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The Responsibility and Authority Mapping Process (RAMP)

The Responsibility and Authority Mapping Process (RAMP). Developed by Management Sciences for Health, Inc. 2006. Presentation outline. Why develop the RAMP? What does the RAMP consist of? Objectives of a RAMP exercise Methodology of application Results of field trial Next steps.

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The Responsibility and Authority Mapping Process (RAMP)

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  1. The Responsibility and Authority Mapping Process (RAMP) Developed by Management Sciences for Health, Inc. 2006

  2. Presentation outline • Why develop the RAMP? • What does the RAMP consist of? • Objectives of a RAMP exercise • Methodology of application • Results of field trial • Next steps

  3. Why develop the RAMP? • Health sector and other reforms are changing how health services are delivered • These changes have considerable management implications • Clear definition of responsibility and authority is lacking • Confusion of roles is common

  4. A simple tool is needed to assess health managers’ understanding of where new management responsibilities reside.

  5. What does the RAMP consist of? • RAMP is a process with three phases • Prepare for field application • Collect, analyze, and present data • Use findings to make management decisions • RAMP instrument facilitates data collection and analysis • RAMP data collection worksheet is an easily adaptable matrix • Nine functional areas • 1-12 functions per functional area • 1-7 determining questions per function • Questions are closed to reduce confusion • Clarifying comments can also be recorded

  6. Nine functional areas • Health service delivery • Public health surveillance and response • Financial resources • Personnel • Drugs, vaccines, and supplies • Equipment and transport • Capital construction and maintenance • Health and management information • Health communication

  7. Excerpt from the RAMP data collection matrix

  8. Objectives of RAMP exercise Practical way to: • Assess whether all respondents have the same understanding about who has responsibility or authority • Compare perceptions among respondent groups about distribution of responsibilities among different power holders • Compare respondents’ understanding at different points in time

  9. Methodology • Interviews: • Guided interviews with groups of respondents, or respondents filling in the data collection form individually • All key respondent groups represented • Analysis and report: • Degree of consensus among respondent groups • Extent of agreement regarding which power holder(s) has responsibility or authority to carry out the functions

  10. A quick tour through the RAMP instrument

  11. Sample completed response sheet

  12. Sample chart showing level of consensus among all respondents

  13. Sample bar chart showing different groups’ responses to a determining question

  14. Analysis of findings in our situation

  15. All functional areas • 136 determining questions • 82 total respondents across all respondent groups

  16. Health service delivery:summary charts • Number of determining questions: 11

  17. Health service delivery: key points • Very low level of consensus • No high or moderate consensus on any questions • No consensus on 36% of questions • Many functions at National level • 23% of answers were “National only;” another 38% were “Shared national and sub-national”

  18. Public health surveillance and response: summary charts • Number of determining questions: 15

  19. Public health surveillance and response: key points • High consensus among responses to 1/3 of questions • Some of this due to high percentage of respondents who said that functions did not exist (35% of answers) • Also the second-highest level of “No consensus”—27% of questions, second only to Health Service Delivery functional area

  20. Financial resources: summary charts • Number of determining questions: 26

  21. Financial resources: key points • Moderate level of consensus for 35% of questions, but low consensus for another 61% of questions • Across all functional areas, the smallest percentage of “No consensus” (4%) • One of the more centralized functional areas: 31% of answers were “National only,” with another 26% “Shared national and sub-national” • Relatively high level of facility involvement, compared to other functional areas • In 13% of answers, perception was that facility alone had the responsibility or authority

  22. Personnel: summary charts • Number of determining questions: 33

  23. Personnel: key points • High or moderate consensus for 61% of questions • Across all functional areas, the second-highest percentage of “None/ Does not exist” answers (22%) • In 17% of questions, function was perceived to be carried out at District level only, higher than any other functional area

  24. Drugs, vaccines, and supplies: summary charts • Number of determining questions: 15

  25. Drugs, vaccines, and supplies: key points • Third highest percentage of questions with “No consensus” (19%) • About 50% of responses indicated some level of National involvement, either “National only” or “Shared national and sub-national”

  26. Equipment and transport: summary charts • Number of determining questions: 13

  27. Equipment and transport: key points • No questions with high consensus • Second-highest percentage of “Low consensus” questions • By far the highest percentage of responses indicating that function takes place at Provincial level only (17%) • Greatest percentage of respondents perceived that these functions are carried out jointly at sub-national levels (without needing to consult the National level)—18%

  28. Capital construction and maintenance: summary charts • Number of determining questions: 7

  29. Capital construction and maintenance: key points • Highest percentage of “Moderate consensus” across all respondents • Approximately 57% of responses showed either High or Moderate consensus—second highest across all the functional areas • High degree of responsibility and authority at National level • 63% of answers were either “National only” or “Shared national and sub-national”

  30. Health and management information: summary charts • Number of determining questions: 11

  31. Health and management information: key points • No “High consensus” for any of the questions in this functional area • Responsibility perceived as concentrated at National level: highest combined percentage of “National only” and “Shared national and sub-national” (64%) • Second highest percentage of responses indicating the perception that functions are carried out jointly at the sub-national level (17%)

  32. Health communication: summary charts • Number of determining questions: 4

  33. Health communication: key points • Very low level of consensus overall • Low consensus on 75% of questions • No consensus on remaining 25% of questions • Despite lack of consensus, nearly half (48%) of responses agreed that responsibility was shared among national and sub-national levels

  34. Next steps • Corrective steps to address key issues • **Fill this out, based on your own findings • Suggestions for further analysis • **Fill this out, based on your own findings

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