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Abt Associates Inc. In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health
better systems, better health
Better Health Systems: Strategies that WorkPresentation Series at the Global Health Council
Michael Rodriguez, MADanielle Altman, MAMarch 6, 2012
Setting the Stage for Health Systems Strengthening: What We Have Learned from Doing Over 30 Health System Assessments
Global Attention to Health Systems Strengthening
Health System Assessment Approach
Assessment
Analysis
Recomm
endations
Prioritization
Decision-making
Programm
ing
Sco
pe
Broadhealthsystem
Focused
USAID’S Health System Assessment Approach
Profiles
Decision-Making Process
Objectives and Use of Health System Assessments
HSA approach piloted in Angola, Benin, and Azerbaijan in 2005-2007
Rapid yet comprehensive/integrated approach
Findings inform stakeholders of critical system strengths and constraints
Recommendations developed that cut across the building blocks
HSS interventions prioritized
Assessment Domains
5
Shape the assessment•Identify needs and priorities of client•Agree on scope and use of assessment•Choose indicators within each module to answer client’s priority questions
1
Data collection and launch workshop•Review background materials and compile data on quantitative indicators•HSA launch workshop for in-country stakeholders•Interview key informants
2
Analyze findings•Analyze findings by building block•Develop cross-cutting findings and recommendations•Prepare preliminary report of key findings and recommendations
3
Validation/prioritization workshop and final report•Validate findings and prioritize recommendations at stakeholder workshop•Produce final report
4
Steps in the Health System Assessment Approach
Eastern Caribbean: Support implementation of US-
Caribbean Regional HIV and AIDS Partnership Framework in
6 countries
Ukraine: Inform health reform agenda
Documented Uses of HSA Results
Lesotho: Inform MOHSW health system activities through Millennium Challenge Account; USG Partnership Framework; National Health Policy and Strategic Plan
Documented Use of HSA in Senegal
HSA Recommendation HSA Action Item
Improve technical coordination at MOH; strengthen the planning unit
Create department of planning, research, monitoring and evaluation at the MOH
Devise strategies to relieve HRH shortages
Change health system at peripheral level, so that health district coordinators do not also head district health centers. Separate district health offices from health centers
Strengthen regional health districts Change design of health system at intermediate level by transforming regional health offices to regional departments of health with more power over human resources management, financial management, and service delivery
Improve planning around health insurance
Draft a law to enable pooling of funds for free-care services and health insurance
Evolution of the HSA Approach 2005 - 2012
Incorporate assessment of private sector Build capacity in HSA methodology Standardize and strengthen stakeholder
engagement approach
Evolution of the HSA Manual
2011 – 2012
25 countriesTanzania, Uganda,
Ukraine, Mozambique, Ethiopia, Benin, St.
Kitts and Nevis, Antigua, St. Vincent and the Grenadines, Grenada, Dominica,
and St. Lucia
Version 1.75
13 countriesVietnam, Namibia,
Nigeria, Senegal, Cote d’Ivoire, Lesotho,
Zimbabwe, Angola, Kenya, Guyana
Version 1.5
2007 – 2010
Version 1.0
3 pilot countriesBenin, Angola,
Azerbaijan
2005 – 2007
11
Incorporating Private Sector into HSA Approach Governments face constraints in delivering essential health services Harnessing private sector can help relieve public sector constraints
and can result in: Increased efficiencies in management Expanded health workforce and service delivery infrastructure Additional resources Increased responsiveness to consumer preferences Broader market for health promotion messages Better/more creative policymaking
Particularly critical to help sustain HIV response as countries face static or declining external aid for HIV/AIDS
Source: International Finance Corporation 2007; Barnes et al. 2009
12
Recognizing Private Sector Role In Health Systems Strengthening
Source: Arur A. et al. 2010. Strengthening Health Systems by Engaging the Private Health Sector: Promising HIV/AIDS Partnerships. SHOPS Project, Abt Associates.
13
Strategies for Strengthening Health Systems Through Partnerships with Private Sector
Source: Arur A. et al. 2010. Strengthening Health Systems by Engaging the Private Health Sector: Promising HIV/AIDS Partnerships. SHOPS Project, Abt Associates.
Building Capacity in the HSA Methodology
Health Systems 20/20’s capacity building strategy aims to transition health system strengthening methodologies to regional partners
Enhance country ownership of HSA process and recommendations
Developing Regional Capacity
Health Systems 20/20 has trained HSPI (Vietnam), IRSP (Benin), and Makerere University (Uganda) in HSA approach
These institutions will market their skills and use the HSA methodology without Health Systems 20/20 support
Health Systems Assessment - Technical Skill SetHealth systems knowledge in six building blocks
Stakeholder engagement
Qualitative data collection and analysis
Technical writing
Building MOH Capacity in HSA
GuyanaMOH staff shadowed Health Systems 20/20
assessment team and participated in collecting data for each module
Health Systems 20/20 wrote bulk of reportMOH will use the approach to monitor progress over
time
Building HSA Capacity – Lessons Learned
Participation of MOH staff on HSA enhances country ownership of HSA recommendations
Intensive training needed, particularly in qualitative data collection and analysis
Need for long-term strengthening of regional institutions
Transferring HSA methodology is a long-term process
Strengthening and Standardizing HSA Stakeholder Engagement Methodology
Engaging Stakeholders in Health System Assessments: A Guide for HSA Teams
Stakeholder Engagement Guide
Guides HSA team in involving a wide range of health system stakeholders – government, nongovernmental and civil society groups, research and academia, and private sector – throughout all phases of the HSA
Describes stakeholder engagement in greater detail than the HSA manual
Stakeholder Engagement Guide cont’d
Provides user-friendly job aids, tools, and guidance: During Planning Phase
Drafting potential list of key stakeholders Planning and coordinating the HSA team participants Conducting pre-assessment visits
Assessment Phase Gathering data Conducting in-country debriefing session on initial findings
Validation Phase Validating findings with stakeholders Prioritizing and action planning key proposed interventions
Summary
Health system strengthening is not a result, it’s a process
The HSA methodology sets the stage for health systems strengthening
The HSA approach highlights linkages across the building blocks
As HSAs have been completed, results have fed back into adaption and modification of the methodology
Version 1.5 of the HSAA Manual
Available at the following URL:
http://www.healthsystemassessment.com/
You can register on the site for updates as they are made
Abt Associates Inc. In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health
better systems, better health
Thank youThank you!
www.HealthSystems2020.org