In 2012, the Ministry of Health requested that a Value for Money (VfM) review of the National Depression Initiative (NDI) be undertaken, which KPMG was subsequently commissioned to complete. The ultimate purpose of the review is to improve the efficiency and effectiveness of services delivered under the NDI programme.
Purpose
The objectives of this review are to:
- examine the cost-effectiveness of existing NDI programme services delivered by Ministry of Health and Health Promotion Agency (HPA) funded NDI service providers
- analyse NDI programme participation and service usage including client demographics where available
- compare NDI with international services / delivery structures for people experiencing depression
- compare NDI with other services for people experiencing depression provided to New Zealanders in the New Zealand context
- analyse the impact of NDI services on Māori, Pasifika and Asian at-risk populations, based on available information
- assess the NDI programme’s methodology to obtain clinical and non-clinical advice
- recommend improvements to NDI programme effectiveness or reach.
The review is intended to identify whether services are being delivered in the most efficient and effective ways to meet Government objectives and to generate the maximum benefit for the level of expenditure. Options for improving the efficiency and cost-effectiveness of the NDI have been provided, where appropriate.
Methodology
Scope of the Value for Money review
The scope of this review is confined to the spend for the NDI (for the 2012–13 financial year this will be $5.13 m). The project scope comprises the following actions: a review of agreed international and Ministry literaturea detailed consultation with key stakeholders including the three service providers (DraftFCB, Phoenix Research Ltd and Lifeline), members of the NDI Reference Network, the Ministry and the HPAa review of the cost-effectiveness of services delivered by the three service providers and the Reference Network.
Key Results
Overall Value for Money
We were unable to draw an overall conclusion on the VfM of the NDI Programme (as distinct from a programme evaluation) due to a lack of data in some key areas. Our review is based on two forms of quantitative data: data on NDI services over time and comparison of NDI service data and data from analogous services. For any given driver, the absence of the first kind of data means that we cannot quantify performance in a given year or identify a trend. The absence of the second kind of data means that even if we can quantify performance and / or a trend, we cannot assess whether it is ‘better or worse’ than we might expect within the market. We also note the complexity of the NDI programme and the difficulty of measuring public awareness outcomes.
However, we identified key areas where sufficient quantitative data was available to allow complete driver assessments. Those areas were:
- There is evidence that awareness and reach within the general population and some target sub-populations is good
- There is evidence that campaign advertising has driven increased help-seeking behaviour amongst the general population and some target sub-populations
- There is evidence that the media campaign is comparatively cost effective (by unit cost)
- There is evidence that the internal research component drives programme development to good effect.
In addition, we found no quantitative evidence of poor performance in any area. Although the NDI generates a lot of detailed programme data, most of it is not suitable for a VfM review as it provides limited insight on the Economy, Efficiency and Effectiveness of services. Consequently a major and recurring opportunity for VfM improvement is the collection of appropriate data.