Islamic Republic of Afghanistan

Ministry of Public Health

Economic Evaluation of the Potential for Intravenous (IV) Fluids

Local Production in Afghanistan

Health Economics and Financing Directorate (HEFD)

in partnership with
Health Partners International of Canada (HPIC)

Final Report

September 30, 2012

 Executive Summary

Background

At present, the Government of Afghanistan holds in storage a significant amount of

equipment for the production of intravenous (IV) fluids. With donated equipment made
available, initial assessments suggested using the existing national pharmaceutical
manufacturing building for the production of the IV fluids. However, after assessments
by the engineering department of the MoPH and an Afghan Construction Company, it
was found that the current building was not suitable for IV fluid production. As a
solution, the Ministry of Public Health (MoPH) requested the Ministry of Finance (MoF)
to fund the construction of a new building for the production of IV fluids with the newly
purchased machinery from China. However, before proceeding, the MoF has asked for
an evaluation of the potential costs and benefits of investing in the national production
of IV fluids in Afghanistan relative to importation. In order to respond to the MoF, the
MoPH collaborated with Health Partners International of Canada (HPIC) from July –
September 2012 to conduct an economic evaluation to examine in detail the associated
costs and benefits of producing IV fluids in Afghanistan, relative to the current model of
importation.

Methods
In order to conduct this assessment, the MoPH/HPIC team developed clear
economic questions to be addressed, established a rigorous costing model using
a spreadsheet format, and developed questionnaires to interview key public and
private stakeholders in the Afghanistan specialty (IV fluids) pharmaceutical
market. The primary data collection effort was supplemented by several key
secondary sources (i.e. MoPH reports and the sub-contracted firm’s contract). In
order to conduct a thorough analysis, both economic and financial perspectives
were applied.

Results
Overall results indicate that the cost of the local production of IV fluids in
Afghanistan is estimated to be on average 20% less than the cost of importation
annually. Analyses indicate these estimates involve reduced transport costs into
Kabul. The estimated total cost of local production from the economic
perspective is just over 2 billion Afs or $42.2 million USD over 10 years. The total
estimated cost of local production from the financial perspective is 1.8 billion Afs
or $37.2 million USD over 10 years.

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Recommendations and Discussion
Based on the above economic evaluation, we recommend the Government of
Afghanistan take further steps towards the financing and local production of IV fluids
over the next 10 years. The analysis clearly highlights the reduced cost per 500ml IV
fluid unit under local production, relative to importation prices, particularly under the
financial perspective. Even if the local production was not to reach an estimated
production of 15,000,000 units by year 5, significant economies of scale are forecasted
over the period of analysis.

As for benefits, within this economic analysis there appears to be both estimated
benefits for possible profit for the producing organization, increased government
revenue, and the provision of steady employment to over 70 people.

Lastly, despite a seemingly clear economic roadmap for the local production of IV fluids
in Afghanistan, considerations must be given for establishing a broader regulatory
framework, a detailed and feasible business plan, and a strategy to attract and maintain
qualified personnel.

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1. Background

At present, the Government of Afghanistan holds in storage a significant amount of

equipment for the production of IV Fluids. In 2005, a rehabilitation committee and
procurement team identified the amount and specification of machinery needed to
rehabilitate production capacities of IV Fluids in Afghanistan. The project was then put
to tender through the Afghanistan Reconstruction and Development Services (ARDS).
The Hunan China Sun Machinery (HCSM) Company was awarded the contract for a total
amount of $7,187,400 to import and install the machinery for IV fluid production. The
contract was approved by the Special Procurement Committee (SPC), which consists of
senior officials from a variety of ministries. The MoPH leadership formally signed the
contract on September 6th, 2007 with the HCSM Company.

With the donated equipment made available, initial assessments suggested using the
existing national pharmaceutical manufacturing building for the production of the IV
fluids. However, after assessments by the engineering department of the Ministry of
Public Health (MoPH) and an Afghan Construction Company, it was found that the
current building was not suitable for IV fluid production. The primary reason for this
conclusion was the extremely poor condition of the building. As a solution, the MoPH
requested the Ministry of Finance (MoF) to fund the construction of a new building for
the production of IV fluids with the newly purchased machinery from China. However
before proceeding, the MoF has asked for an evaluation of the potential costs and
benefits of investing in the national production of IV fluids in Afghanistan relative to
importation.

As of the end of 2008, the MoPH had received nine containers out of a total of 23
containers of machinery from HCSM. The containers, with the machinery still inside, are
currently in storage. HCSM will import the remaining machinery once the MoF agrees to
pay the remaining funds as per the contract. Hence, the production of IV fluids project
has been stalled since 2008.

In order to respond to the MoF, the MoPH sought assistance from Health Partners
International of Canada (HPIC) to identify a lead consultant to work collaboratively with
the MoPH to conduct an economic evaluation to examine in detail the associated costs
and benefits of producing IV fluids in Afghanistan, relative to the current model of
importation.

2. Main Economic and Policy Questions to be Addressed

In order to make the analysis applicable to policymakers and stakeholders interested in

this issue and to offer recommendations for possible directions forward, the Health
Economics and Financing Directorate (HEFD) in the Afghanistan MoPH with the

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technical support of HPIC began to undertake this economic study in July 2012. In order
to develop the appropriate methodology, key economic questions were developed to
guide the investigation and analysis. These include a primary economic question,
followed by key economic and policy sub-questions as follows.

Primary economic question:

a. Should Afghanistan produce IV Fluids for domestic consumption or should the

country pursue a strategy/model of importing IV Fluids to support the health sector?
What are the associated costs and benefits of both models?

Key economic and policy sub-questions:

b. What are the estimated costs of producing IV Fluids in Afghanistan including

infrastructure, equipment, raw materials, salaries, recurrent costs such as electricity,
etc. under the current investment strategy for 5-10 years? What are the estimated
benefits of this production over this time period?

c. What is the estimated annual market demand for IV fluids in Afghanistan in terms of
number of 500ml units for the next 5-10 years?

d. What is the estimated cost of local production relative to estimated average import
prices?

3. Methodology

In order to address the above questions in detail, a rigorous economic model and data
collection methodology was required.

a. Economic Model

Cost and Benefit Analysis of Alternatives

The overall economic model to be applied for this study includes a detailed cost analysis
of the production facility (proposed for Kabul) including infrastructure, equipment,
human resources, training, raw materials, recurrent costs, etc. over a 5-10 year period.
Cost centers to be examined include overhead and management, support centers, and
direct production materials. A cost allocation model was be used as necessary to
develop final unit cost estimates of production of varying types of IV Fluids.

Similarly, for the importation model, costs of importation will be examined in detail
including purchasing, transport, distribution, accessibility, and timeliness (or cost of
lack of materials or stock-outs).

Benefits will be identified and described for both alternatives, but not in the traditional
benefit-cost analysis approach of examining benefit-cost ratios. It is clear that
Afghanistan must obtain IV Fluids to advance the health of the Afghanistan population

5
but the broader economic question relates to which course of action (local production
or importation) should be implemented.

Market Analysis for IV Fluids

In addition, a market analysis was conducted to understand:

 The annual demand (in units) for IV Fluids in Afghanistan

 Current pricing by distributors of IV Fluids in Afghanistan.
 Current overall market failure as related to IV Fluids in Afghanistan and the
region.

b. Costing Instruments and Data Collection Sources

The primary instrument to conduct the cost analyses includes an Excel-based

spreadsheet model used to conduct multi-cost center analysis focusing on achieving unit
costing from both local production and importation models. A societal perspective was
applied as much as possible to gather both economic and social costs. Finally, in this
instrument, the analysis focuses on two distinct costing perspectives: economic and
financial. The economic perspective pertains to a broader approach involving estimated
financial outlays as well as the market value of all donated resources. The financial
perspective is more narrowly defined and only includes the need for financial outlays
over the 10-year forecast of local production. For example, donated equipment costs are
included in the economic perspective, but not under the financial perspective.
Equipment maintenance costs are included under both perspectives.

Market Analysis questionnaire

Based on previously developed methodology, the HEFD team developed a market

analysis questionnaire and interviewed five main IV fluid distributors in Afghanistan.
The questionnaires were designed to address all aspects of IV fluid market in
Afghanistan such as price of the primary fluids, added costs to imported IV fluid,
problems within importation and distribution and main countries that export IV fluids
to Afghanistan. Qualitative and quantitative aspects of the IV fluid market were
discussed in the questionnaires. The distributors were requested to fill the
questionnaires within two weeks. Once received, the HEFD team followed up with
respondents to discuss any inconsistent or ambiguous points within the questionnaires
to provide clarification. Overall, there were eleven key questions in the market analysis
questionnaires. (See questionnaires in the annex 2).

Domestic production questionnaire

For the purpose of the local domestic production analysis, a questionnaire for domestic
production was designed on basis of the earlier described Excel-based costing tool.
Specifically, there were seven main cost centers addressed in the questionnaire as
follows:

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 Infrastructure (building)/land
 Machinery and equipment
 Human resources
 Raw materials
 Training
 Capacity building
 Miscellaneous recurrent expenditure; water, electricity, machinery maintenance,
etc.

Detailed information was requested in each above mentioned categories from a variety
of stakeholders including MoPH staff, Pharmaceutical Enterprise, and private sector
representatives. The main recipient of the questionnaire was Afghanistan
pharmaceutical enterprise. This institution is responsible for a functioning medicine
factory owned by the public in Kabul. This institution was instructed on how to
complete the questionnaire within two weeks. Most of the questions were completed,
although some of the questions were referred to other involved institutions and the
international literature. In addition, the questionnaire was distributed to private sector
representatives who are affiliated with some private manufacturing companies in the
country. Both market analysis and domestic production questionnaires were developed
in English and then translated into Persian by the HEFD team.

Finally, other data sources examined include: MoPH, MoF, Ministry of Economy (MoEC)
records, current distributors of IV Fluids in Afghanistan, public records, assessment
reports including “An Assessment of the Pharmaceutical Manufacturing Industry in
Afghanistan 2011” by the India Institute of Health Management Research, and two
specific reports comparing the local production IV Fluids with importation:

Feasibility of Production of Intravenous Fluids in Malta, Vella et al., 2012

Virkia Pharmaceuticals Project, VPS Intravenous Project, Business Plan, Uganda, 2011

With regard to the study timeline, data collection took place in July and August 2012.
Analyses and reporting took place in late August and early September 2012.

c. Data Analysis and Assumptions

The data analysis focused on comparing the overall estimated costs of local production
and importation to meet the current and future needs of the Afghan population and in
consideration to current pricing structures in the market. The analysis was conducted
on a 5-year and 10-year basis. Throughout the analysis, an exchange rate of 48
Afs=$1USD was applied, reflecting the rate of exchange during the analysis period. The
following is a list of assumptions applied in the analysis.

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Local Production Analysis Assumptions

 Infrastructure (building)/land (fixed cost)– The analysis includes construction of

a building sized of 5588 square meters for IV fluid production. The estimated cost per
square meter is $400 USD or approximately 19,200 Afs. The life span of the building for
production purposes is 20 years and an amortization rate of 10% is applied based on
data received from Pharmaceutical Enterprise. It should be noted that land costs are
included in the economic analysis, but are excluded from the financial analysis since the
land is already donated (government owned).
 Machinery and equipment (fixed cost)– A full list of machinery and equipment
required for IV Fluid production was reviewed with staff from the HCSM firm.
Furthermore, the original market value and remaining life years of each item were
identified. An amortization rate of 3% was applied over the course of the life years.
Machinery and equipment costs were included in the economic analysis, but excluded
from the financial analysis.
 Human resources (fixed cost) – A full list of human resources (see annex 1) was
developed with key stakeholders in order to ultimately support full production of
15,000,000 (500ml) units of IV Fluid per year. The staffing model is assumed to be a
fixed resource until this production level is achieved. These costs are estimated from
both economic and financial perspectives. A 3% inflation rate is applied.
 Raw materials (variable cost) – A full list of raw materials was developed. Raw
materials costs were obtained from a variety of sources. The Malta and Uganda studies
both of which applied a unit cost of $0.13 USD (approx. 6 Afs) per 500ml unit were used
as reliability estimates for costing raw materials in Afghanistan. These costs are
estimated from both economic and financial perspectives. A 3% inflation rate is applied
to raw materials. Based on discussions with stakeholders, we assume that this cost
includes customs fees in Afghanistan.
 Training (fixed cost) – Training costs are estimated to be incurred every two years
as refresher trainings provided to existing staff and initial trainings for new staff. These
costs are estimated from both economic and financial perspectives.
 Installation costs (fixed cost) – These costs are incurred in the first year and are
included as part of the HCSM contract. They are included in the economic analysis, but
excluded from the financial analysis.
 Miscellaneous recurrent costs (variable costs); water, electricity, machinery
maintenance, etc. – These costs are estimated to be approximately 10% of the total cost
of operation.

Importation Analysis Assumptions

 Average IV Fluid Prices: These prices are estimated to be an average across IV

fluids in the importation market in Afghanistan. It should be noted that this is generally
a narrow range of costs at present (23-27 Afs per 500 ml fluid unit). Furthermore, these
costs only include transport to Kabul as both local production and importation are
assumed to have the same transport costs from Kabul to locations across the country.

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IV Fluid Production Capacity and Market Demand

The production of IV fluids is estimated to include the following fluid types: Dextrose,
Saline, Ringer, Amino Acids, Glucose, Plasma, Sodium Chloride, Manitol and Mix.

Based on multiple stakeholder interviews with both private sector representatives and
Pharmaceutical Enterprise, the current market demand in Afghanistan is estimated to
be 12,000,000 (500 ml units) annually within the current population. Total production
capacity for the domestic production facility is as follows:
Year 1 – 5,000,000 (500 ml units)
Year 2 – 7,000,000 (500 ml units)
Year 3 – 9,000,000 (500 ml units)
Year 4 – 12,000,000 (500 ml units)
Years 5-10 – 15,000,000 (500 ml units)

Figure 1 below highlights the assumptions of local production over the 10-year period
based on proportional estimates of population growth and maximum capacity of the
local production plant.

Figure 1.

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 4. Results

The results of the economic evaluation are organized from both economic and financial
perspectives highlighting both total and unit costs of domestic production.

Table 1 shows the estimated economic costs of the local production of IV Fluids in
Afghanistan over a 10-year period. It should be highlighted that raw materials generally
represent the highest proportion of costs annually, while other cost drivers include
infrastructure, equipment, and human resources. The total economic cost of operation is
estimated as 139,587,661 (Afs) of $2,908,076 USD in year 1 and 242,974,203 (Afs) or
$5,061,963 USD in year 10.

Table 1. Estimated Economic Costs of the Local Production of IV Fluids in

Afghanistan

Resource Category Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10

Infrastructure/Building/Land 22,053,843 22,053,843 22,053,843 22,053,843 22,053,843 22,053,843 22,053,843 22,053,843 22,053,843 22,053,843
Equipment 14,627,578 14,627,578 14,627,578 14,627,578 14,627,578 14,627,578 14,627,578 14,627,578 14,627,578 14,627,578
Human Resources 57,306,240 55,317,427 56,976,950 58,686,259 60,446,846 62,260,252 64,128,059 66,051,901 68,033,458 70,074,462
Raw Materials 31,200,000 44,990,400 59,580,144 81,823,398 105,347,625 108,508,053 111,763,295 115,116,194 118,569,680 122,126,770
Training 3,600,000 - 3,780,000 - 3,969,000 - 4,167,450 - 4,375,823 -
Recurrent Expenditures and
Maintenance 10,800,000 11,124,000 11,457,720 11,801,452 12,155,495 12,520,160 12,895,765 13,282,638 13,681,117 14,091,550

Total Annual Costs Afs 139,587,661 148,113,248 168,476,235 188,992,529 218,600,387 219,969,886 229,635,990 231,132,154 241,341,498 242,974,203
Total Annual Costs $USD $ 2,908,076 $ 3,085,693 $ 3,509,922 $ 3,937,344 $ 4,554,175 $ 4,582,706 $ 4,784,083 $ 4,815,253 $ 5,027,948 $ 5,061,963

Table 2 shows the estimated financial costs of the local production of IV Fluids in
Afghanistan over a 10-year period. It should be highlighted that raw materials generally
represent the highest proportion of costs annually, while other cost drivers include
infrastructure, equipment, and human resources. The total financial cost of operation is

10
 estimated as 115,508,400 (Afs) or $2,406,425 USD in year 1 and 218,894,942 (Afs) or
$4,560,311 USD in year 10.

Table 2. Estimated Financial Costs of the Local Production of IV Fluids in

Afghanistan

Resource Category Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10

Infrastructure/Building/
Land 12,602,160 12,602,160 12,602,160 12,602,160 12,602,160 12,602,160 12,602,160 12,602,160 12,602,160 12,602,160
Equipment - - - - - - - - - -
Human Resources 57,306,240 55,317,427 56,976,950 58,686,259 60,446,846 62,260,252 64,128,059 66,051,901 68,033,458 70,074,462
Raw Materials 31,200,000 44,990,400 59,580,144 81,823,398 105,347,625 108,508,053 111,763,295 115,116,194 118,569,680 122,126,770
Training 3,600,000 - 3,780,000 - 3,969,000 - 4,167,450 - 4,375,823 -
Recurrent Expenditures
and Maintenance 10,800,000 11,124,000 11,457,720 11,801,452 12,155,495 12,520,160 12,895,765 13,282,638 13,681,117 14,091,550

Total Annual Costs Afs 115,508,400 124,033,987 144,396,974 164,913,268 194,521,126 195,890,625 205,556,729 207,052,893 217,262,237 218,894,942
Total Annual Costs $USD $ 2,406,425 $ 2,584,041 $ 3,008,270 $ 3,435,693 $ 4,052,523 $ 4,081,055 $ 4,282,432 $ 4,313,602 $ 4,526,297 $ 4,560,311

Furthermore, figure 2 shows the estimated progression of financial costs over the 10-
year period. Costs seemingly rise in the first 4 years, but then subsequently stabilize in
years 5-10, partly due to production maximizing out at 15,000,000 (500ml units).

Figure 2. Estimated Financial Costs of Production by Year for IV Fluid Production

over 10 years (Afs)

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 Furthermore, Figure 3 shows the key cost drivers for the cost of local production costs
over the 10-year period. Raw materials and human resources represent the largest
proportion of estimated costs. As noted earlier in this report, we assume that the cost of
raw materials includes customs fees in Afghanistan, although a $0.01 (approx. 0.5 Afs)
addition for such fees (per unit) would reflect a 7.5% annual increase in raw materials
costs, still below the cost of importation.

Figure 3. IV Fluid Local Production – Estimated Key Cost Drivers by Category – 10

Years (Afs)

IV Fluid Produc on Kabul

Es mated Key Cost Drivers - 10 Years (Afs)
250000000

Recurrent Expenditures and

200000000
Maintenance
Training

Raw Materials
150000000
Human Resources

100000000

50000000

0
1 2 3 4 5 6 7 8 9 10

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 Figure 4 represents a comparison of the estimated average local production unit costs
(under the economic perspective) with estimated average import prices. It should be
noted that import prices are estimated to be higher each year after year 1. Average
import prices are assumed to be 25 Afs in years 1-5 and 27 Afs in years 6-10.
Meanwhile, local production unit cost estimates, even when considering donated
resources, are expected to stabilize just above 15 Afs per 500ml in year 5. This
considerable difference appears from qualitative discussions to be largely due to
savings in import transportation costs to Kabul.

Figure 4. Estimated Total Average Economic Local Production Unit Costs and
Estimated Average IV Fluid Import Prices over 10 years (Afs).

Total Average Produc on Economic Unit Costs and

Es mated Average Import Prices (Afs) - 10 Years
30.00

25.00 Es mated Average Import Price (Afs)

Es mated Average Economic

Produc on Unit Costs (Afs)
20.00

15.00

10.00

5.00

0.00

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 Figure 5 represents a comparison of the estimated average local production unit costs
(under the financial perspective) with estimated average import prices. The same
assumptions are held for importation prices. Meanwhile, local production unit cost
estimates, are even lower under this model at an average below 15 Afs per 500ml per
year over the 10-year period.

Figure 5. Estimated Total Average Financial Local Production Unit Costs and
Estimated Average IV Fluid Import Prices over 10 years (Afs).

Total Average Produc on Financial Unit Costs and

Es mated Average Import Prices (Afs) - 10 Years
30

25 Total Es mated Produc on Unit Costs

(Afs)
Es mated Average Import Price (Afs)
20

15

10

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Figure 6 shows the estimated economies of scale for both total average economic and
financial local production costs over the 10-year period. Economies of scale are reached
in year 5 (14.57 Afs per unit) under the economic model, and year 5 (12.97 Afs per unit)
under the financial model.

Figure 6. Estimated “Economies of Scale” - Total Average Economic and Financial

Local Production Unit Costs over 10 years.

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Figure 7 shows the estimated annual profit if the local production units are priced at
22 Afs each year (below the estimated import market price). Total profit over the
10 year period is estimated to equal 917,968,819 (Afs) or $19.1 million USD.

Figure 7. IV Fluid Local Production – Estimated Annual Profit (Afs) over 10

years

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 Finally, Figure 8 shows the estimated annual tax revenue if the tax is 10% of local
production cost each year. For example, year 1 shows a revenue of approximately
9,192,696 (Afs) while year 10 shows a revenue of just over 20,000,000 (Afs), almost
double to year 1.

Figure 8. IV Fluid Local Production – Estimated Annual Tax Revenue (Afs) over
10 years

5. Recommendations, Benefits, and other Important Considerations

Based on the above economic evaluation, we strongly recommend the Government of

Afghanistan take further steps towards the financing and local production of IV fluids
over the next 10 years. The analysis clearly highlights the reduced cost per 500ml IV
fluid unit under local production, relative to importation prices, particularly under the
financial perspective. Even if the local production was not to reach an estimated
production of 15,000,000 units by year 5, significant economies of scale are forecasted
over the period of analysis.

As for benefits, within this economic analysis there appears to be both estimated
benefits for possible profit for the producing organization, increased government

17
revenue, and the provision of steady employment to over 70 Afghans (or citizens from
other countries if expertise is not available in Afghanistan).

Within the context of this recommendation and assumed benefits, a few considerations
should be given to some issues of uncertainty. First, from stakeholder interviews, it is
worth highlighting the fact that customs procedures for raw materials can be very long
and cumbersome, which can add to the societal cost of local production. Secondly,
questions remain about the quality of medicines and raw materials being imported into
Afghanistan and IV fluids are no exception. These questions can pertain to importation
of both IV fluids and raw materials. The costs of raw materials under local production in
Afghanistan are assumed to capture the cost of standardized, international quality raw
materials for the production of IV fluids. Although difficult to quantify, it should be
noted that logistical, supply-chain delays can equally impact the cost of importing IV
fluids or raw materials and must be minimized to reduce these hidden costs. Lastly,
one of the major costs associated with local production is estimated to be human
resources. Although the rates of pay represent the market rate for qualified experts and
staff, Afghanistan may have difficulty staffing these positions based on current levels of
capacity in country, and in this case, it would require attracting qualified staff from
abroad.

In addition, it is important to note that national production of IV fluids may be difficult

to realize in Afghanistan without a national regulatory structure. This structure would
oversee the production of standardized, quality IV fluids for domestic consumption
throughout Afghanistan. We recommend a review of the existing structure, policies, and
supervision procedures of the General Directorate for Pharmaceutical Affairs (GDPA) in
the MoPH in order to identify and plan for an adequate regulatory framework for local
production.

In order to make local production of IV fluids a sustainable reality in current-day

Afghanistan, it will require the development of a flexible, detailed 5-10 year business
plan reflecting the roles and strengths of both the public and private sector. A public
only model would most likely put the burden on the MoPH for all the roles of providing,
purchasing and regulation, while a public/private partnership would provide a more
balanced approach. The public sector could provide the necessary regulatory
framework, while the private sector, given its experience in the importation market,
could assist to identify qualified personnel, secure quality raw materials, and price IV
fluids appropriately within a competitive pharmaceutical market.

It should be noted that varying organizational models of production of IV fluids have

existed in other country contexts including public production, public/private
partnerships and not-for-profit operations (such as in Uganda). Ministry of Public
Health should consider the strengths and weaknesses of alternative models in order to

18
maximize cost-efficiency in local production of IV fluids and strengthening this
component of the health system.

6. Data Collection and Analysis Team and Staffing, Roles

Health Partners International Canada (HPIC): Dr. Aaron Philip Blaakman

(International Advisor) led the investigation, organized the workplan, data
collection, and analysis. He coordinated directly with HEFD and HPIC. Dr. Abdul
Alim, HPIC Afghanistan, apart from sponsoring this project, had technical inputs to
the study.

HEFD Staff: Dr. Husnia Sadat, Mr. Zawoli and, Dr. Reshad Osmani were all involved
in components related to data collection, cost and market analysis, and final
reporting of the study results. Dr. Ahmad Shah Salehi guided the entire process from
HEFD end.

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