A new tool to automate process map generation using Activity-Based Costing and Management data

Activity-Based Costing and Management (ABC/M) examines the resources used, and their associated costs, to deliver health services through direct client observation. ABC/M has been supported in sub-Saharan Africa and south Asia by an array of funders to facilitate health program budgeting, monitoring, and sustainability planning. One output of ABC/M is the process map, which is a visual diagram that uses boxes, circles, arrows, and labels to depict how a health service is delivered. Process maps can illustrate the experience of a single client, including the time, location, order, and provider of each step in the delivery of a health service, or can show averages (e.g., the average time observed to deliver a health service) across clients at a specific health facility, across select facilities, or nationwide. Such process maps can be used by decision-makers at facilities as well as by national policymakers to identify inefficiencies, allocate resources, and/or explore adherence to protocols. Until now, generating process maps has been a key challenge, as ABC/M implementers had to create each separate process map manually, using shapes and text boxes in programs such as Microsoft PowerPoint, which was time-consuming and subject to error. The Analytics for Advancing the Financial Sustainability of the HIV/AIDS Response (AFS) project, with support from USAID and PEPFAR, developed code in R--an open-source, free programming language for statistical computing and data visualization--to automatically generate process maps. This code as well as instructions for users, legends for the graphics, and illustrative examples are all publicly available on GitHub. This article presents an illustrative set of process maps, which were developed for validity tests on the tool. Using this tool, researchers and policymakers can accurately construct each process map with data from ABC/M applications in minutes rather than days, as previously required.