How To Build A Picture Of The Health System Using The Health Systems Assessment Approach

1. How To Build A Picture Of The Health System Using The Health Systems Assessment Approach USAID/Global Health Bureau Mini-University 2010 Catherine Connor

2. Session Objectives • Introduce systematic approach to • Assess a country’s health system • Identify health systems strengthening activities • By the end of the session participants will • Develop understanding of the Health Systems Assessment Approach: A How-To Manual by participating in small group exercise using an actual country assessment

3. Session Agenda • Welcome (5 min) • Overview of Health Systems Assessment Approach (10 min) • Using the tool to assess a country’s performance – small group exercise (25 min) • Report out top recommendation (10 min) • Actual country recommendations (10 min) • Invitation for feedback/Adjourn

4. Overview of theHealth Systems Assessment Approach

5. Global Attention to Health Systems Strengthening

6. System Weakness: Inadequate, unmotivated, unskilled staff; poor quality of care; stock-outs What to do? What to invest in?

7. Different tools/methods: range of scope and step in the decision-making process Broad Health System World Bank Country Status Report HiTS PAHO profiles Scope National Health Accounts SPECTRUM LiST MBB HMN assessment Focused Analysis Profiles Assessment Programming Prioritization Decision-making Recommendations Decision-Making Process

8. Health Systems Assessment Approach Broad Health System USAID’S Health Systems Assessment Approach (HSAA) Scope Focused Analysis Profiles Assessment Programming Prioritization Decision-making Recommendations Decision-Making Process

9. Expert guidance and references for each building block chapter Donor mapping Inform stakeholders of critical systems strengths and constraints, and develop recommendations across the six building blocks Comprehensive yet rapid Create consensus and momentum to act What’s the Value Added?

10. HSA Approach - Conceptual Framework Public and Private Sectors PEOPLE Consumers Patients Voters Communities Households

11. Manual guides each step of a Health Systems Assessment Stakeholder workshop and final report Validate findings and conclusions with local stakeholders Prioritize recommendations Create final report and recommendations 5 Analyze Findings Identify relevant tables to compile information and analyze findings by building block Discuss initial findings with fellow group members and synthesize conclusions across modules Prepare a summary of initial findings and recommendations Hold a post-assessment debriefing as needed 4 Collect Data Compile and review background materials; identify additional resources needed, information gaps, and key informants Organize stakeholder workshops as needed Prepare a contact list and interview key informants 3 Logistics Prepare an assessment budget Assemble an assessment team and assign responsibilities Prepare the logistics checklist Schedule and conduct team planning meeting 2 Shape the Assessment Speak with client; Identify the needs and priorities of the client Agree on the scope, time frame, and dates of the assessment Choose relevant indicators within each module to answer the client’s priority questions 1 Stakeholder workshop agenda, presentation format, sample reports Methods for team to synthesize findings, articulate links across functions Tutorial and indicators for each health system function Sample budgets, schedules, team assignments Tutorial on health systems and sample scopes

12. Each Module has standardized indicators across countries Health Systems Database provides 74 indicators for 180 countries Multiple sources: World Health Organization (WHO), World Bank, UNICEF, UNAIDS, UNESCO, Measure DHS http://healthsystems2020.healthsystemsdatabase.org

13. Each module guides you to understand and assess each indicator • Definition • Rationale • Interpretation • Suggested data sources • Stakeholders to interview • Links to other modules on cross-cutting issues • Issues to explore • Notes and caveats

14. Use of the Health System Assessment Manual

15. Using the Health Systems Assessment Approach to assess Kenya’s health systems performance Small Group Exercise

16. Situation – Use this HSA to help Kenya reduce maternal mortality • Kenya is using this Health System Assessment to inform their review of the annual health sector operational plan and as an input for future health policy. • A key health priority is reduction of maternal mortality. While Kenya’s MMR is lower than its peers, it has remained stagnant over the last several years despite targeted efforts by donors and the government.

17. Small Group Exercise – 25 minutes • You are part of the assessment team that has been in Kenya for the last two weeks assessing the function listed on your table. You are now meeting to analyze your findings and its interactions with the other 5 areas. • Brainstorm recommendations to reduce maternal mortality. • For the stakeholder workshop TOMORROW, select: • 1 short term recommendation for the annual health sector plan • 1 longer term recommendation for the future health policy To reduce maternal mortality

18. Kenya Team Report Outs One minute to share • 1 short term recommendation for the annual health sector plan • 1 longer term recommendation for the future health policy

19. Kenya HSA Maternal Health RecommendationsLisa Maniscalco Washington, DC October 8, 2010

20. Recommendations (1) Pharmaceutical Management: Do away with the current push system employed by KEMSA for distribution to the facilities. Strengthen capacity at all facility levels to plan and order medicines based on usage and projected need. Improve private sector pharmaceutical service coverage, especially for rural and under-served areas. Two strategies to consider are: an incentive system for setting up pharmacies in these areas; and a flexible accreditation system for informal drug sellers. HIS: As has been done with the faith-based community, develop MOUs between the GOK/health ministries and other major private sector stakeholders regarding procedures, roles, and responsibilities around health information, monitoring, and evaluation. Provide incentives to private sector participants to encourage and expand health information related services.

21. Recommendations (2) Finance: Fast-track the training of DHMTs and health facility committees to be able to budget and account for direct funding. Allow Districts and health facilities to undertake AOPs planning based on resource envelope, to get away from zero-based budgeting and allow for more targeted programs at the district level Service Delivery Empower the system to take on AOP activities identified at the decentralized levels. -- This can be accomplished through a more transparent allocation of funds and better prioritization of activities. Decentralized planning will enable provinces/districts to purchase necessary items for referrals (transport and communication) and outreach services. It will also provide flexibility in addressing health needs which are unique to certain areas of the country. The referral strategy needs to be implemented.

22. Recommendations (3) HRH: Accountability in distribution. Inequities in provider distribution must be addressed at the national and district levels. Transparency in distribution, hiring, and placement will shed bright light to discourage cronyism and favoritism. Attract health workers to the rural areas. Governance: Create or strengthen formal roles for interested CSOs, FBOs, and individuals to participate in sector policy process, including planning, monitoring and evaluation. Enhance the use of high-quality HMIS data for analysis and packaging to facilitate policy development. This will improve transparency and accountability.

23. Thank you

24. We welcome your feedback http://www.healthsystems2020.org/content/resource/detail/528/ • Overall observations about the assessment tool? • Challenges / factors in making recommendations? • Imagine doing an assessment like this in a country setting – what do you see as essential elements / steps that you think should be part of the process? • What did you need more of in order to come up with informed recommendations? • What levels of information would have been useful? • What kinds of applications do you see for the Health Systems Assessment tool?