Development of the Health Systems Assessment Approach

1. Development of the Health Systems Assessment Approach Mursaleena Islam Abt Associates Inc. April 25, 2007

2. Background • USAID/Global Health Bureau initiative to systematize health systems assessments • Develop a rapid yet comprehensive/integrated health systems assessment approach

3. Purpose • Key purpose(s) • Inform PHN officers and Missions about health systems functions • Allow PHN officers to conduct a rapid assessment of a country’s health system, possibly during early phases of program development and project design, as well as program monitoring and evaluation • Inform all stakeholders of critical health systems strengths and constraints, help prioritize intervention opportunities, and create consensus and momentum to act

4. Product Development Ladder • Develop product concepts, refine and test, replicate nationally, and institutionalize • Tool originally defined as fairly mechanical and universally applicable – a way to codify expert knowledge • Well documented and transferable • Still may take time to apply the tool, compile data, and prepare recommendations – however, should take less time than an ad-hoc/unpackaged process Adapted from: Arias, J., T.Cleland, P. Connell. 2004. Interim Assessment of the Partners for Health Reformplus (PHRplus) project

5. Audience for the Assessment Tool • USAID PHN officers • Ministries of Health • Anyone conducting health systems assessments • Health systems specialists or generalists

6. Tool Development Timeline • Initial conceptualization: Jan - Mar 2005 • First draft of tool: Apr - Jun 2005 • First pilot test: Aug 2005 • Significant refinement post pilot test: Sep - Dec 2005 • Second pilot test: Apr - May 2006 • Refinement post pilot test: Jun - Sep 2006 • Copyediting and finalizing: Oct - Dec 2006

7. Tool Development Partners • USAID/GH • PHRplus (now Health Systems 20/20) • RPM Plus • QAP

8. Conceptual Framework • Need an approach that helps to: • Diagnose health systems strengths and weaknesses • Prioritize key constraints and areas for interventions • Identify potential solutions • Existing tools (in early 2005) did not offer quantitative comprehensive health systems assessments • Some focused on profiles (PAHO, European Observatory) • None allowed for integration across health systems functions

9. Conceptual Framework (cont.) • Used WHO framework Functions the system performs Stewardship (oversight) Creating resources (investment and training) Delivering services (provision) Financing (collecting, pooling, and purchasing) Source: Adapted from WHO (2001)

10. Conceptual Framework (cont.) • Drilled down into each function to structure assessment approach and added link to performance and impact

11. Challenges • Priority health service areas • Private sector • Public health • Decentralization • Indicator-based approach • Quantitative indicators vs. qualitative questions • Screening questions • Desk review vs. stakeholder interviews

12. Challenges (cont.) • Accessible to a generalist • Technical approach and operational process needed to be well-documented • General overview chapter on health systems • Key concepts defined and detailed descriptions of indicators and technical analysis • Chapters on operational process

13. Thank you Reports related to this presentation are available at www.healthsystems2020.org