CORE Plus Guide

User’s Guide for CORE Plus
(Analysis of Cost and Revenue Plus) Tool

Version 1
September 2007
Elizabeth Lewis
Thomas McMennamin
David Collins
Management Sciences for Health
The tool is based on CORE, the Cost and Revenue Analysis Tool, developed by Management
Sciences for Health (MSH) (www.msh.org).
No part of this publication, including the related spreadsheet-based tool, may be reproduced or
transmitted in any form or by any means, electronic or mechanical, including photocopy,
recording, or information storage and retrieval system, without prior permission of publisher. In
any use of the publication or tool, credit must be given to MSH.
The use of the spreadsheet-based tool requires a license for the appropriate software, such as
Microsoft Excel, available under license from Microsoft Corporation. This tool is not a product
of Microsoft Corporation and is not guaranteed by that company.
CORE and CORE Plus were developed in part through support from the U.S. Agency for
International Development (USAID), under various projects. Further modifications have been
made with funding from MSH. The opinions expressed in this guide are those of the authors and
do not necessarily reflect the views of USAID or Management Sciences for Health.
CORE Plus User’s Guide version 1 page 2

Table of Contents
Overview......................................................................................................................................... 4
1. Introduction............................................................................................................................... 5
2. Description................................................................................................................................ 8
3. General tips ............................................................................................................................. 10
4. Step-by-step guidelines........................................................................................................... 11
4.1. Starting.........................................................................................................................11
4.2. Setting the assumptions................................................................................................12
4.3. Entering utilization data...............................................................................................16
4.4. Entering data on service staff.......................................................................................19
4.5. Calculating staff costs. .................................................................................................23
4.6. Calculating fixed and administrative staff costs. .........................................................24
4.7. Examining total facility costs.......................................................................................26
4.8. Examining total facility revenue..................................................................................27
4.9. Analyzing the results....................................................................................................28
4.10. Comparative reports.....................................................................................................34
5. Changing norms and prices..................................................................................................... 38
6. Comparing facilities................................................................................................................ 39
7. Cautions .................................................................................................................................. 40
ANNEX A: NORMS .................................................................................................................... 41
Table A-1: Clinic-level (Level A) service need norms............................................................42
Table A-2: Referral-level (Level B) service need norms.........................................................44
Table A-3: Standard minutes per clinic-level (Level A) service .............................................45
Table A-4: Standard minutes per referral-level (Level B) service ..........................................47
ANNEX B: FLOWCHARTS OF CALCULATION METHODS................................................ 48
B-1: Calculation of Services Needed.......................................................................................49
B-2: Calculation of Staffing Numbers .....................................................................................50
B-3: Calculation of Cost per Service .......................................................................................51
ANNEX C: UNDERSTANDING AND REVIEWING THE SERVICE PRACTICE
WORKSHEETS...................................................................................................................... 52
ANNEX D: LIST OF DATA REQUIRED FOR A CORE PLUS ANALYSIS........................... 58

Overview
This guide contains the following sections:
1. Introduction
2. Description
3. General tips
4. Step-by-step guidelines
5. Changing norms and prices
6. Comparing facilities
7. Cautions

1. Introduction
The purpose of the CORE Plus tool is to help managers and planners estimate the costs of
individual services and packages of services under different scenarios. These cost estimates are
based on certain norms, and the estimated costs can be compared to actual costs to see the
variations between the two sets of figures.
The tool is adapted from a previous cost and revenue analysis tool called CORE1, developed in
1998 and used in many countries. This version of the tool was adapted for costing priority health
services (in the accompanying example, key reproductive health and child survival services).
One major difference between CORE and CORE Plus is that this more recent version contains a
new component—a population and epidemiological section—to allow the user to estimate the
expected numbers of services, depending on disease prevalence and incidence rates, the size of
the facility’s catchment population, and so on.
The purpose of the tool is to estimate the cost of each type of service in a facility that provides an
integrated priority service package. Different countries and regions each have their own
definitions of which services are included in a basic package of services; the illustrative
spreadsheet that accompanies this User’s Guide is based upon Haiti’s Priority Service Package
(PSP), which focuses on reproductive health and child survival services.2
A standard costing approach has therefore been used, as is used in some hospitals3. In this
approach, a standard unit cost is established for the variable costs of each service, and the total
variable costs are then estimated by multiplying those unit costs by the numbers of services.
Standard semi-variable or step-variable costs, such as nursing staff, are set to vary with major
changes in the quantity of services provided. For example, if a nurse spends 30 minutes with
each new client on a family planning visit, then the facility would need to hire an additional
nurse for every 16 new family planning clients per day (assuming an eight-hour shift). Standard
fixed costs, such as rent, are set to remain constant notwithstanding changes in service volumes.
Total standard costs can be used for projecting funding needs; in addition, they can be compared
with actual costs to determine efficiency. Capital costs are not included although it is possible to
include depreciation.
In CORE Plus, standard costs are based on normative4 costs. Rather than model the standard
costs on current installed capacity in facilities, these costs are based instead on certain norms.
For instance, the Service Practice Worksheets provide detail on which types of staff provide
certain types of health services, as well as the drugs, supplies and lab tests that should be used for
such cases. Thus, if we know the unit costs of each of these cost elements, we can determine the
normative cost to treat each type of case. The Service Practice Worksheets included in CORE
Plus specify staff times that have been developed by a small team of health care providers based
on their experience. All treatment guidelines described in the Service Practice Worksheets
are norms that were established for a specific application of the tool and do not represent
1
Available from Management Sciences for Health, Boston (www.msh.org).
2
See André, Jean et al., Paquet de Services Prioritaires, Projet Haïti Santé 2004, June 2000.
3
Herkimer, Jr., Allen G. Understanding Hospital Financial Management. 1986. Aspen Publishers Inc.
4
In this model, normative is taken to mean desirable, not average.

international standards. The estimated types and quantities of drugs, supplies, and tests in the
sample spreadsheet are based primarily on Ministry of Health treatment guidelines in Haiti.
CORE Plus takes into account the fact that there may be regional differences in some of the
costs. For example, personnel in more remote rural areas may receive bonus payments as an
incentive for them to work in these more isolated areas. Similarly, the cost of drugs and supplies
may be higher in more remote areas, simply because the extra cost of transporting the supplies
must be included in the total cost.
Some of the norms and standards used in CORE Plus are shown in the Annexes. The norms
used to estimate the numbers of services needed at the clinic and referral levels are shown in
Tables A-1 and A-2 of Annex A. In addition, the standard times used to determine direct salary
costs are shown in Tables A-3 and A-4. The standard quantities and costs of other resources
used in the tool, such as drugs and tests, are not shown here because of space limitations. The
norms, standards, and prices should be reviewed and modified, where necessary, before using the
tool. Again, these norms are not international standards, but rather norms developed by
health care providers working in the context of country where the tool was recently
utilized.
The tool is a dynamic model built on spreadsheets, and can be used for community-based
services, dispensaries (Disp.), health centers (HC), and hospital/referral level. A user can
immediately see the impact of changing key variables, such as the number of services, on
resource requirements and costs. Also a user can easily see the formulas used in the tool and
can, if necessary, change them. The norms and standard costs used in the tool can easily be
adjusted and can thus be updated regularly or modified for a particular region or province. This
includes incidence and prevalence rates, service utilization rates, Service Practice Worksheets,
salary levels, drug prices, and administration costs. Where new services are added, these can
also be included.
CORE Plus allows the user to compare a variety of standard costs. First, if the user knows the
size of the catchment population and the prevalence or incidence rates of illness or conditions
such as pregnancies, the tool will estimate the quantity of services needed, thus indicating the
resources and funding required to provide priority health services to a specified population.
Standard costs can also be estimated for the actual numbers of services provided, and compared
with actual costs to indicate the level of efficiency. In addition, standard costs can be estimated
for projected numbers of services, where the user wishes to see the cost impact of increasing or
decreasing certain services.
It should be noted that the version of the tool distributed with these guidelines reflects the direct
costs of most of the curative ambulatory care services provided within the facilities, as well as
defined community-based services. This version does not, however, provide estimates of total
primary health care costs, since it covers only those services that are defined in the priority
health services package.
The tool has several uses for a planner or manager. It can be used to estimate:

• the cost of providing a particular package of services, such as a priority health services
package,
• the cost of different service delivery models, such as community-based or facility-based,
• ideal staffing patterns for different numbers and mixes of services,
• efficiency levels of services currently provided, and
• estimated prices for contracting services in areas where services are not currently offered.
The remaining sections of this guide describe how to use CORE Plus. This is intended to be a
simple introductory guide and does not cover all aspects of the tool in detail. It also provides
basic, but not detailed, guidance on interpreting the results of the tool. Further assistance may be
obtained from the authors, who may be contacted through Management Sciences for Health.

2. Description
CORE Plus is contained in a Microsoft Excel workbook, which is a collection of individual
worksheets linked together. You have two separate Excel files; one is a blank template, and the
other is a filled-in workbook that contains sample data for a fictitious health facility.
• Worksheet A: Assumptions is used to enter general information such as the population and
working hours of the facility.
• Worksheet B: Need is used to enter and calculate the number of each service provided by the
facility, based partly on the population data in worksheet A.
• Worksheet C: Service_Staffing is used to enter and calculate the number of staff, the
proportion of time that they spend providing services, and the cost of each type of staff.
• Worksheet D: Staff_Costs is used to calculate and allocate staff costs, based on figures from
worksheet C and the individual service practice worksheets.
• Worksheet E: Fixed_Costs is used to enter the cost of administrative staff and other costs,
such as electricity.
• Worksheet F: Total_Costs is used to enter some special costs, to calculate variable costs
based on figures from worksheet B and the individual service worksheets, and to aggregate
costs from the worksheets D and E.
• Worksheet G: Revenue is used to enter information on fees charged (if any) for the services
provided. The user can also enter information on waivers or exemptions.
• Worksheet H: Summary is used to present the costs in different ways based on figures from
worksheet F.
• Worksheet I: Reports is used to present comparisons of key figures under different scenarios,
drawing mainly on figures in worksheet H.
• Individual Service Practice Worksheets contain the standard quantities of resources used for
each service, including the average time of each type of staff person, as well as the drugs,
supplies, and lab tests used. Annex C provides an overview of the layout and rationale
behind the service practice worksheets.
The diagram below shows how the different worksheets in the workbook are linked:

Figure 1. Relationship of the worksheets in CORE Plus workbook
Cost elements:
• D. Staff costs
A. Assumptions B. Need C. Service • E. Fixed costs
Staffing • F. Total costs
I. Reports
G. Revenue H. Summary (comparing different
scenarios)
Key:
Service practice
worksheets Output/
(Normative quantities for Input/
Results
each service: staff time, Data entry
drugs, supplies, and lab
tests)

3. General tips
Here are a few general tips to help you as you use the tool.
If you are not very familiar with Excel, the following brief explanation of terms should help:
− Excel spreadsheets are comprised of rows and columns. The rows are labeled with
numbers—for example, row 3 or row 124. The columns are labeled with letters—A, B,
C, and so on. Each place where a row intersects with a column is called a cell, and each
cell is referred to by its column letter and row number. So, for example, if the directions
tell you to go to cell A4, you would find the cell in the first column, four rows from the
top of the sheet.
− An Excel workbook can contain several worksheets. Each worksheet has a name, which
can be seen on the worksheet tab at the bottom of your screen.
− The active worksheet is the one with its name highlighted. If you need to go to different
worksheets within the same workbook, simply click with your mouse on the name of the
worksheet tab that you want, and Excel will move the cursor to that worksheet.
The cells used for entering data are shaded green (e.g., facility name, catchment population). The
other parts of the workbooks that are not shaded green contain formulas or pre-set calculations.
You should not erase or change cells in these parts of the tool. The Service Practice Worksheets
and prices in the individual worksheets should be changed only at national or provincial levels
(see Section 5).
Each worksheet is protected to prevent formulas from being deleted or changed. You may still
type in the areas shaded green, but if you try to change other cells you will see an error message.
If you need to make changes to a worksheet, you will have to unprotect the worksheet first (from
the Tools menu, choose Protection, and then Unprotect Sheet. After you have finished making
your changes, choose Tools, Protection, Protect Sheet, and then click OK). We recommend
that the head of each organization (or the national or provincial level, if being used in the public
sector) protect the sheets with a password so that standards and formulas cannot be changed at
lower levels.
We have included comments in the tool to provide more detail when necessary. For example,
comments are included to show where some of the prevalence or incidence rates were obtained.
They also explain how certain calculations were done. If a cell contains a comment, you will see
a small red triangle in the upper right-hand corner of the cell. The comment itself will not
display automatically. If you would like to read the comment, move your mouse so it is on the
cell that contains the comment, and the comment will “pop up” on your screen. Move the mouse
off the cell to make the comment disappear again.

4. Step-by-step guidelines
4.1. STARTING
Note: Annex D provides a list of the data needed to conduct a CORE Plus analysis; you may
wish to print Annex D and gather the required data before reading further.
You should use the “blank” workbook, not the “example” workbook to enter data for your
facility. As soon as you open the “blank” workbook file you should see a dialog box asking if
you want to “Enable Macros”. You should click on the “Enable Macros” button. When the file
opens you should click on File and then Save As and save the file with a new name—preferably
the name of the facility and year so that you can recognize it in the future. This way the “blank”
version of the file can be used for other facilities, or for future years at the same facility.
When you open the file you should see the screen below (see Figure 2). You work through the
workbook in the order of the pages, so you should start with the page labeled A_Assumptions,
then move on to B_Need, and so on. You can see the names of the various worksheets on the
different tabs near the bottom of the screen, and you can tell that A_Assumptions is the “active
page” because its name is highlighted on the worksheet tab (all the other worksheet tab names
are shaded gray).

Figure 2. Starting screen (A_Assumptions) of CORE Plus
4.2. SETTING THE ASSUMPTIONS.
Preliminary data: You will enter some preliminary data first. The data that you type will
appear on each worksheet in the workbook, so that when you print your results you will always
know which facility, time period, and currency were used for the calculations.
• Begin on the page titled A_Assumptions (the worksheet shown above). Enter the name of
your facility in cell B1 (put the cursor in cell B1 and type the name of your facility).
• Type the period for which you have data in cell B3. For example, if you are looking at costs
and utilization for the year 2006, enter the number 2006 in cell B3. If you are looking at
quarterly data, you may type in something like “Jan-Mar 2006” to indicate the time period.
• In cell B4, type in the currency you are using (e.g., francs or pesos).
Question A1: type of facility. Click on cell G8. You will see a small arrow appear at the right
of the cell. This is a restricted cell, that is, you may fill it in only with a number of pre-set

choices. Click on the arrow at the right of the cell and you will see a drop-down menu.
Highlight the appropriate choice and hit the Enter key.
Question A2: location of facility. Click on cell G10 and choose the location (primarily urban or
rural area).
Question A3: catchment population. Enter the facility’s clinic-level catchment population in
cell G12. This is the catchment population for which you provide clinic-level (or first tier)
services. If your facility also sees patients who are referred from other facilities (or from within
your own facility), you will enter the referral catchment population in a subsequent step. For
example, your facility might be part of a larger network of facilities, and the smaller ones refer
their more serious cases to your facility. Thus, your referral catchment population would be
larger than your clinic catchment population (i.e., the people who use your facility for basic
services because your facility is the closest to them geographically).
Figure 3. Relationship of clinic- and referral-level catchment populations
Health clinic A Health clinic B

catchment catchment
population population
Health Center
Health clinic F G catchment Health clinic C
catchment population catchment
population (clinic-level population
services)
Health clinic E Health clinic D

Referral catchment catchment
catchment population population
population for
Health Center G
Question A4: population distribution. Enter the population distribution (in percentages) for
the different age groups in your catchment area in cells C16 through D21. The actual numbers
will then be calculated automatically. If you do not have the distribution for your area, you can
begin by using national or regional figures and then changing them when you have more
accurate data. (The tool links to generic distribution figures, based on the location you chose in
step A2, but you may overwrite the formulas with actual percentages if they are different.)
Question A5: referrals. This question also has a pull-down menu choice. Click on cell G24,
click on the drop-down arrow, and choose Yes or No by highlighting the correct response.

Question A6: referral catchment population. If the answer to the previous question was No,
this question is not applicable and will be shaded in gray. If the answer to question A5 was Yes,
you will need to enter the referral catchment population of the facility here, in cell G27. The
population figures for each age bracket will calculate automatically when you enter the total
referral catchment population.
Question A7: contraceptive prevalence rate. While most assumptions related to service
utilization are on the second worksheet page, B_Need, this assumption is separated because it is
used to calculate more than one rate on the B_Need page. Enter the contraceptive prevalence
rate in your area, expressed as a percentage (e.g., 66%), in cell G38.
Question A8: percentage of population served. In cell G40, enter the percentage of people in
your catchment area who are served at your facility. If there are no other health services
available in the area, and people seek care at your facility, you may enter 100%. If other
facilities compete with yours, if many people go to traditional healers, or if some people do not
seek care when ill, then you would enter an estimate that is less than 100%.
Question A9: hours per day that the facility is open. Click on cell G42 to get a drop-down
menu of choices. If your facility is open different hours on different days, you may take the
average and enter it here. For example, if you are normally open Monday through Friday from
08:00 to 16:00 (eight hours per day), but you have extended hours until 18:00 on Mondays and
Wednesdays, and until 17:00 on Thursdays, your average would be (10+8+10+9+8)/5, or nine
hours per day.
Question A10: days per week that the facility is open. Click on cell G44 and choose the
appropriate response from the drop-down menu.
Question A11: days per year that the facility is open. Enter the number of public holidays in
cell G47, and then answer the Yes/No question directly below it in cell G48. If the facility is not
open on public holidays, this number will be subtracted from the total number of days available.
Question A12: available work days per staff person. Enter the average number of days that
staff take leave (cell G52), need to use sick time (cell G53), and spend time in training (cell
G54). The total of these numbers is subtracted from the number of days per year that the facility
is open to get the average number of available work days per staff person.
Question A13: staff turnover rate. Your facility may have low, medium, or high level of
turnover, depending on many factors. For instance, you may have high turnover because your
facility is located in a particularly remote area. Click on cell G57 and choose the estimated level
of turnover for your facility.
Question A14: average base salaries. Later in the data entry process, on the
C_Service_staffing page, you will type in detailed data about actual staff at your facility.
However, one of the features of this tool is that it will show you different scenarios so that you
can compare different situations. For example, if your facility has never offered child survival
services before, but you would like to start offering these services, you can determine estimated

costs to do so, as well as estimated staffing need. This question asks you to enter average base
salaries (before benefits are calculated) so that, even if you do not have a particular type of staff
person currently, you can still get reasonable cost estimates for providing new and different
services in the future. The figures should be entered in cells G61 through G73. (The types of
staff named in this question are illustrative, based on staffing in a number of countries; the staff
categories can be adapted to your own situation if need be.)
Question A15: ratio of benefits to base salary. Enter in cell G75 the average ratio of benefits
to base salary. For instance, if all staff receive an allowance to cover the cost of uniforms, meals,
etc., figure out the percentage of these additional benefits to the base salary.
Question A16: normative percentage of direct service time. In cell G77, enter the normative
percentage of direct service time. That is, on average, how much time do clinical staff spend
with clients or on client-related activities? For instance, a nurse may spend 80% of her time with
clients, and the remainder of her time in administrative meetings.
Question A17: transport cost on drugs purchased. If the base prices of the drugs need to be
adjusted due to the additional cost of transporting them to your facility, enter that percentage
here in cell G79.
Question A18: transport cost on supplies purchased. If the base prices of the medical
supplies need to be adjusted due to the additional cost of transporting them to your facility, enter
that percentage here in cell G81.
Question A19: average mark-up for drugs. If your facility sells the drugs for more than the
purchase cost, enter the percentage mark-up here in cell G83 (e.g., if you charge patients 2%
more than what your facility paid for the drugs, you would enter 2% in cell G83).
Question A20: average mark-up for medical supplies. If your facility passes along the cost of
medical supplies (e.g., syringes, sutures, and bandages) to patients, and the price charged is
higher than the purchase cost, enter the percentage mark-up here in cell G85.
Question A21: average mark-up for laboratory tests. If your facility passes along the cost of
laboratory tests (e.g., HIV test or malaria smear) to patients, and the price charged is higher than
the purchase cost, enter the percentage mark-up here in cell G87.
Question A22: average mark-up for radiology services. If your facility charges a fee for
radiology services, and that fee is higher than the cost, enter the percentage mark-up here in cell
G89.
Question A23: exchange rate for price conversions. If some of the normative prices (e.g., the
unit costs of drugs) are in dollars or another currency, enter the exchange rate in cell G91. If all
figures used are in the local currency, enter the number 1 in this cell.
Question A24: scenario selection. The available scenarios are as follows:

• Scenario A: Actual Services and Actual Costs. This scenario reflects the actual services
provided, based on the entries in row 21 of worksheet B_Need. It also reflects the actual
expenditures made, for example the expenditure on drugs and supplies purchased.
• Scenario B: Actual Services and Normative Costs. This scenario reflects the actual services
provided, as under Scenario A. But it substitutes the normative costs for the actual costs.
Thus, it reflects the number of staff that should be employed according to the staff times used
in the Service Practice Worksheets instead of the actual number of staff. The numbers of
staff required are rounded to the next whole number on the assumption that part-time staff
cannot be used (e.g., if 3.4 nurses are required, the figure is rounded up to 4). Similarly it
reflects the quantities of drugs that should be used instead of the quantities of drugs
purchased.
• Scenario C: Needed Services and Normative Costs. This scenario reflects the estimated
numbers of services needed, based on the population, incidence and prevalence rates and
expected service utilization rates (as shown in row 19 of worksheet B_Need). It also reflects
the quantities of resources (staff, drugs etc.,) that should be used to provide the needed
services.
• Scenario D: Projected Services and Normative Costs. This scenario reflects the projected
numbers of services entered in row 20 of worksheet B_Need, where the user wishes to see
the costs of services that are different from the actual services and the needed services. The
normative costs are used to estimate the total costs.
• Scenario E: Projected Services and Ideal Staff. This scenario uses the same numbers of
services as Scenario D, but estimates the staff costs based on an ideal number of staff. This
shows the total staffing pattern and cost if one can employ part-time staff as needed. For
example if the services require 3.4 professional nurses, the tool includes only the cost of
those 3.4 nurses.
For now, you should choose Scenario A, until you have finished entering the service statistics
and current data for your facility. Later, you will change this to see how the different scenarios
affect number of visits, costs, and so on (see Section 4.9, which discusses how to analyze the
results). Some of the figures shown on the worksheets depend on the current scenario (that is,
the one that was last selected). To make it easier for you to remember which scenario has been
selected, look at cell B5 of worksheets B_Need through H_Summary; the scenario name
appears in that cell.
4.3. ENTERING UTILIZATION DATA.
Now move on to the second sheet in the workbook, B_Need. See the sample screen below in
Figure 4. To do this, simply click with your mouse on the worksheet tab near the bottom of your
screen. The worksheet will become the active worksheet and the tab will be highlighted.

Figure 4. The B_Need page of CORE Plus
Across the top of the worksheet, you will see the name of the facility and the time period that
you filled in on the A_Assumptions page. These data appear on each sheet automatically for
easy reference.
In row 9, you will see a list of the services that have been defined as the priority service package,
both at the clinic and referral level. (If you said on the first page that your health facility does
not handle referral cases, the referral part of the worksheet will be shaded gray).
Underneath row 9, the tool automatically calculates the estimated quantity of services.
• First, it automatically calculates the relevant population. For example, for prenatal care, the
relevant population is comprised of women of reproductive age (age 15-49). The figures
come from the population distribution entered on the A_Assumptions page.
• Next you will see the prevalence or incidence rate. If you have any questions about how the
rate was determined, move your mouse over the cell to see the comment.
• These two numbers are multiplied together to give you the “Total Quantity of Cases” figure
in row 13.
• Row 14 shows you the percentage of people expected to use services at your facility—again,
this figure is based on your answer to the question on the A_Assumptions page about the
percentage of population served at your facility.

• Row 15 shows the result of the Total Quantity of Cases times the estimated percentage of
people served at your facility.
• Rows 16 and 17 apply only to referral cases. Of the quantity of cases that you expect to see,
what percentage will actually be referred after a primary care visit? The result appears in
row 17.
• Row 18 contains norms set at the national, provincial, or district level for a reasonable
number of services or visits per type of case. In our example, for prenatal care, the norm is
three visits per pregnancy.
• Finally, the quantity of cases is multiplied by the quantity of services to get an estimate of the
quantity of services needed; the figure is shown in row 19.
The above calculations are shown visually in Flowchart B1 in Annex B.
Actual services:
Enter your own data in row 21, labeled Actual services. If your facility offers referral services
but you do not have the data separated by clinic-level versus referral-level, enter your data in the
green-shaded area in row 38 instead, and the services will be split automatically for you, based
on the proportion of services needed as calculated above. (This is not an ideal solution, because
your facility may have different referral patterns, but it will give you a rough idea of how the
cases might be divided between the two levels.) Note that the total number of all services should
be slightly more than the total number of visits to the facility (headcount), since some patients
would have received more than one service when they visited the facility.
Note for users who enter data in row 38 rather than row 21:
• After entering your service figures in row 38, go back to row 21 and enter a formula in cell
C21: type the equal sign, followed by the cell reference C39. The formula will be:
=C39
• Copy this formula across to each green-shaded cell in row 21 (both for clinic-level and
referral-level services).
Projected services:
If you would like to see the staffing and cost impact of adding new services, or significantly
changing the quantity of services offered, you may enter those figures in row 20. For example, if
you do not currently offer child survival services, but you want to see the effect of adding the
child survival services described in the PSP, you can copy the figures on actual services from
row 21 into row 20, and then copy the quantity of “needed visits” for child survival from row 19
into row 20. Then, when you run the scenarios, you can see the effects of adding this service.
Adding and deleting services

The services that comprise the Priority Service Package (PSP) are named in each column of the
B_Need page of CORE Plus. It is possible that your facility offers additional services that are
not included in the PSP. If this is the case, you may wish to add extra columns to the tool to
show the full range of services provided. You will need to add columns to each worksheet page
that shows a listing of the services, and you will have to develop Service Practice Worksheets for
these other services.

It is possible to include more services by adding more columns. However, it is better if this is
done by a person with advanced spreadsheet skills, as great care must be taken with the copying
of formulas to avoid errors. Deleting columns should also be avoided as this will also cause
errors if not done properly. (If you do not offer certain services and do not want them to appear
on a printout of your results, you can hide the columns instead.) If you do not wish to include a
service you can use the Projected Services feature described above and put zero against that
service.
4.4. ENTERING DATA ON SERVICE STAFF
Now click on the third worksheet tab, C_Service_staffing. You will see a sheet like the one
below in Figure 5. This sheet is used to enter and calculate figures for staff who provide services
directly to patients.
Questions C1, C2, C3, C4, and C5 are answered automatically from the information entered in
worksheet A_Assumptions.
Figure 5. The C_Service_staffing page
For the following section, the Salary Costs Worksheet (rows 13-82), you fill in the names and
positions of staff working at your facility.

This section is divided into staff categories. That is, 13 staff categories have been defined in
each of the Service Practice Worksheets. For lower-level facilities, based on these guidelines,
you most likely will not have some categories of staff. The assumption is that lower-level
facilities do not need staff such as a Pediatrician, Anesthesiologist, Radiologist, or General
Practitioner. This is because patients coming for community-based or Dispensary services do
not need to see these types of staff. However, if your facility is a Health Centre (HC) or
Hospital, you would need staff working in these roles.
For each type of staff category, you will need to fill in some data. Below is a description of each
column on the C_Service_staffing page, and what data (if any) you need for each one. Some of
the columns contain formulas; for these, you do not need to fill in data. The formulas are already
part of the tool, and Excel will perform the calculations automatically when you enter data in
other areas of the tool.
• Column B: Name (and position, if needed for easy reference). The first row of each block
(e.g., cell B15) shows the category of job; this is linked from the A_Assumptions page. In
the second and third rows of each block (additional rows can be added if necessary for a
particular category of staff), enter the name of each staff person. Note that you should not
include any volunteer or visiting staff who are not paid from the facility budget.
• Column C: Do you have this type of staff? This is a Yes/No question. Click in the cell and
then click on the arrow to the right of the cell. Choose Yes or No. A message will appear,
beginning in column E. It will either say “OK” or give you an error message. This is to help
guide you with the data entry. For example, if you say that you have a Radiologist, but your
facility does not handle referral cases, you will get an error message because the Service
Practice Worksheets indicate that a Radiologist’s services are not used at the Dispensary or
Health Centre level (i.e., the Radiologist handles only the more complicated cases at the
referral level).
• Columns D and E: Ideal Number of Staff and Number of Staff (rounded up). These two
columns calculate figures automatically, based on utilization data and the norms in the
Service Practice Worksheets. Ideal Number of Staff refers to the number of staff per
category that you would need if the Service Practice Worksheets were followed. This
calculation assumes that you have flexibility in hiring; for example, if you only need
someone half-time, you would be able to hire a person to work half-time. Number of Staff
(rounded up) is calculated based on the assumption that you may not have hiring flexibility.
For example, if you only need someone to work two hours per day, you still might need to
hire someone full-time, due to hiring regulations. The method used to calculate the number
of staff is shown in Flowchart B2 in Annex B.
• Column F: Actual Number of Staff. List the actual number of staff here. If you are listing
staff individually by name, the number will usually be 1. However, if you have several staff
working at the same level, you might want to list them together. For example, you might
have five Professional Nurses who all have identical salaries and who spend all their time in
a similar way, so you would list “5” under Actual Number of Staff. Do not list staff

together unless they all work in the same area performing similar tasks, and unless they
all earn the same salary. If their salaries are different, or they spend their time
performing different tasks, list them separately. For example, of these five nurses, one
may work primarily providing reproductive health care and another may work half-time
providing pediatric care. You would list them separately under the appropriate categories. If
a person works less than full-time, calculate the amount of time worked and enter it
here instead of “1.” For example, if a full-time person works eight hours per day, five days
per week, and you have someone who works two hours per day, five days per week, this
person works 2/8 of a full-time shift, or 1/4, or 0.25. You would enter 0.25 for Actual
Number of Staff.
• Column G: Number of Staff for this Scenario. You do not need to fill in anything in this
column; the tool will calculate it automatically for you, based upon which scenario you have
chosen.
• Column H: Average Gross Salary (for FT). In this column, you fill in the base salary for
the staff person, not including the benefits. If you have someone working less than full-time,
you would fill in the salary for a full-time person; the tool will calculate the prorated salary
for you.
• Column I: Average Salary including Benefits. This calculation is performed by the tool. It
takes the base salary you have entered and adds the value of the benefits provided, to arrive
at the total compensation package for the staff person. Note that the figure in the subtotal
line is based on a full-time salary, so if the staff person works less than full-time, the figure
will appear high. Adjustments for staff working less than full-time should appear in the next
column.
• Column J: Total Annual Salary. This is a weighted average calculation of salary plus
benefits for all staff working within a staff category type. You do not need to enter data here;
the tool does the calculations automatically.
• Column K: Hours Worked per Year. Again, you do not need to fill in data here. The
formula takes the number of staff and multiplies it by the number of hours that the facility is
open per year (based on assumptions you entered on the A_Assumptions page).
• Column L: Average Salary per Hour. This is another automatic calculation. It is the total
annual salary (column J) divided by the hours worked per year (column K).
• Column M: Direct Service Time (%). Enter a decimal to indicate how much time each
staff person spends on direct service to clients. This is time in consultation, or time filling
out a patient’s chart. It does not include participation on committees or administrative duties.
For example, if someone spends 80% of his time on direct service to clients, you would enter
0.8 in the appropriate cell of the tool.
• Column N: Total Direct Service Time. This is another automatic calculation, based on
direct service time and whether the person works full-time or not.

• Column O: Annual Direct Service Salary. This is an automatic calculation; it is the
proportion of the salary that is allocated to direct service, based on the percentage of direct
service time that you entered in column M.
• Column P: Total Direct Minutes Available. This is also an automatic calculation; it

multiplies the hours worked per year by the direct service time percentage, and then
multiplies the result by 60 to convert from hours to minutes. Figures are expressed in
minutes because the times are listed in minutes in the Service Practice Worksheets, so that is
the unit for calculations elsewhere in the tool as well.
• Column Q: Annual Admin. Salary. This is another automatic calculation. The Annual
Direct Service Salary (Column O) is subtracted from the Total Annual Salary (Column J) to
give the part of salary and benefits that are allocated to Administrative costs.
The method used to calculate direct, indirect, and administrative salary costs is shown in
Flowchart B3 in Annex B.
Following are some common questions and explanations.
What if I get an error message when I say that I have a particular type of staff person?
If the tool gives you an error message if you indicate that you have a particular type of staff, it is
because of the personnel time norms set up in the standard treatment protocols. For example, if
you enter data in the tool to show that your facility has an Obstetrician/Gynecologist, but your
facility is not a hospital, you will get an error message. Is this specialist handling cases that
could be seen by a professional nurse? If so, list the specialist under the category of professional
nurse. On the other hand, if your facility does handle referral-level cases, then your data on the
B_Need page should reflect that; you should list actual number of services provided at the
referral level.
What if my staff have multiple qualifications and serve in more than one type of staff
category?
CORE Plus will calculate staffing patterns for you, based upon the utilization data you entered
and the times listed in the Service Practice Worksheets. It is possible that you will have staff
people who work under more than one staff category. For example, a Professional Nurse has
also been certified to treat pediatric patients, but you do not have a separate nurse assigned to
that role exclusively. If this is the case, talk with the nurse and the supervisor to determine
approximately how much time the nurse spends in each role, and enter the calculations
accordingly. For example, a full-time Professional Nurse might spend 50% of her time in the
Professional Nurse role, 30% of her time working in the community as a Community Health
Nurse, and 20% of her time carrying out administrative activities. You would list the nurse twice
on the staffing page: once under the Professional Nurse category, with “Actual Number of Staff”
set to 0.6, (50% direct time and 10% administrative time) and once under the Community Health
Nurse category, with “Actual Number of Staff” set to 0.4 (30% community work and 10%
administrative work).

In rows 85 through 88 at the bottom of this worksheet (row numbers may differ if you have
added extra rows for staff categories above), the tool sums up the total direct minutes available
for all staff that you have listed; the total direct service salaries; the total administrative salaries;
and the total number of service staff full-time equivalents (FTEs) for the scenario that you have
chosen. These totals are used in calculations elsewhere in the tool.
4.5. CALCULATING STAFF COSTS.
Staff cost calculations take place on the sheet D_Staff_Costs. You do not need to enter any data
on this sheet. A brief description appears below:
• As mentioned earlier, for each type of service defined in the package, there are Service
Practice Worksheets. The number of minutes that each staff category spends with a client is
referred to in the section D1 of D_Staff_Costs.
• In section D2, the total quantity of services is multiplied by the number of minutes for each
service, to get the total estimated number of minutes spent per year by each type of staff.
• In section D3, the total minutes are multiplied by the average salary per minute (average
salary per hour divided by 60 minutes per hour). This figure shows the estimated cost to
provide the service staff time over the year.
• Section D4 calculates the “indirect” cost of staff providing patient care. In this case,
“indirect” does not refer to administrative time. Rather, it measures the cost of staff
inactivity. For instance, if a nurse was ready, willing, and available to see three patients per
hour, but she saw only two patients per hour for scheduling or other reasons, the cost of the
“down” time or slack time is figured in this section.

Figure 6. The D_Staff_Costs page
4.6. CALCULATING FIXED AND ADMINISTRATIVE STAFF COSTS.
Next, click on the fifth worksheet tab, E_Fixed_Costs. Here you will enter data on
administrative staff costs and fixed costs such as electricity, water, cleaning, security, and so on.
You will also enter the amounts spent on drugs, supplies, and tests (lab, x-ray). See Figure 7
below.

Figure 7. The E_Fixed_Costs page
• List administrative staff (that is, staff who do not provide any direct services, and who are not
listed on the C_Service_Staffing page) in section E1. List the name and position in column
C, the salary (including benefits) in column D, and the actual number of staff in column F.
• In section E2, fill in the other operating costs. Some categories are already listed; if you need
others, you may add them. Type in the corresponding cost in column H.
• In section E3, fill in actual costs for x-rays, drugs, supplies, and lab tests. The tool calculates
the difference between actual and expected costs, based on standard prices and treatment
guidelines, and enters the figures in worksheet F_Total_Costs. This is done so that the
actual expenditure is shown under Scenario A, instead of the normative expenditure. The
total expenditure under Scenario A should then equal the total expenditure according to the
financial system of your facility.
• In each case, the Variance column (column I) shows the difference between normative and
actual cost.
• Column J, entitled “Use in model,” is just a reference for you so that you can see whether the
particular scenario is making use of the normative or actual costs.

4.7. EXAMINING TOTAL FACILITY COSTS.
The sixth worksheet in the file, F_Total_Costs, shown below in Figure 8, is primarily to provide
you with the results of the cost analysis, but there are a few areas where you might need to enter
data in special cases.
Figure 8. The F_Total_Costs page
• Any commission or fees based on individual services should be entered in row 12. A
formula would have to be entered to link the commission to the relevant service data.
• Because so few of the types of cases require x-rays, and because these services are often
contracted out, median unit costs for x-rays are not included in the Service Practice
Worksheets. If you have unit costs for x-rays, you may enter them in the appropriate column
of row 14.
• If you have special equipment for a particular service and you are depreciating it, enter that
cost in the appropriate column of row 42.
• If your facility is responsible for contributing some funds toward regional or central office
support costs, enter that amount in cell D51.

4.8. EXAMINING TOTAL FACILITY REVENUE.
Some facilities provide services free of charge, because they have outside financial support and
they choose not to collect fees. Other facilities do charge fees. If you charge fees, you will need
to fill in revenue data on the sheet G_Revenue. The facility data, names of services, and so on,
are already filled in automatically; you need to enter only the information on fees charged for
each type of service, as well as any waivers and exemptions. The tool then calculates
automatically the net revenue per service. See Figure 9 below.
Figure 9. The G_Revenue page
In row 13, the quantity of services provided is automatically linked in from the B_Need page.
In row 14, you should enter the figures for the fee charged (if any) for each service in the
health services package provided at your facility. If you do not charge fees, you may enter
zero (0) or leave the cell blank.
In rows 28-30, the tool allocates additional revenue from pharmacy, radiology, and lab
services. Many facilities do not track this revenue by service, and so the tool contains
formulas to allocate total revenue for these ancillary services.
o Enter the total pharmacy revenue (if tracked separately) in cell D28.
o Enter the total radiology revenue (if tracked separately) in cell D29.
o Enter the total laboratory revenue (if tracked separately) in cell D30.

In rows 34-40, the tool makes adjustments to gross revenue to show the impact of waivers,
discounts, and cash differences.
o In row 34, enter the amount of waivers given for consultations.
o In cell D35, enter the total amount of waivers given for pharmacy charges.
o In cell D36, enter the total amount of waivers given for radiology service charges.
o In cell D37, enter the total amount of waivers given for laboratory charges.
o In row 38, enter the amount of discounts given.
o In row 39, enter the amount of cash differences.
The tool will automatically calculate the net revenue per service in row 43.
You are now finished with data entry.
The next step is to see if actual cost and revenue data were entered accurately. You must click
on Scenario A before you do this to ensure that you are looking at the actual total cost figures.
The total costs shown in column D, row 52 of worksheet F_Total_Costs should be the same as
the total expenditure on the financial report from which you took the cost figures. You should
compare the two figures and make sure that they agree. If you have taken any figures from other
sources, for example regional office costs, they should be added to those shown on the financial
report. You should also compare total revenue from the financial report with the calculated
revenue on worksheet G_Revenue, cell D40 (total revenue less waivers, discounts, and cash
differences).
Once you have agreed the actual costs and revenue, save the workbook, and then study the
results of your cost analysis.
4.9. ANALYZING THE RESULTS.
Utilization analysis.
CORE Plus provides many areas for analysis. Before you even begin to look at costs or revenue,
you may have questions about the quantities of services. When you compare needed services
(row 19 of the B_Need page) with actual services (row 21 of the same page), do any of the
results surprise you?

Figure 10. Comparing Needed and Actual Services
In the example above, the tool estimated that Buffalo Hill Health Centre should provide 2,123
prenatal services, based on the population, the expected rates for pregnancy, percentage of cases
seen, and visits per pregnancy. However, during the year it recorded only 1,254 services. There
could be many possible explanations, such as:
• Perhaps women came to the health centre for one or two visits instead of the expected three
visits.
• More clients than expected went to another facility, or to a traditional healer.
• The catchment population may be smaller than the figure entered on the A_Assumptions
page.
If there is a large discrepancy between the quantity of cases you expected to see and the quantity
you did actually see, this might be an area that warrants more study. Perhaps access is a
problem, or perhaps the clients in your catchment area are not aware of all the different services
that you offer. Or they cannot take time away from their work to make the journey to the health
centre, because they will lose that day’s income if they do not go to work.

Cost analysis.
This is not an exhaustive discussion of cost analysis; rather, it offers some brief pointers and
suggestions.
Firstly, you should note that the figures shown on the F_Total_Costs worksheet depend on the
current scenario—that is, the one that was last selected. Recall that the current scenario is shown
in yellow on row 5. If you want to analyze actual services provided and actual costs incurred,
make sure that you are using Scenario A.
At the bottom of the F_ Total_Costs page, you will see a summary of total variable and fixed
costs. The variable costs are those that change with the quantity of services offered, and in the
tool are comprised of drugs, tests, and clinical supplies. The fixed costs do not change when
service quantities change unless you need to hire more staff to take care of an increased level of
patients. Other fixed costs include facility running costs.
In the example below, the variable costs represent about 1% of total costs, while fixed costs
represent about 99% of total costs. See Figure 11. This is an unusual pattern; in this example,
the variable costs are extremely low because many of the drugs and supplies have been donated,
and did not represent a cost to the facility.
Note that negative numbers may appear in certain rows in this worksheet, and they will be
carried through into the next worksheet, H_Summary. This should only happen when Scenario
A is run. They will appear in rows 29 through 32 of F_Total_Costs if the actual expenditure in
rows 47 through 51 of E_Fixed_Costs is more than the normative expenditure in those same
rows. In this case the tool uses the normative costs to allocate the unit costs shown in rows 22
through 26 on the F_Total_Costs worksheet and then has to make negative adjustments in rows
29 through 32 to bring the total costs in line with the actual expenditure. The adjustments are
spread proportionally across all the services that were charged with supplies.
Similarly, where the normative time of any staff members comes to more than one full-time
equivalent, or FTE, as shown in Column D of the C_Service_Staffing worksheet, the normative
costs are shown in row 38 of the F_Total_Costs worksheet. In other words, the normative cost
of the staff person comes to more than the actual expenditure. Negative adjustments are then
made in row 39 to bring the total costs to match the actual expenditure. In this case, the
adjustments are made only for those services that were charged with the time of that specific
staff member.

Figure 11. The lower part of F_Total_Costs worksheet, showing breakdown of costs
Here are some questions you might ask when you see your own results:
• If we are asked to control our costs, which area(s) can we control most easily?
• Is it possible to get better prices for drugs and supplies we procure?
• Are there ways we can reduce some of the fixed costs, such as by transferring staff to a
busier facility, or cutting down on utility costs by turning off lights that are not needed?
Revenue analysis.
The revenue analysis page shows you a number of things: whether and how much you charge for
services; the net revenue as compared to the gross revenue; and the amount of any waivers or
exemptions that were given. Some organizations charge reduced or “token” fees for preventive
and family planning services, because they want to encourage their clients to come to the health
facility for those services. You can use the revenue page to answer the following types of
questions:
How does net revenue compare to gross revenue?

Is the facility meeting its revenue target (if it has a target)?
If fees are increased and quantity of services provided does not change, how will revenue be
affected?
You can carry out further analyses when you compare the costs and the revenue. For example,
the summary page will show you the percentage of cost recovery that your facility has achieved.
It will also show you which services cost the most to provide, either because they require

significant staff time or expensive drugs and supplies. It will also show the results of any “what-
if” analyses you have done.
The summary page.
First, recall that the figures shown on the H_Summary worksheet depend on the current
scenario—that is, the one that was last selected. The current scenario is shown in yellow on row
5. If you want to see summary results for another scenario, go back to the A_Assumptions page
and change the scenario there, in question A24.
The page entitled H_Summary displays several things. A sample is shown below in Figure 12:
• First, in section H1 it shows the number of services from the B_Need page as a reference for
studying the cost summary information. It also shows the numbers of services provided for
each type of treatment as a percentage of the total number of services.
• Next, and also for reference, it shows the variable and fixed unit costs per service in section
H2 so that you can see which services are more costly to provide. For example, you can see
that an average prenatal consultation at the Health Centre level cost over 744 shillings, of
which 434.01 shillings was variable costs (drugs, etc.) and 310.78 shillings was fixed costs
(staff, etc.). You can also see that the direct staff cost of providing the service was 117.98
shillings, and the indirect staff cost was 25.63 shillings, indicating that there was some
“slack” time and that there were too many staff for the number of patients seen.

Figure 12. The H_Summary page
• Section H3 shows the revenue per service (both the net revenue and the surplus or loss per
service, as calculated on the G_Revenue page).
• Section H4 shows revenue and cost recovery for service categories, such as the reproductive
health services as a group, and the child survival services as a group. It also shows cost
recovery by facility level, so if your facility provides both primary care and referral services,
the revenue and cost recovery can be calculated separately for each.
• Section H5 displays total facility costs and revenue. If you have both clinic and referral level
services, it will give you a breakdown by each level. Figure 13 below shows the lower half
of the H_Summary worksheet. In this example, the facility does not offer referral services,
so the clinic level and facility totals are the same. We can see that salary costs are 95% of
total facility costs, and drugs/supplies/tests are almost 1% of the total. (Recall that in this
example, many of the drugs and supplies were donated.) The remaining costs are other fixed
costs.
• Section H6 shows staff utilization for direct service delivery. Some of these results may
surprise you. According to the example, the professional nurse category staff are spending
about 79% of their available direct service time actually providing patient care, but the
community health nurses are using slightly over 1% of their available direct service time.
This indicates that staffing levels should be reviewed.

Figure 13. The lower half of the H_Summary page
4.10. COMPARATIVE REPORTS.
The worksheet tab I_Reports will show you the results of the different scenarios. To run the
scenarios, simply click with your mouse on the gray buttons in row 6. For example, to run
Scenario A, you put your mouse over the button labeled “Run Scenario A” and click on it. Do
the same for scenarios B through E. Note that you must run each Scenario every time you want
to see the results of changes in data entry, as these figures do not change automatically each time
a change is made (unlike the other worksheets). A sample of the I_Reports worksheet is shown
in Figure 14 below.
Clinic-level services
The top section of the sheet shows the comparative results for clinic-level services (Level A).
You can see that the catchment population stays the same, as does the estimated number of
clients (rows 8-10). The differences begin to appear in row 13, Quantity of services provided.
Since Scenario C represents the estimated total number of services needed by the population,

based on disease prevalence or incidence rates and the rates of services per case, this figure is
higher than any of the others.
Some of the comparisons that can be made based on the example below are as follows:
• The average number of services provided per capita (for those with access to the facility) was
actually 1.04, whereas the estimated number of services needed was 4.33. In other words,
people are not using the services as much as they should. For scenarios D and E (projected
services), the difference is that these latter scenarios include the introduction of child survival
as well as reproductive health services, and thus show an increase in the number of services
per capita to 1.12.
• Under Scenario B the total cost is 17.4 million shillings, which is higher than the actual cost
of 14.1 million shillings. This is partly because the drugs, tests and clinical supplies are
included at their normative costs instead of their actual costs (in this example, actual cost is
lower because some of the drugs and tests, such as for treating HIV, are donated). Also, the
number of staff is adjusted upwards in line with the staffing norms set in the tool. The
number of services is the same under both scenarios.
Figure 14. The I_Reports page
• Under Scenario C the total cost is 31.4 million shillings, much higher than the actual cost of
14.1 million shillings under Scenario A. This is to be expected, since the needed number of

services is over four times the actual. The difference in cost is not as much as the difference
in the number of services, as staff should be used more efficiently with increased volume of
services, and the tool assumes that other fixed costs, such as electricity, would not increase.
• Under Scenario D the total cost is 17.7 million shillings. This is slightly more than the cost
of Scenario B, reflecting the cost of adding child survival services.
• Under Scenario E the total cost is 17.0 million shillings. This is less than the total cost of
17.7 million shillings under Scenario D, even though the number of services is the same.
This is because Scenario E calculates staff costs on the basis that staff can be hired for the
exact amount of time needed. For example, if the services require 3.4 nurses, the cost is
based on 3.4 nurses (rather than having to “round up” to full-time staffing when only part-
time staffing might be needed in some categories of staff).
Referral-level services
The middle section of the I_Reports sheet is similar to the above, but it shows summary results
for referral-level services (if applicable). Since the example shown in Figure 14 above is for a
clinic, there are no referral-level services.
Combined statistics
The bottom part of the sheet shows combined figures for the total facility, and then summarizes
staff and facility use.
• In the example below, you can see that with an ideal staffing level, staff costs would be only
62% of total costs, compared with the actual of 95%.
• You can also see that the clinic would have to nearly double the number of staff seeing
patients—from 58.5 to 100—if it had to provide all of the needed services in the catchment
area (compare Scenario A—Actual services with Scenario C—Needed services).
• Interestingly, under Projected Services (Scenarios D and E), the total number of staff is lower
than with the actual staffing in Scenario A. This is most likely due to more efficient use of
staff and a review of how staff are spending their time, as compared with the stated activities
on the Service Practice Worksheets.

Figure 15. Combined statistics (clinic- and referral-level) on the I_Reports page

5. Changing norms and prices
The norms used in the tool should be reviewed regularly and updated where necessary. They can
be found in several places of CORE Plus, as described below. In some cases no norms were
available, and “best guesses” were used. In such cases research should be carried out to develop
proper norms. The norms should be changed only at national, provincial, or district levels
(whichever level has the authority to determine service practices), since it is crucial that the same
norms be used throughout an area for consistency and comparability. Care should be taken when
changing norms, especially where costs may have been used in preparing service level
agreements.
The three types of norms used to determine the numbers of services needed appear in the
B_Need worksheet.
The relevant population figures are shown in row 11, and are derived through a formula that
refers to a certain group of the population shown in the worksheet A_Assumptions.
The incidence or prevalence rates are entered in row 12, and the comment attached to each
cell describes the source of the figure used.
The figure for the quantity of services per case is shown in each service column in row 18.
These figures are linked in from the individual service practice worksheets and should be
modified there if necessary.
If your country, province, or district has administrative staffing norms, you may use them in the
worksheet E_Fixed_Costs to determine how many administrative staff should be employed, as
well as reasonable costs for recurrent expenditures such as electricity and fuel. For example, a
norm might be that a facility needs one receptionist for every four or five clinical staff.
Norms are also used to calculate salary differences among different regions of the country. If
organizations routinely pay higher salaries to staff as an incentive for them to work in more
remote locations, these are factored into the normative costs. Regional variations in cost are also
considered when calculating drug and supply prices, based on the assumption that it costs more
to transport these commodities to some of the more isolated areas.
The remaining norms appear on the individual service practice worksheets, namely the type of
person who should provide a service, the number of minutes required, and the quantities and
types of tests, drugs, and clinical supplies.
Standard costs of resources should be reviewed and updated annually, or more frequently if cost
changes are large. These costs should be changed only at the national or provincial level, for
consistency and comparability. Drug prices can be updated on the Drug_list worksheet;
similarly, supply and lab test prices can be updated on the Supply_list and Lab_test_list
worksheets, respectively. Standard fixed costs appear in column G on the E_Fixed_Costs
worksheet, and standard variable costs appear on the individual service practice worksheets.

6. Comparing facilities
You may want to compare the results of several facilities or build up a picture of a network of
facilities. In this case you must make sure to save the workbook for each facility in a separate
file. You can then open a new workbook, which will be a “summary” workbook, and enter the
key findings from each facility file into one worksheet. The best place to find the key findings is
in the I_Reports worksheet. Set up your new workbook so that you have one column for each
facility. This new worksheet can be linked directly to the facility workbooks and will update
automatically if you open the facility workbooks before you open the summary workbook. To
link a cell in the summary worksheet to a cell in a facility worksheet you should do the
following.
• Put the cursor on the destination cell in the summary sheet
• Enter the equal sign (=)
• Go to the other file and worksheet, click on the source cell that contains the data you want to
link, and press Enter.

7. Cautions
The CORE Plus tool was developed for facility- and community-based ambulatory care services.
The modeling of other services is more complex and is simplistic in this version of the tool. The
resource needs, especially staffing, and costs of facilities that provide these services should be
analyzed and interpreted with caution. Keep in mind the following:
• Community-based care. It is difficult to set norms for numbers of visits by facility staff to
communities, since the time taken will vary greatly according to the type of visit and the
distance. The assumptions regarding need and time required that are used in the tool will
need to be adjusted, depending on the geographic location and ease of community access for
the facility. All of the assumptions for community-based care should be reviewed for
accuracy.
• Inpatient care. The resource needs for looking after inpatients have not been included. In the
case of maternity, for example, only the cost of the delivery has been included. Staffing
norms would have to be included, as well as the cost of other resources such as patient food.

ANNEX A: NORMS
• Table A-1: Clinic-level (Level A) service need norms
• Table A-2: Referral-level (Level B) service need norms
• Table A-3: Standard minutes per clinic-level (Level A) service
• Table A-4: Standard minutes per referral-level (Level B) service

TABLE A-1: CLINIC-LEVEL (LEVEL A) SERVICE NEED NORMS
Prevalence or Reference Quantity of

SERVICE Target population incidence (data services per
rate source) case
Dispensary (Disp.) :
Prenatal consultation (Disp.) Women, 15-49 11.7 percent 3
Delivery and post-partum (Disp.) Women, 15-49 1
Postnatal consultation (Disp.) Women, 15-49 1
Post-abortion care (Disp.) Women, 15-49 1
Family planning (Disp.) Women, 15-49 6
Responsible sexuality: Youth
Youth, ages 15-24 1
(Disp.)
Men 25 years and
Responsible sexuality: Men (Disp.) 1
over
Men and women
STI / AIDS (Disp.) 1
15-59
Well-child visit/ monitoring (Disp.) Infants 0-11 months 5
Acute respiratory infection/ ARI Children 0-4 years
2
(Disp.) old
Children 0-4 years
Fever of unknown origin (Disp.) 1
old
Children 0-4 years
Mild malnutrition (Disp.) 1
old
Children 0-4 years
Mild diarrhea, dehydration (Disp.) 1
old
Children 0-4 years
Pulmonary TB (Disp.) 2
old
Children 0-4 years
Other illnesses (Disp.) 1
old
Health Centre (HC) :
Prenatal consultation (HC) Women, 15-49 3
Delivery and post-partum (HC) Women, 15-49 1
Postnatal consultation (HC) Women, 15-49 1
Post-abortion care (HC) Women, 15-49 1
Family planning (HC) Women, 15-49 6
Responsible sexuality: Youth (HC) Youth, ages 15-24 1
Men 25 years and
Responsible sexuality: Men (HC) 1
over
Men and women
STI / AIDS (HC) 1
15-59
Well-child visit/ monitoring (HC) Infants 0-11 months 2.4
Acute respiratory infection/ ARI Children 0-4 years
1
(HC) old
Children 0-4 years
Severe fever (HC) 1
old
Children 0-4 years
Severe malnutrition (HC) 1
old

Prevalence or Reference Quantity of
SERVICE Target population incidence (data services per
rate source) case
Persistent diarrhea, dehydration Children 0-4 years
1
(HC) old
Children 0-4 years
Pulmonary TB (HC) 1
old
Children 0-4 years
Other illnesses (HC) 1
old
Community-based care :
Prenatal consultation (Comm.) Women, 15-49 3
Delivery and post-partum (Comm.) Women, 15-49 1
Family planning (Comm.) Women, 15-49 6
Responsible sexuality: Youth
Youth, ages 15-24 1
(Comm.)
Responsible sexuality: Men Men 25 years and
1
(Comm.) over
Men and women
STI / AIDS (Comm.) 1
15-59
Well-child visit/ monitoring Children 0-4 years
2.4
(Comm.) old
Children 0-4 years
Other illnesses (Comm.) 1
old

TABLE A-2: REFERRAL-LEVEL (LEVEL B) SERVICE NEED NORMS
Quantity of
Target Prevalence or Reference
SERVICE services per
population incidence rate (data source)
case
Prenatal consultation/ high-risk
Women, 15-49 1
(Hospital)
Delivery and post-partum (Hospital) Women, 15-49 1
Post-abortion care (Hospital) Women, 15-49 1
Infants 0-11
Newborn/ complications (Hospital) 1
months
Infants 0-11
Neonatal conjunctivitis (Hospital) 1
months
Severe malnutrition with Children 0-4
1
complications (Hospital) years old
Severe dehydration with Children 0-4
1
Other childhood illnesses with Children 0-4
1

TABLE A-3: STANDARD MINUTES PER CLINIC-LEVEL (LEVEL A) SERVICE
Recall that these are weighted average times; for any given case, actual time might be more or
less.
Traditional birth attendant

Community health nurse
Community health agent

Head nursing assistant
Community volunteer
General practitioner
Professional nurse
Nursing assistant
Clerk
DIRECT TIME PER SERVICE (in
minutes)
Dispensary (Disp.) :
Prenatal consultation (Disp.) 33.9 3.0
Delivery and post-partum (Disp.) 215.0 3.0
Postnatal consultation (Disp.) 62.2 3.0
Post-abortion care (Disp.) 15.0 3.0
Family planning (Disp.) 35.8 3.0
Responsible sexuality: Youth (Disp.) 5.0 3.0
Responsible sexuality: Men (Disp.) 7.0 3.0
STI / AIDS (Disp.) 87.0 3.0
Well-child visit/ monitoring (Disp.) 35.0 3.0
Acute respiratory infection/ ARI (Disp.) 20.0 3.0
Fever of unknown origin (Disp.) 24.0 3.0
Mild malnutrition (Disp.) 35.0 3.0
Mild diarrhea, dehydration (Disp.) 30.0 3.0
Pulmonary TB (Disp.) 18.0 3.0
Other illnesses (Disp.) 17.0 3.0
Health Centre (HC) :
Prenatal consultation (HC) 26.0 11.3 3.0
Delivery and post-partum (HC) 173.0 208.0 60.0 3.0
Postnatal consultation (HC) 34.2 6.0
Post-abortion care (HC) 20.0 20.0 25.0 3.0
Family planning (HC) 45.0 23.0 55.0 15.0 3.0
Responsible sexuality: Youth (HC) 3.0 5.0 2.0 3.0
Responsible sexuality: Men (HC) 2.0 6.0 3.0
STI / AIDS (HC) 85.0 7.0 3.0


Community volunteer
Professional nurse
Nursing assistant
Clerk
DIRECT TIME PER SERVICE (in
minutes)
Well-child visit/ monitoring (HC) 15.0 26.0 3.0
Acute respiratory infection/ ARI (HC) 31.0 5.0 3.0
Severe fever (HC) 61.0 2.0 3.0
Severe malnutrition (HC) 23.0 15.0 3.0
Persistent diarrhea, dehydration (HC) 13.0 75.0 3.0
Pulmonary TB (HC) 18.0 2.0 3.0
Other illnesses (HC) 25.0 5.0 3.0
Community-based care :
Prenatal consultation (Comm.) 70.0
Delivery and post-partum (Comm.) 87.0 137.0
Family planning (Comm.) 45.0
Responsible sexuality: Youth (Comm.) 6.3
Responsible sexuality: Men (Comm.) 4.3
STI / AIDS (Comm.) 92.0
Well-child visit/ monitoring (Comm.) 32.0
Other illnesses (Comm.) 33.0

TABLE A-4: STANDARD MINUTES PER REFERRAL-LEVEL (LEVEL B) SERVICE

Obstetrician/Gynecologist

Community volunteer
Professional nurse
Nursing assistant
Anesthesiologist
Pediatrician
Radiologist
Clerk
DIRECT TIME PER SERVICE
(in minutes)
Prenatal consultation/ high-risk
50.0 3.0
(Hospital)
Delivery and post-partum (Hospital) 228.0 15.0 20.0 2.0 3.0
Post-abortion care (Hospital) 110.0 3.0
Newborn/ complications (Hospital) 48.0 10.0 3.0
Neonatal conjunctivitis (Hospital) 13.0 3.0
Severe malnutrition with
23.0 3.0
complications (Hospital)
Severe dehydration with
33.0 3.0
Other childhood illnesses with
23.0 3.0

ANNEX B: FLOWCHARTS OF CALCULATION METHODS
• B-1: Calculation of Services Needed

• B-2: Calculation of Staffing Numbers
• B-3: Calculation of Cost per Service

B-1: CALCULATION OF SERVICES NEEDED
Worksheet B_Need:
Estimates of number of services needed
Total population
% male/female
and age groups
Multiply
Number male/female
and age
Incidence and
prevalence rates
Multiply
Number of persons
affected % with access to
facility
Multiply
Number using facility

Number of services per
treatment/case
Multiply
Total number of
services needed, by Key:
type of service Input or Output
Process

B-2: CALCULATION OF STAFFING NUMBERS
Worksheet C_Service_Staffing:
Calculation of staffing numbers
Used in Scenarios B, C, D, or E
Total hours % service time

available by staff type
Multiply
Service time available

by staff type
Total direct time

Divide time needed
needed by staff
by time available
type
Total staff needed, Used in Scenario E

in FTEs* by staff type
Round up
Total staff needed, Used in Scenarios

in whole numbers B, C, and D
by staff type
Key:
Input or Output
* Note: “FTEs” are full-time equivalents.
Process

B-3: CALCULATION OF COST PER SERVICE
Worksheet D_Staff_Costs:
Calculation of cost per service
Total salary Subtract total
% service time by staff type
by staff type service salary
cost from total
Multiply salary cost
Total hours
worked
Total service salary
Total admin.
by staff type
salary cost
Quantity of Divide service
each service salary by hours
Subtract direct service salary
Standard worked
from total service salary
time per
Multiply
service per
staff type Average Total indirect cost
Total direct time hourly salary per staff type
per staff type for cost per staff
each service type
Allocate in proportion to
direct salary cost per staff
Multiply type for each service
Total direct cost per staff Total indirect cost per

type for each service staff type for each service
Sum all staff Sum all Sum all Sum all staff
types for services for services for types for
each service each staff type each staff type each service
Total direct cost Total direct cost Total indirect cost Total indirect cost
per service per staff type per staff type per service
Sum staff Sum staff

type totals type totals
Total direct Total indirect Key:

costs costs Input or Output
Note: Salary figures include benefits. Process

ANNEX C: UNDERSTANDING AND REVIEWING THE SERVICE
PRACTICE WORKSHEETS
The service practice worksheets are the building blocks of the entire CORE Plus tool. The
worksheets provided in the sample spreadsheet have been reviewed by Haitian health
professionals in accordance with treatment guidelines set forth by the Ministry of Health.
However, you should review them to see if any changes need to be made for your particular
country, province, or area (e.g., iodine supplementation is not routinely prescribed for expectant
mothers during prenatal visits, unless the health facility is in a part of the country where iodine
deficiency is a problem).
The service practice worksheets are divided into three sections. At the top right of each section,
you will see a question that asks, “Per case or per visit?” Sometimes it is easier to specify the
normal treatment guidelines for a visit (e.g., acute respiratory infection), while at other times it is
easier to describe the treatment for a type of case (e.g., listing all of the required drugs to fully
treat a case of TB over a six-month period). With these worksheets, you have the flexibility to
do either, and if it makes sense, you can also choose differently for each section. For example,
you might define staff time per visit and medicines needed per case. If you specify a treatment
per case, the tool will calculate a per-visit cost by dividing the per-case treatment cost by the
number of visits listed in cell Q3 of each service practice worksheet. The default number of
visits in the blank template is one visit. This is not indicative of a standard protocol and
should be modified in accordance with recommendations of health personnel familiar with
the context in which the tool is applied.
Please keep the following in mind when reviewing the service practice worksheets for
appropriateness:
• In the example provided, the majority of drug costs, and some supply costs, are taken from the
PROMESS “Liste de Prix en Gros” from August 2004. Obviously, the cost of drugs,
supplies, and lab tests at your facility will differ. You need to review the master list of drugs,
supplies, and lab tests to ensure that the costs shown are accurate for your situation.
• The list of medical supplies includes only disposable supplies that are consumed during a
patient visit. Thus, while it may be necessary during a visit for a health professional to use a
stethoscope, thermometer, etc., these items and larger pieces of medical equipment will not
appear on the list of supplies.
SECTION 1: SERVICE DELIVERY STAFF TIME

In this first section, each activity involved in service provision is listed—that is, each interaction
between the client and the service provider is described.
• In cell Q5, ensure that the proper choice is selected (either visit or case). If you need to
change from one to the other, click on the cell and make your choice from the drop-down
menu.
• In column B, each activity is listed. Review the activities to see if your own norms are
similar or different, and make changes as necessary.
• In columns C through O, you will see an estimate of the number of minutes needed for this
type of visit (or case). Again, the sample spreadsheet provided includes figures that have

been reviewed by health professionals in Haiti. If you need to adjust the figures, please do so
only in consultation with Ministry of Health staff at the national or provincial level
(whichever administrative level has the responsibility and authority to define norms). Note
that this section includes all activities, such as registering the client, taking the medical
history, providing counseling, collecting any needed samples, or referring the client if
necessary.
- In some cases an average amount of time has been used. For instance, if 15% of women
who come for prenatal visits will need special counseling or referral for complications,
how much time has been allocated for this activity in the worksheet? It may take 10
minutes for this extra counseling, but we do not want to include 10 minutes for each and
every visit on the service practice worksheet, because not every prenatal client needs this
extra counseling. Thus, a weighted average has been used instead: 15% x 10 minutes =
1.5 minutes on average. For any given visit, the number of minutes may be under- or
over-estimated. However, if we average all visits over the year, then the total time
estimate will be close to the reality.
• The total minutes for each category of personnel are summed automatically and linked to the
D_Staff_Costs worksheet of the tool.
SECTION 2: DRUGS AND MEDICAL SUPPLIES

menu.
• Drugs are listed first, then supplies.
• Note that although “enriched milk” is not a drug, it is included in the drug list rather than the
supply list because it is given in cases of malnutrition, and the description of treatment (e.g.,
twice a day for 15 days) is similar to treatment guidelines for drugs.
Here is an explanation of the different data needed, or the calculations done, in each column of
this section of the worksheet.
• The first part of Section 2 shows the drugs used to treat the given illness or condition:
- Drug, Protocol, Dosage, Unit:
¾ Click and choose from the drop-down menu to list the needed drug(s).
¾ These cells link to the master drug list, so you are restricted to only those drugs on the
master list.
¾ You may see a drug name listed more than once. This is because a drug may come in
different strengths, forms, etc. Ensure that the drug name, strength, and form are all
correct (e.g., amoxicillin 250 mg tablet PO (per oral).
- Number of times/day:
¾ Type in a number to indicate how many times a day the medication should be taken
- Number of days/cycles:
¾ Type in a number to show how many days the treatment should continue (or how
many cycles, in the case of family planning)
5
Row reference may be slightly different if extra rows were added in previous section.

- % of cases treated:
¾ For each drug listed in this section, enter a number between 1% and 100% (of all the
clients who come for this type of visit, what percentage receive this particular drug?).
If only a small percentage of clients have complications that result in an additional
drug being prescribed, you can list the additional drug and then indicate that a small
percentage of clients would receive it.
- Drug formulation:
¾ This is to double-check your choice in the first column—is the drug a tablet, syrup,
injectable, etc.? It is not necessary to fill in this column, but it will help anyone who
is verifying the worksheet for accuracy.
- Dosage:
¾ This may or may not be the same as the drug strength that you chose from the pull-
down list. For example, the dose may be 400 mg, but you have only 200 mg tablets
in stock. Thus, you would instruct the client to take two tablets instead of one to get
the correct dosage.
- Units per dose:
¾ Here the worksheet should list the number of units needed to make up the correct
dosage. In the example above, the number would be 2 (2 x 200 mg tablets = 400 mg
dosage).
• In general, if the drug listed is a liquid (e.g., intra-muscular or syrup to be given
orally), the number of milliliters should be listed here (because the drug list
calculates the average cost per milliliter).
• If the drug is in tablet form, the number of tablets should be listed here.
• If the drug is a cycle of oral contraceptives, the “unit” will be the number of
cycles prescribed per visit.
• If the drug is a pre-filled syringe with measured vaccine or injectable
contraceptive, the “unit” will be 1 (one injection).
- Total units
¾ Based on the prior inputs, the tool calculates automatically the number of items for
this type of drug (times per day x number of days x % of cases treated x units per
dose).
- Unit cost
¾ The tool links in the unit cost automatically from the master drug list. Once the name
of the drug is chosen from the pull-down list, the tool finds the corresponding cost
and displays it here.
- Additional costs (x%)
¾ This figure is calculated automatically, based on the drug’s unit cost and the extra
transportation charge (if applicable) indicated on the A_Assumptions page.
- Weighted average cost per treatment
¾ This is the average cost of the drugs needed to treat this type of case. The tool
calculates it automatically by multiplying (unit cost + additional cost) x total units.
The total is then linked to the F_Total_Costs page.
- Comments
¾ Any explanatory notes or special circumstances should be noted here (e.g., for a
pediatric case, you may see “Dose is 50 mg per kilo of child’s weight. Here we have
used an average weight of 20 kilos for estimating total quantity of medicine needed”).

• The second part of Section 2 shows the medical supplies used during a visit or course of
treatment:
- Medical supplies:
¾ Click and choose from the drop-down menu to list the needed supply or supplies.
¾ These cells link to the master supply list, so you are restricted to only those supplies
on the master list.
¾ You may see a supply name listed more than once, but with slight variations. Take
care when reviewing the worksheet to ensure that the list has the appropriate supply
for the particular type of case. For instance, the list contains many different types of
syringes (such as Syringe, 10 cc, with needle; Syringe, 5 cc, with needle; or Syringe, 5
cc, without needle).
- Name of associated drugs (if IM or IV):
¾ Fill in this column only if the supply is a needle, syringe, or some other supply
needed to administer one of the drugs listed in the first part of Section 2.
- Quantity used:
¾ This column shows the quantity of the supply that is used during the treatment. It
might be 1 (e.g., one syringe with needle) to give a vaccine, or it may be greater than
1 (you might need more than one pair of sterile latex gloves, depending upon the type
of exam to be done).
- Number of times used:
¾ This column shows the number of times the supply is needed. Usually it will be 1,
but sometimes (e.g., in the case of ongoing treatment at the hospital level) the figure
will be higher than 1.
- Total quantity:
¾ The figure in this column is calculated automatically by multiplying the figures in the
two previous columns (Quantity used x Number of times used).
¾ The percentage here shows whether the particular supply is used for all persons
treated for a given condition or illness, or if the treatment applies only to a lower
percentage of the clients. For instance, if women have three prenatal visits on
average, then about 33% of women coming for a prenatal visit receive a “Woman’s
Health Card,” on the assumption that the card is given only at the initial visit and not
at the follow-up visits.
- Supply unit:
¾ This column is used only rarely. It is for clarification if necessary. For instance, if a
supply is distributed in large quantities (such as “fixative spray for PAP test”), the
supply unit would be 1 can.
- Dispensing unit:
¾ This column must always be filled in. The number will usually be 1. However, in the
example above with the “fixative spray,” the dispensing unit would be some number
less than 1. (The unit cost for the supply is the cost of the can, but one can could be
used for many samples. If one can of fixative spray could be used for 25 Pap smear
samples, then the dispensing unit is 1/25, or 0.04.)

- Total units:
¾ Based on the prior inputs, the tool calculates automatically the number of items for
this type of supply (Total quantity x % of cases treated x Dispensing unit).
- Unit cost:
¾ The tool links in the unit cost automatically from the master supply list. Once the
name of the supply is chosen from the pull-down list, the tool finds the corresponding
cost and displays it here.
- Additional costs (x%):
¾ This figure is calculated automatically, based on the supply’s unit cost and the extra
transportation charge (if applicable) indicated on the A_Assumptions page.
- Weighted average cost of treatment:
¾ This is the average cost of the supplies needed to treat this type of case. The tool
calculates it automatically by multiplying (unit cost + additional cost) x total units.
- Comments:
¾ Any explanatory notes or special circumstances should be noted here.
SECTION 3: LABORATORY TESTS

menu.
- Laboratory test:
¾ Click and choose from the drop-down menu to select the needed lab test.
¾ These cells link to the master lab test list, so you are restricted to only those tests on
the master list.
- Quantity:
¾ This column shows the quantity of tests used during the treatment. It will usually be
1 (e.g., one Pap smear), but could be greater than 1 (e.g., a child hospitalized for a
severe fever might have blood work done more than once to monitor his/her white
cell count as treatment continues).
¾ The percentage here shows whether the particular test is used for all persons treated
for a given condition or illness, or if the treatment applies only to a lower percentage
of the clients. For instance, 100% of clients receiving treatment for a sexually-
transmitted infection might be tested for HIV, but only 5% of those clients would
receive a second HIV test (in case the first test was positive).
- Unit cost:
¾ The tool links in the unit cost automatically from the master lab test list. Once the
name of the lab test is chosen from the pull-down list, the tool finds the corresponding
cost and displays it here.
- Weighted average cost of treatment:
¾ This is the average cost of the lab tests needed to treat this type of case. The tool
calculates it automatically by multiplying (Quantity x % of cases treated x Unit cost).
6
Row reference may be slightly different if extra rows were added in either of the previous sections.

- Comments:
¾ Any explanatory notes or special circumstances should be noted here.

ANNEX D: LIST OF DATA REQUIRED FOR A CORE PLUS ANALYSIS
This list outlines the types of data that you should compile in order
to carry out a cost and revenue analysis.
Note that if you wish to analyze only your actual utilization, costs,
and revenue (Scenario A), you do NOT need to collect all of the
data listed below. The data elements that are marked with an
asterisk are used only for running comparative scenarios.
Each description below highlights the title of the worksheet in SMALL CAPS and the name of the
worksheet tab in [bold and square brackets].
• Worksheet A: ASSUMPTIONS [A_Assumptions]

- The name of your facility
- The period covered by the analysis (for example, the year 2006 or January-March 2006)
- The currency used
- Type of service delivery point (dispensary, health centre, community-based service
delivery, or hospital)
- Location of service delivery (capital city, other urban area, or rural area)*
- Catchment population*
- Population distribution by age groups*
- Whether your facility sees referral cases or not (Yes or No)*
- Catchment population for referral services, if applicable*
- Contraceptive prevalence rate*
- Percentage of the catchment population that seeks services at your facility*
- Number of hours/day that the facility is open
- Number of days/week that the facility is open
- Number of days/year that the facility is open
- Average number of working days available for each employee (total days open per year,
less holiday, sick, and vacation time, as well as time spent in training)
- Staff turnover rate (low, medium, or high)*
- Average base salary for each category of staff*
- Ratio: percentage of benefits to base salary
- Normative percentage of direct service time*
- Transport costs for medicines procured (as percentage of purchase cost)
- Transport costs for supplies procured (as percentage of purchase cost)
- Mark-up for drugs
- Mark-up for supplies
- Mark-up for lab tests
- Mark-up for radiology services
- Exchange rate used to convert drug and supply prices, if applicable
- Choice of scenario:
¾ Scenario A: Actual services and actual costs
¾ Scenario B: Actual services and normative costs

¾ Scenario C: Needed services and normative costs
¾ Scenario D: Projected services and normative costs
¾ Scenario E: Projected services and ideal staffing
• Worksheet B: SERVICE NEEDS [B_Need]

- Prevalence or incidence rate for each illness or type of case*
- Actual number of services provided
- Projected level of services (if you wish to add new services, or to see the impact of
making significant changes in the quantity of services provided)*
- Other services—description and quantity provided (if your facility offers services beyond
the priority service package)
• Worksheet C: DETERMINATION OF PERSONNEL CHARGES [C_Service_Staffing]

- For each category of staff:
¾ Do you have this type of employee? (Yes or No)
¾ Name
¾ Actual number of employees (if you are not listing individual names, and if all
employees thus grouped earn the same salary and allocate their time the same way)
¾ Base salary (gross) (for a full-time worker)
¾ Direct service time (percentage)
• Worksheet D: STAFF TIMES AND COSTS [D_Staff_Costs]

All of the calculations on this worksheet draw from data on other worksheets; you do not
need to enter any data here.
• Worksheet E: OTHER FIXED OPERATING COSTS AND ADJUSTMENTS TO ACTUAL

DRUG/SUPPLY EXPENSES [E_Fixed_Costs]
- List of support/administrative personnel (those who do not provide direct services and
who are not listed on the C_Service_Staffing worksheet)
¾ Names and job titles/categories
¾ Salary and benefits
¾ Number of employees in each category
- Other running costs of the facility
- Actual cost/expenditure on drugs, supplies, radiology, and laboratory tests
• Worksheet F: TOTAL COSTS [F_Total_Costs]

- The main function of this worksheet is to collect the cost information from the other
worksheets and show the result of the cost analysis; however, in special cases, you may
need to enter some data here also.
¾ If service providers are paid a commission, the percentage or amount of the
commission per service provided
¾ Unit costs for radiology services
¾ Cost of special equipment needed for one particular service
¾ The total amount of funds needed to cover the running costs/support for a regional or
central office (if your facility is expected to contribute to cover the cost of such an
office)

• Worksheet G: REVENUE [G_Revenue]
- The amount charged for each service in the service package (if applicable)
- The price charged to patients for radiology services for each service (if applicable, and if
you answered 0% to question A22 on the A_Assumptions page)
- Actual revenue from ancillary services
¾ Total revenue from pharmacy services
¾ Total revenue from radiology services
¾ Total revenue from laboratory services
- Total amount of waivers granted for outpatient consultation fees
- Total amount of waivers granted for pharmacy services
- Total amount of waivers granted for radiology services
- Total amount of waivers granted for laboratory services
- Total amount of discounts given
- Total amount of cash differences
• Master lists for DRUGS, MEDICAL SUPPLIES and LABORATORY TESTS [Drug_list,
Supply_List, and Lab_Test_List]
- Unit cost for each drug (to verify that the cost is correct)
- Unit cost for each medical supply (to verify that the cost is correct)
- Unit cost for each laboratory test (to verify that the cost is correct)

CORE Plus Guide

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CORE Plus Guide

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User’s Guide for CORE Plus

(Analysis of Cost and Revenue Plus) Tool

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4.2. SETTING THE ASSUMPTIONS.

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Figure 3. Relationship of clinic- and referral-level catchment populations

Health clinic A Health clinic B

Health clinic E Health clinic D

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Question A24: scenario selection. The available scenarios are as follows:

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4.3. ENTERING UTILIZATION DATA.

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Adding and deleting services

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4.4. ENTERING DATA ON SERVICE STAFF

Figure 5. The C_Service_staffing page

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• Column P: Total Direct Minutes Available. This is also an automatic calculation; it

Following are some common questions and explanations.

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4.5. CALCULATING STAFF COSTS.

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4.6. CALCULATING FIXED AND ADMINISTRATIVE STAFF COSTS.

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Figure 8. The F_Total_Costs page

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Figure 9. The G_Revenue page

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You are now finished with data entry.

4.9. ANALYZING THE RESULTS.

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 How does net revenue compare to gross revenue?

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The summary page.

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4.10. COMPARATIVE REPORTS.

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Figure 14. The I_Reports page

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How does net revenue compare to gross revenue?