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