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HEALTH SECTOR. ( Presented by Christine Bousquet, Independent Consultant). Key trends at policy level. Emphasis on a strategic framework and a coherent policy Increasing health care in underserved and remote areas Building of health system through contracting bodies (NGOs)
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HEALTH SECTOR ( Presented by Christine Bousquet, Independent Consultant)
Key trends at policy level • Emphasis on a strategic framework and a coherent policy • Increasing health care in underserved and remote areas • Building of health system through contracting bodies (NGOs) • Promotion of increased consumer voice
Among the main achievements: • A structured health system is functional with increased level of activities • Lessons learning process at all levels with improved collaboration, communication and transparency • Improved system in place for monitoring
Actors of change at national level • Progress towards a strong institutional leadership and ownership • Donor efforts to coordinate external resources • A step further: pooling of donor funds • Increased role of universities
Actors of change at field level(1) The Provincial Public Health Departments: • Increased role for coordinating operators, monitoring and problem-solving • Building capacity through PRR process • But strong reliance upon NGOs with unclear mechanisms for allocation of funds
Actors of change at field level (2) • NGOs as non-state providers: fast in adapting to the new context with a risk of becoming “institutionalised” • Other NGOs as agents of social changes • Increased community participation
Limiting factors to change: (1) The private for profit sector: does it matter? • Studies examining the efficiency and quality of private care are lacking • Limited role of private medical care in preventive interventions • Lack of consumer protection or regulation
Limiting factors to change (2) The blurred line between public and private: • A majority of health professionals seek alternative sources of income • Forces to change fundamentally this system are weak • The contractors may have little influence over the practices of health professionals • Possible negative impact on the quality of care, on ethics and professional values
Some issues for discussion (1) The necessity to take into account the private for profit sector: • Building public-private partnerships • Lobbying for regulation and enforcement • Performance based as opposed to process based • Are financial bonuses sufficient: what is the role of other incitation mechanisms (career, professionalism, media, peer pressures, law)?
Some issues for discussion (2) The BPHS implementation: • Has gone fast • With an increased scope of activities How to maintain focus on results without compromising quality?
Some issues for discussion (3) • Increased importance of national NGOs • The implementation of EPHS may remain with the MOPH • Some NGOs are responding to specific needs • How will the NGOs evolve in the future and what will be their added value?
Some issues for discussion (4) Increasing the overall level of resources: • The current system is only sustainable if donor money continues to be forthcoming both for BPHS and EPHS • But uncertain level of donor commitment for the future • What can be the alternatives?