Health System Development Programme2006-2011

Objectives1. To promote utilization of health systems research

to improve health systems performance by enhancing research culture among decision makers at all level

2. To explore and develop an appropriate and sustainable financing mechanism for fair financing of health and equitable delivery of services

3. To expand and strengthen international co-operation in line with the 30 year long term health plan by collaborative activities

Project

1. Health Systems Research and Development Project

2. Developing Alternative Financing Mechanisms for Health Project

3. International Health Cooperation Project

Health System Research and Development Project

Developing Alternative Financing Mechanism for Health Project

International Health Cooperation Project

Strength

Health System Research

• Able to disseminate knowledge and skills on heath systems concepts and health systems research (HSR) methodology to health managers who provide services to the community.

• Able to develop user friendly HSR tools for health system strengthening, assessments and quality improvements

• HSR studies can provide technical know-how for health systems strengthening, assessment and quality improvements.

StrengthHealth Financing• Health financing assessment and development of new scheme

was initiated in collaboration with WHO Consultants

• Interest of all stake holders and donors after implementing awareness raising workshops at township level

• Attention of the international donors based on publication of National Health Accounts and health financing studies

• Appropriate health manpower (Health Economists) posted in the planning division but still limited number

WeaknessHealth System Research

1. There has no financial support for HSR studies conducted by mid-level health managers.

2. There has weaknesses in dissemination of information to the higher level health authority to take action based on HSR findings.

Weakness

Health Financing1. Poor advocacy to high level policy making body on health

financing situation 2. Lack of interest of decision maker on health financing situation3. Limited number of skilled health manpower especially health

economists4. Lack of skilled staff on financing and budgeting in the township

health system5. No or limited community awareness on health financing issues 6. Current health financing and costing research is not covered all

the area and need more research on alternative health financing and efficient utilization of limited resources

7. Need more partners on implementing new financing scheme

Requirements to be fulfilled for achieving targets

Health System Research1. Dedication by project personnel, knowledge, experiences and

skills on research management obtained by actual implementation of the project contribute achievements of the targets.

2. Political supports and guidance from Departmental Head, sharing and discussion of experiences on project implementation among technical colleagues were contributions for the achievements

3. Close collaboration and coordination with health and health related departments such as Department of Health, Department of Medical Sciences, General Administration Department , Central Statistical Organization, national and international NGOs were the contributors for achievement

Requirements to be fulfilled for achieving targets

Health Financing1. High level advocacy meeting on current health financing situation and

options for protecting the poor achieving Universal Coverage2. Capacity building in the area of health economics to mid level officers3. Feasibility studies on development of new health financing methods

should be explored4. Financial management and mobilization of funds in township health

system should be extended to more townships5. Connecting with more partners on solving the problem of waiving the

poor and vulnerable (technical as well as financial)6. Awareness raising of community through implementing new

financing scheme in the pilot area (knowing by doing)7. More research on costing, cost effectiveness for assisting the decision

making (improving efficiency)

Other comments

Health Financing• Providing more knowledge on advantage of health insurance

especially in the area of fund pooling and risk pooling among the solidarity group to all levels

• Awareness raising of other countries’ experiences on health financing situation among different regions of WHO

1. Identify key barriers / bottlenecks to increase sustained coverage which are beyond the control of the service delivery system

HRH shortages, Distribution,

Quality, motivation etc.Transport to reach the ‘hard to reach’ (especially for outreach)Affordability and fund flow issues especially to district levelInfrastructure at periphery, LogisticsManagement monitoring & supervision Coordination with and between partners

2. Identify what causes lead to these problems

problem analysis

3. Identify how to overcome them formulate your objectivesidentify interventions

At what level are the performance constraints & bottlenecks?

OPERATIONAL LEVEL

PROGRAM LEVEL

SYSTEM LEVEL

Policy & sector analysis: PHC, PRSP, MDGS

Strategy analysis: RED, MPA, demand vs. supply driven

Needs analysisHR: skills, skills mix, retentionCapital: stores, equipment, vehiclesCapacity building

Strengthening interventions

Service deliveryService delivery

Drug Drug Supply & Supply & QualityQuality

LogisticsLogistics

Advocacy &Advocacy &CommunicationCommunication

SurveillanceSurveillance

ISS

3DF

NHSC

CCM

GF

UNFPA

WHO

UNICEF

INGOs

Strengthening Systems

Service deliveryService delivery

Drug Supply & Drug Supply & QualityQuality

LogisticsLogistics

Advocacy &Advocacy &CommunicationCommunication

SurveillanceSurveillance

MoF, World Bank,

UNICEFGov’T, UNDP,MNPED

GAVIHSS

HSS

HSSSWAp

UNICEFPRSP

Policy space

Service deliveryService delivery

Drug Supply & Drug Supply & QualityQuality

LogisticsLogistics

Advocacy &Advocacy &CommunicationCommunication

SurveillanceSurveillance

EQUITY

STEWARDSHIP

ACCESS

PRO-POOR

Strategic Framework: An example from DPRK

STRATEGIC AREA 2

Non

Communicable Disease

(1) Chronic Diseases (2) Injury (3) Mental health (4) Aged care & Disability (5) Tobacco Control

STRATEGIC AREA 3

Communicable

Disease

(1) Immunization (2) Malaria (3) TB, (4) HIV, (5) Hepatitis B treatment (6) Pandemic Planning and emerging diseases

STRATEGIC AREA 4

Women’s and

Children Health

(1) Maternal Health (2) Neo natal Health (3) Reproductive Health (4) Child Health (5) Nutrition (6) Adolescent Health

P R O G R A M S

NATIONAL DEVELOPMENT PRIORITIES, LAW AND INTERNATIONAL AGREEMENTS

MEDIUM TERM DEVELOPMENT PLAN FOR THE HEALTH SECTOR IN DPRK

SYS TEM

STRATEGIC AREA 1

Health System

(1)Policy, Planning & Coordination (2) Health Information (3) Human Resources (4) Drug Supply & Logistics Systems (5) Financing & Financial management (6) Service Delivery Systems (7) Science & technology (8) Community participation

STRATEGIC AREA 5 The Social and Environmental Determinants of Health

(1) Food Safety (2) Health & Hygiene promotion (3) Climate Change (4) Safe water & Sanitation (5) Health Life Conditions (6) Emergency preparedness

MULTI SECTOR AND SOCIETY

Health Outcomes and MDG Goals

Links Between Objectives and Actions

STRATEGIC AREA 1 HEALTH SYSTEM OBJECTIVE

Planning Sub Objective Strategic Approach

HR Sub Objective Strategic Approach

Finance Sub Objective Strategic Approach

Essential Medicine Sub Objective Strategic Approach

Service Delivery Sub Objective Strategic Approach

Community Participation Sub Objective Strategic Approach

5 priority actions for each sub objective