and process by which this task will be undertaken.
B. Impact and Outcome that we expect to achieved
Impact:
A global reduction in maternal and child mortality with accelerated progress towards attainment of
MDGs 4 and 5.
Outcome:
Improved effectiveness and value for money of DFID and partner RMNH programmes.
How outcome will lead to impact:
Routine monitoring of maternal and newborn lives saved will tell us the extent to which we have
achieved the results set out in the FfR. Combined with routine programme evaluation, global and
partner monitoring and evaluation, the mid-term review and final evaluation of the FfR this will
generate evidence on effective policy and programme interventions to improve the quality of lives of
women and children.
DFID will establish a Monitoring and Evaluation Reference Group (MERG) to bring cross DFID
coherence on all matters relating to monitoring and evaluation of the FfR. The ERG will review and
make recommendations in response to monitoring and evaluation findings. DFID will act on these
recommendations through a range of channels which include:

working through country programmes, using appropriate funding approaches in each case, to
support countries and communities to achieve our health goals;

working through relevant multilateral institutions that play important strategic coordination,
funding and normative guidance roles for the delivery of malaria and RMNH results;

improving the effectiveness and efficiency of the global response through international
institutions, partnerships and global civil society;

investing in global public goods including tackling resistance, building and sharing evidence
and supporting market efficiencies;

investing in research and working with academic partners to improve the evidence base in
terms of what works best to improve outcomes, and to improve the dissemination of this
knowledge; and

harnessing UK expertise through better partnerships with academics, civil society,
professional bodies and partnerships with other UK government departments to help deliver
this framework.
In addition to the Annual Reports (including lives saved results), findings of the mid-term review and
final evaluation will be disseminated widely as a global public good through mechanisms such as
DFID knowledge hubs and professional networks, posting on DFID internal and external websites,
and peer reviewed publications. Additionally, DFID’s unique position as a Board member of the
Partnership for Reproductive, Maternal and Child Health (PMNCH) and member of the RMNH
Alliance provides opportunity to share information and mobilize partners to take up evidence.
As DFID and partners implement evidence and revise policy and programmes accordingly, the
overall effectiveness and efficiency of the global response to maternal and newborn health will be
strengthened. Through improved efficiency a given level of investment will reach a wider population,
and through improved effectiveness programmes will have a greater impact on lives saved and
illness averted. As a result, there will be a global reduction in maternal and child mortality and
progress towards attainment of MDGs 4 and 5 will be accelerated.
Appraisal Case
A. What are the feasible options that address the need set out in the Strategic case?
Option 1
Internal DFID monitoring
Under this option DFID establishes a standard methodology against which DFID staff report the number
of maternal and newborn lives saved on an annual basis. Results are aggregated centrally.
Option 2
Select , through competitive tender, an external provider to measure lives saved
Under this option a tender is announced and a provider selected to develop and implement a
methodology for modelling lives saved and to measure annual and cumulative results accordingly.
Option 3
Direct contract to John Hopkins University (JHU) to estimate maternal and newborn lives
saved using the Lives Saved Tool (LiST)
Under this option JHU is contracted directly, without competition, to generate annual and cumulative
estimates of maternal and newborn lives saved using LiST
Option 4
The “Do Nothing” counterfactual
Under this option DFID does not measure the number of maternal and newborn lives saved through
DFID support.
B. Assessing the strength of the evidence base for each feasible option
As described above, the measurement of lives saved is part of the overall monitoring and evaluation
process of the FfR. The theory of change (Figure 1) assumes that provision of resources by DFID
together with the time of health and statistical advisors will enable the development/modification of a tool
to generate estimates of maternal and newborn lives saved through DFID support. Results generated
will measure progress over time towards DFID ‘lives saved’ goals. Annual results will be reviewed within
DFID and will inform the mid-term review of the RMNH FfR. DFID will take action in response to results
estimates and mid-term review recommendations in order to strengthen the portfolio of projects and
programmes to improve maternal and newborn health and ensure that goals are attained. Evidence on
the development and implementation of the tool will be widely disseminated through scientific literature
and meetings, enabling partners to conduct similar estimates of the outcomes of their projects and
modify projects and programmes in response. As a result the effectiveness of DFID and partner
activities to improve maternal and newborn health will be increased and progress towards MDGs 4 and
5 will be accelerated.
Figure 1
Theory of Change
INPUT
Monitoring and
evaluation reference
group: knowledge
and expertise
exploited through
quarterly meetings
and additional inputs
as required.
IMPACT
LiST Tool: the LIST tool
is modified to enable
retrospective estimation
of maternal and newborn
lives saved as a result of
DFID support.
Standard Template and
Guidance for reporting
input data: A set of input
data is defined, a
template for annual
reporting of data by
country offices is created
together with supporting
guidance.
Annual results
estimates: Estimates of
maternal and newborn
lives saved are generate
annually for DFID
supported countries and
aggregated for all DFID
support. Results are
reviewed by DFID and
inform midterm review
and final evaluation of
FfR. DFID RMNH
portfolio modified as
necessary in light of
findings.
Dissemination of
modified LiST and
evidence as a global
public good: Evidence
on development and use
of tool is disseminated
widely, enabling partners
to improve the monitoring
and evaluation of their
RMNH programmes and
take any necessary
action to improve
performance
A global reduction in maternal and child
mortality with accelerated progress
towards attainment of MDGs 4 & 5.
DFID staff time:
Policy, research and
country office staff
collaborate with JHU
to modify LiST.
Country office health
and results advisors
provide annual input
data for LiST
analysis.
OUTCOME
Improved effectiveness and value for money of DFID and
partner RMNH programmes.
DFID financial
resources: enable
JHU staff to
undertake project
including travel for
workshops to modify
LiST and to discuss
annual results with
DFID.
OUTPUT
In the table below the quality of evidence for each option is rated as either Strong, Medium or Limited
Option
Evidence rating
Rationale
1
Limited
Results cannot be tracked annually. Results not
statistically robust.
2
Limited
Delay in generation of first set of results. Significantly
greater time requirement from DFID staff compared to
other options.
3
Strong
Results can be generated within 1-2 months. Results
robust and credible with global community.
4
Limited
Since DFID has committed to publishing results annually
there are clear negative implications of not publishing.
Option 1 Internal DFID monitoring
DFID could develop a standard methodology against which DFID staff would report the number of
maternal and newborn lives saved on an annual basis. The obvious method to measure lives saved
would be to measure changes in maternal and newborn mortality rates within countries over time and to
combine these with population estimates to calculate a change in absolute numbers of deaths. Finally a
fixed attribution rate could be applied to determine the number of lives saved through DFID support.
However, national mortality rates are not monitored on an annual basis, are measured differently
between countries (eg DHS or MICS) and are subject to wide margins of error. Therefore, estimation of
results using this method would not be reliable and would not allow for annual progress to be tracked.
The DFID Maternal and Newborn Senior Research Fellows have advised against this approach.
Therefore this option is rated as LIMITED.
Option 2 Select, through competitive tender, an external provider to measure lives saved
An alternative approach to measure lives saved is to model estimates using a defined set of input data.
A computerized tool could be developed to generate estimates from the input data. Input data could be
gathered from national and/or global data sources.
Open competition would generate a range of proposals that could be assessed for their strengths and
weaknesses as well as cost, which would allow DFID to select the most robust and cost-effective
methodology.
However significant DFID input would be required under this option. Firstly, the procurement process
itself, including the review of alternative methodologies and understanding of proposed computerized
models, would consume a significant amount of time of procurement and technical staff within Policy and
Research Divisions. Secondly, to ensure ownership by DFID staff at country level, it would be necessary
to closely involve DFID country health and results advisors for the development and field testing of the
tool and methodology. DFID staff would also need to provide input data on an annual basis for the
model, and would need to be involved in the quality assurance of results generated.
Additionally, given the complexity of this task and the need to develop a computerized model to generate
the lives saved estimates this option would require a substantial amount of time before the first set of
results could be finalized. It is unlikely that results would be available in time for inclusion in the next
DFID annual report.
Therefore this option is rated as LIMITED.
Option 3
Direct contract to John Hopkins University (JHU) to estimate maternal and newborn lives
saved using the Lives Saved Tool (LiST)
LiST is a computer-based tool which allows users to set-up and run multiple scenarios to estimate the
impact of different packages of RMNH interventions and coverage levels for their countries, states or
districts. These scenarios provide a structured format for users to combine the best scientific information
about effectiveness of interventions for maternal, neonatal and child health with country specific
information about cause of death and current coverage of interventions to inform their planning and
decision-making as well as to help prioritize investments and evaluate existing programs. This tool
utilizes publically available information on demography, family planning, HIV (incidence as well as
prevention and treatment) and coverage of maternal and child health interventions to estimate the
number of lives saved by changes in these characteristics. The effect sizes and general model have
been developed by the Child Health Epidemiology Reference Group (CHERG) and are updated
regularly to reflect the most recent knowledge available. LiST is built into the freely available Spectrum
Policy Modelling Software (futuresinsitute.org).
LiST was devised by the John Hopkins Bloomberg School of Public Health. JHU remains the centre of
expertise in the use of LiST, including its potential application.
LiST is widely used in the RMNH community to estimate the impact of RMNH programmes. Generally,
LiST is used to estimate the potential impact of programmes at the planning stage, in order to guide the
most cost effective intervention or combination of interventions.
DFID internal consultation, in particular drawing on the expertise of the Maternal and Newborn Senior
Research Fellows, concluded that LiST would be an appropriate tool to measure maternal and newborn
lives saved. Although LiST has not, as yet, been used retrospectively to estimate lives saved from
programme activities, a collaboration between DFID and JHU to develop this methodology, and refine
LiST as necessary, could provide a global public good for implementation by other partners.
Under this Option a series of workshops, led by JHU, will be held with DFID staff to define input data,
revise and test the LiST model. Guidance will be prepared for DFID health and results advisors, outlining
the input data required and data sources. On an annual basis DFID staff will be asked to complete a
standard template to submit all required country level input data a (eg skilled birth attendant coverage,
contraceptive prevalence rate etc). This template will be sent directly to JHU. JHU will provide support to
DFID staff as required, to ensure that data submitted is accurate and complete. JHU will run the LiST
analysis and then share preliminary results with DFID staff for review and agreement before
presentation to the MERG.
Consultation with JHU has confirmed that this is a feasible option. Since the LiST model has already
been devised and is widely implemented the modification of the tool to generate lives saved estimates
can be done relatively quickly (2-3 months) and hence results estimates will be available soon thereby
meeting DFID’s commitment to publish results annually. However, as above, significant input from DFID
is required, including field testing, provision of input data and quality assurance of results.
Therefore this option is rated as STRONG.
Option 4
The “Do Nothing” counterfactual
Under this option DFID does not monitor, nor report, the number of maternal and newborn lives saved
through DFID support. This option would result in a failure of the Government to deliver on its
commitment for transparency and value for money through results reporting.
Therefore this option is rated as LIMITED.
What is the likely impact (positive and negative) on climate change and environment for each
feasible option?
Categorise as A, high potential risk / opportunity; B, medium / manageable potential risk / opportunity; C,
low / no risk / opportunity; or D, core contribution to a multilateral organisation.
Option
Climate change and environment risks Climate
change
and
environment
and impacts, Category (A, B, C, D)
opportunities, Category (A, B, C, D)
1
C
C
2
B
C
3
C
C
4
C
C
This programme has varying climate and environment risks depending on the option selected. The
second option – development of a new computerised tool – has a higher risk because it would entail
significant air travel and field testing in countries, thus travel-related emissions would be expected to be
significant. Option 1 has a low risk because in the first case there would be limited travel required as the
majority of the work would be done by country advisers already in-country, although some international
travel to support country advisers would be likely. Option 3 is considered low risk because the number of
meetings requiring air travel between the USA and the UK and from the USA to selected country offices
is limited. It is important that the project maximises the use of email, teleconferencing and videoconferencing to keep travel to the absolute minimum required.
None of the options offer any opportunities because of the focus of this programme is to model
estimated maternal and newborn lives saved and not to look at causes.
C. What are the costs and benefits of each feasible option?
Costs of each feasible option
Costs can be considered in 3 categories: contractor salary and benefits; contractor travel and per diem;
and DFID travel and subsistence.
A. Contractor salary and benefits
This includes the salary and associated benefits of staff employed by the contractor to undertake the
work. In Table 1 below, it is assumed that each contractor will allocate a Principle Investigator, Research
Associate and Administrative Assistant for the project. It is assumed that the annual salary and fringe
benefits are the same for each type of worker, regardless of the provider.
The ‘length of effort’ (LOE) to develop the tool and run annual models is estimated for both Option 3
(LiST anlaysis) and Option 2 (analysis using newly developed tool). LOE is greatest in 2012/13 since the
tool will be developed and tested during this time. Option 2 is estimated to require double the LOE in
2012/13 when compared to Option 3 since the former requires development of a new model and
computerized tool, whereas the latter only requires modification of an existing tool.
LOE in 2013/14 and 2014/15 are less than Year 1 and are the same for both options. LOE in these
years allows for data input, analysis and generation of results. In 2015/16 the LOE increases slightly
since an additional cumulative analysis will be undertaken and contractor staff may also contribute to the
final evaluation of the RMNH FfR and associated dissemination meetings.
There will be no contractor costs with Options 1 and 4.
Table 1 Contractor Salary and Benefits, Options 2 and 3
Salary plus
Staff description
LOE
fringe,
2012-2016*
2012/13
2013/14
2014/15
2015/16
Option 2
Principle Investigator
50%
15%
15%
20%
£75,865
Research Associate
80%
25%
25%
30%
£75,925
10%
5%
5%
5%
£8,812
Administrative Coordinator
Indirect costs @36% of
57,817
salaries and benefits
Option 2 Total
£218,419
Option 3
*Principle Investigator
25%
15%
15%
20%
£57,490
Research Associate
40%
25%
25%
30%
£57,525
5%
5%
5%
5%
£7,112
Administrative Coordinator
Indirect costs @36% of
salaries and benefits
Option 3 Total
£43,966
£166,093
* Annual salaries plus benefits in 2012/13 are estimated as follows:
Principle Investigator: £73,500; Research Associate: £46,000; Administrative Co-ordinator: £34,000
A 3% annual rate of inflation is applied for salary plus benefit in subsequent years.
B. Contractor travel and per diem costs
The contractor will be expected to travel on several occasions throughout the duration of the project. In
2012/13 (year 1) the contractor will organize tool development workshops to develop and field test the
model with DFID staff. For Option 3, it is estimated that three workshops will be conducted – one in
London, one in Asia and one in Africa. Option 2 is estimated to require six tool development workshops
since it is likely that the new tool will need greater testing and modification than Option 3.
It is also anticipated that the contractor will make annual trips to London to meet with DFID Policy, FCPD
and Research Staff in Years 1, 2 and 3 of the project. The purpose of these trips is to share and discuss
preliminary annual results for clarification and agreement. In the final year of the project it is anticipated
that the contractor will make 2 trips to London, one of which will be to discuss and agree final year and
aggregate results, and the second trip will be to participate in a possible dissemination event of the
RMNH FfR final evaluation.
Tables 2 and 3 describe the contractor travel and per diem costs for Options 2 and 3.
Table 2
Contractor travel and per diem, Option 2
Option 2
2012/13
2013/14
2014/15
Total all
years
2015/16
Cost
Number
of days
No
staff
Number
of trips
total
Number
of trips
Total
Number
of trips
Total
Number
of trips
Total
Journey cost
100
n/a
2
3
600
1
210
1
221
2
463
1,494
Daily per diem
Africa
300
6
2
3
10,800
1
3,780
1
3,969
2
8,335
26,884
1,250
n/a
2
2
5,000
0
0
0
5,000
170
7
2
2
4,760
0
0
0
4,760
1,100
n/a
2
2
4,400
0
0
0
4,400
170
7
2
2
4,760
0
0
0
4,760
London
Airfare
Daily per diem
Asia
Airfare
Daily per diem
Total Direct
30,320
3,990
4,190
8,798
47,297
Indirect costs
@36%
10,915
1,436
1,508
3,167
17,024
Total costs
41,235
5,426
5,698
11,965
64,325
*A rate of inflation of 5% per annum is applied to airfare and per diem costs
** It is assumed that the contractor is a European Institution and therefore travel costs to London have
been estimated at £100 per trip. This may or may not be the case.
Table 3
Contractor travel and per diem, Option 3
Option 3
2012/13
2013/14
Cost
Numbe
r of
days
No
staff
Number
of trips
total
Numbe
r of
trips
Airfare
Daily per
diem
Africa
550
n/a
2
2
2,200
300
6
2
2
Airfare
Daily per
diem
Asia
1,250
n/a
2
170
7
Airfare
Daily per
diem
1,100
170
2014/15
2015/16
Total
all
years
Total
Numbe
r of
trips
Total
Numbe
r of
trips
Total
1
1,155
1
1,213
2
1,273
8,215
7,200
1
3,780
1
3,969
2
4,167
26,884
1
2,500
0
0
0
2,500
2
1
2,380
0
0
0
2,380
n/a
2
1
2,200
0
0
0
2,200
7
2
1
2,380
0
0
0
2,380
London
Total Direct
Indirect costs
@36%
Total
18,860
4,935
5,182
5,441
44,558
6,790
1,777
1,865
1,959
16,041
26,650
6,712
7,400
60,599
0
7,047
0
*A rate of inflation of 5% per annum is applied to airfare and per diem costs
Option 1 (internal DFID monitoring) and Option 4 (‘do nothing’ counterfactual) incur no travel and per
diem costs.
C
DFID travel and subsistence costs
As outlined in Section B above, DFID country office and policy division staff will participate in the
workshops for the development and field testing of the computerized model. Workshops will be
organised in Africa for African based staff, in Asia for Asian based staff and in London for UK based staff
plus a small number of country office staff. Option 2 is estimated to require twice the number of
workshops when compared to Option 3 since the former requires development of a new model and
computerized tool, whereas the latter only requires modification of an existing tool.
Since the development of the model is not a routine activity and is not a responsibility of Country Offices,
DFID travel and subsistence costs for these workshops are included in this Business Case.
Table 4 Cost per workshop for DFID staff participation
Average
airfare
Visa
cost
Accommodation
per day
Subsisten
ce per
day
Number
of days
Cost
per
person
Number of
travelling
participants
Total per
workshop
London
1,000
0
150
60
5
2,050
2
4,100
Africa
1,000
80
100
50
5
1,750
10
18,300
Asia
1,000
80
100
50
5
1,750
10
18,300
Table 5 Total cost for DFID staff participation in workshops, Options 2 and 3
Option 2
Workshop location
London
Africa
Asia
Total
Number of
workshops
2
2
2
6
Option 3
Total cost
8,200
36,600
36,600
81,400
Number of
workshops
1
1
1
6
Total cost
4,100
18,300
18,300
40,700
Options 1 and 4 will not incur DFID staff travel and subsistence costs.
Table 6 Summary of costs
Contractor salary and
Contractor travel
DFID staff travel and
benefits
and per diem
subsistence
Option 1
£0
£0
£0
£0
Option 2
£218,419
£64,325
£81,400
£364,114
Option 3
£166,093
£60,599
£40,700
£267,392
Option 4
£0
£0
£0
£0
Total
Benefits of each feasible option
The purpose of the project is to generate annual and final cumulative estimates of maternal and
newborn lives saved. As described under Section B above, Options 1 and 3 could generate results
beginning in 2012/13. Therefore the total number of result estimates for these Options will be 5 (annual
results for 4 years plus a final cumulative set of results). Under Option 2 the first set of results will be
available in 2013/14 and therefore the total number of results estimates will be 4 (annual results for 3
years plus a final cumulative set of results). Under Option 4, no results will be generated.
Summary of costs and benefits of each feasible option
The costs and benefits of each feasible option are described in Table 7, below. Option 3 (contract to
JHU) offers the lowest cost per result estimate.
Table 7
Option
Option 1
Option 2
Option 3
Option 4
Summary of costs and benefits of each feasible option
Number of result
estimates
5
4
5
0
Cost
Cost per result estimate
0
£364,114
£267,392
0
£0
£91,029
£53,478
n/a. No results estimated
D. What measures can be used to assess Value for Money for the intervention?
Measures that will be used to assess value for money of the intervention include:

Cost per annual results estimate generated

Number (%) of annual estimates produced on time

Average number of days taken by each health and/or results advisor to gather and submit input
data plus time taken for review and finalization of result estimates
E. Summary Value for Money Statement for the preferred option
Options 1 and 4 are not considered appropriate since these options will not generate robust estimates of
lives saved that would stand up to public scrutiny.
The preferred option is Option 3, contract to JHU to estimate maternal and newborn lives saved using
LiST. This option will generate results beginning in 2012/13, and offers the lowest cost per result when
compared to competitive tender. Additionally, since LiST is a widely accepted and utilized tool, results
estimated using LiST are likely to be credible to the global community.
Commercial Case
Indirect procurement
A. Why is the proposed funding mechanism/form of arrangement the right one for this
intervention, with this development partner?
The work will be funded through an Accountability Grant to JHU. The Accountability Grant will specify
the purpose to which DFID funds will be used, the schedule of disbursement and reporting
requirements. The Grant will also provide for DFID to modify or terminate its financial support if any
changes occur which, in the opinion of DFID, impair significantly the development value of the work
or if JHU does not deliver the expected outputs.
JHU has the technical competence to perform the work and is recognized globally for its expertise in
designing and implementing LiST. JHU has run a previous training workshop for DFID staff on the
use of LiST, hence has a proven record of accountability to DFID, and has demonstrated the
competence of JHU staff to provide training and to support DFID advisors.
B. Value for money through procurement
JHU’s technical and commercial capabilities have been assessed to ensure that it can offer
sustainable quality which represents value for money throughout the life of the project. By hosting a
short series of workshops (in DFID offices) economies of scale will be achieved in revision of the
LiST model. Demands on DFID staff time will be minimized by the creation of a template and
guidance for the submission of data for the LiST analysis. JHU will conduct the actual analysis and
will engage with DFID staff through telephone and/or VC for any required follow up.
Since DFID aims to engage with a partner with demonstrable competence to generate lives saved
estimates, at a lower cost than through competitive tender, direct engagement with JHU rather than
open competition is justified.
Financial Case
A. What are the costs, how are they profiled and how will you ensure accurate forecasting?
As shown in Table 12 below, the estimated budget for the project is £267,393. The main cost drivers
are contractor salary and benefits; contractor travel and per diem costs; contractor indirect costs; and
DFID staff travel and subsistence costs.
A. Contractor salary and benefits
Contractor staff assigned to the project include a Principle Investigator, Research Associate and
Administrative Coordinator.
The salary and benefit costs of contractor staff are presented in Table 8 below. As described
previously, the LOEs for the Principle Investigator and Research Associate are highest in 2012/13
and lowest in 2013/14 and 2014/15. The annual salary of each staff member in 2012/13 is taken as
the baseline and an inflationary rate of 3% is applied thereafter.
Table 8
Contractor salary and benefits, by year
Baseline
annual
salary +
benefits
Principle
Investigator
Research Associate
Administrative
Assistant
Total salary plus
benefits
2012/13
2013/14
2014/15
2015/16
Total
LOE
Cost
LOE
Cost
LOE
Cost
LOE
Cost
73,500
46,000
25%
40%
18,375
18,400
15%
25%
11,356
11,845
15%
25%
11,696
12,200
20%
30%
16,063
15,080
57,490
57,525
34,000
5%
1,700
5%
1,751
5%
1,804
5%
1,858
7,112
38,475
24,952
25,700
33,000 122,127
B Contractor travel and per diem costs
In 2012/13 two staff members will travel to London, Africa and Asia in order to conduct workshops for
development of the LiST tool and to meet with DFID staff to present and discuss the first set of
results. In 2013/14 and 2014/15 two staff members will make one trip to London for the presentation
and discussion of results, and in 2015/16 two staff members will make two trips to London for the
presentation of results and possible participation in a dissemination workshop for the FfR evaluation.
Estimated travel and per diem costs are presented in Table 9.
Table 9
Contractor travel and per diem costs, by year
Travel
2012/13 2013/14 2014/15 2015/16
Total
Airfares
8,000
1,155
1,213
2,547
12,915
Per Diem
15,560
3,780
3,969
8,335
31,644
Total travel costs
23,560
4,935
5,182
10,882
44,559
C Contractor indirect costs
JHU policy stipulates an indirect cost of 36% for agreements with non-research external
organisations where the bulk of JHU work is conducted ‘on campus’. This rate is applied to JHU
direct costs in Table 10 below.
Table 10
Contractor indirect costs, by year
2012/13
2013/14
2014/15
2015/16
Total
Total salary, benefits and travel costs
62,035
29,887
30,882
43,882
166,686
Indirect cost
22,333
10,759
11,118
15,798
60,007
D
DFID staff travel and subsistence costs
In 2012/13 DFID staff will participate in workshops to develop the LiST Tool. There will be three
workshops with approximately 12 participants each. For the London workshop the majority of
participants will be UK based while two will be from overseas. For the African and Asia workshops
two participants will be locally based while the other 10 will travel from other countries in the Region.
Estimated costs include flights, visas and subsistence.
There will be no DFID staff travel after the first year of the project.
Table 11 DFID staff travel and subsistence costs, by year
2012/13
2013/14 2014/15 2015/16 Total
Travel
22,000
0
0
0
22,000
Subsistence
17,100
0
0
0
17,100
Visa
1,600
Total DFID costs
40,700
1,600
0
0
0
40,700
Summary of costs
Table 12 Summary of costs
2012/13
2013/14
2014/15
2015/16
Total
Contractor salary and benefits
38,475
24,952
25,700
33,000
122,127
Contractor travel and per diem
23,560
4,935
5,182
10,882
44,559
Contractor Indirect
22,333
10,759
11,118
15,798
60,007
40,700
0
0
0
40,700
125,068
40,646
42,000
59,680
267,393
DFID staff travel and
subsistence
Total
Forecasts of spend
JHU will provide annual budget reports and forecasts of spend to the DFID Programme Officer. If
there is any need to adjust the yearly budget, within the total envelope above, this will be discussed
and approved by DFID in advance of any adjustment.
B. How will it be funded: capital/programme/admin?
Programme budget – sitting with the Group Management Unit (Aries 203368)
C. How will funds be paid out?
Funds will be disbursed to JHU quarterly in arrears upon receipt of a detailed statement of
expenditure and consistent with Blue Book requirements.
D. What is the assessment of financial risk and fraud?
JHU has in place reasonable policies and procedures and systems for managing its finances and
procurement. It has a well-established finance and administrative office and extensive experience in
managing project budgets. All costs will be incurred directly by JHU hence there is minimal risk of
financial mismanagement or fraud.
E. How will expenditure be monitored, reported, and accounted for?
JHU will maintain records of the disbursement of grant money and will report activities completed and
expenditure on a quarterly basis. JHU will submit Annual Audited Accounts for each financial year of
the Accountability Grant.
DFID will:

Review annual work plans and budgets to monitor efficiency and identify cost savings

Track progress and budget execution through quarterly narrative and financial reports
Financial tracking and payments will be maintained in ARIES in accordance with Blue Book
requirements.
Management Case
A. What are the Management Arrangements for implementing the intervention?
A Project Officer will be assigned within the ARHT for the day to day administration of the project
including financial tracking, compliance and other administrative functions. An A2 health advisor will
provide the lead technical role, with support from the A1 Maternal and Newborn Health Advisor and the
Maternal and Newborn Senior Research Fellows.
Within JHU the project will be managed by a Principle Investigator, a member of the senior faculty of
JHU, supported by an administration officer.
B. What are the risks and how these will be managed?
The main risks and strategies to mitigate these risks are presented in Table 13 below.
Table 13
Risks and mitigation strategies
Risk
Failure to determine input data and
to modify LiST to generate lives
saved estimates
Probability
Low
Impact
High
DFID country offices do not provide
input data to JHU for the generation
of annual estimates
Low
High
JHU does not generate results as
scheduled. Insufficient information is
available for annual reports
Low
Moderate
Results generated are not credible
with the global community
Low
Low
Risk Mitigation Strategy
A series of workshops will be held with
DFID staff to develop and refine the LiST
tool. The DFID Maternal and Newborn
Senior Research Fellows will peer review
the model and methodology during
development and prior to implementation.
DFID staff will be involved in the
development of the tool and awareness will
be raised through health advisor and
statistical advisor cadre meetings. Standard
methodology will be developed, including a
table for input data and guidance will be
prepared on how to complete the table.
JHU will provide ongoing support to country
offices to ensure that input data is complete
and accurate.
The contractual arrangement with JHU will
stipulate that funds will only be disbursed if
JHU provides results in accordance with
the planned schedule. The technical lead
will maintain regular contact with JHU to
ensure that JHU is on track to deliver
results.
JHU will be encouraged to disseminate the
revised LiST tool and to publish scientific
literature on the development and
implementation of the tool. The mid- term
review of the FfR will provide opportunity
for independent external review of the
approach taken with recommendations
made to DFID as necessary
C. What conditions apply (for financial aid only)?
n/a
D. How will progress and results be monitored, measured and evaluated?
Progress and results will be monitored and evaluated within the context of the overarching monitoring
and evaluation framework of the RMNH FfR. The FfR monitoring framework tracks progress against all
RMNH Level 2 indicators and includes both a mid-term review and final evaluation. The measurement
of lives saved will provide input data to inform both the mid-term review and final evaluation.
Success will be measured by the generation of country level and aggregate estimates of maternal and
newborn lives saved on an annual basis.
A logical framework has been developed with indicators and targets against which progress will be
monitored by DFID. The logical framework will form the foundation of annual output-to-purpose reviews
of the project to examine progress against outputs and outcomes. A project completion report will be
conducted by DFID as a final assessment of project performance.
Lograme
Quest No of logframe for this intervention: 3689191