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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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The responsibility and authority mapping process ramp l.jpg

The Responsibility and Authority Mapping Process (RAMP)

Developed by Management Sciences for Health, Inc.

2006


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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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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


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


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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


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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


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Excerpt from the RAMP data collection matrix


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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


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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


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A quick tour through the RAMP instrument


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Sample completed response sheet


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Sample chart showing level of consensus among all respondents


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


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Analysis of findings in our situation


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All functional areas

  • 136 determining questions

  • 82 total respondents across all respondent groups


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Health service delivery:summary charts

  • Number of determining questions: 11


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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”


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Public health surveillance and response: summary charts

  • Number of determining questions: 15


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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


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Financial resources: summary charts

  • Number of determining questions: 26


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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


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Personnel: summary charts

  • Number of determining questions: 33


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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


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Drugs, vaccines, and supplies: summary charts

  • Number of determining questions: 15


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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”


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Equipment and transport: summary charts

  • Number of determining questions: 13


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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%


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Capital construction and maintenance: summary charts

  • Number of determining questions: 7


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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”


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Health and management information: summary charts

  • Number of determining questions: 11


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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%)


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Health communication: summary charts

  • Number of determining questions: 4


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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


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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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