Better Health Systems: Strategies that Work Presentation Series at the Global Health Council

1. Setting the Stage for Health Systems Strengthening: What We Have Learned from Doing Over 30 Health System Assessments Better Health Systems: Strategies that Work Presentation Series at the Global Health Council Michael Rodriguez, MA Danielle Altman, MA March 6, 2012

2. Global Attention to Health Systems Strengthening

3. Health System Assessment Approach Broad health system USAID’S Health System Assessment Approach Scope Focused Analysis Profiles Assessment Programming Prioritization Recommendations Decision-making Decision-Making Process

4. Objectives and Use of Health System Assessments • HSA approach piloted in Angola, Benin, and Azerbaijan in 2005-2007 • Rapid yet comprehensive/integrated approach • Findings inform stakeholders of critical system strengths and constraints • Recommendations developed that cut across the building blocks • HSS interventions prioritized

5. Assessment Domains

6. Steps in the Health System Assessment Approach • Validation/prioritization workshop and final report • Validate findings and prioritize recommendations at stakeholder workshop • Produce final report 4 • Analyze findings • Analyze findings by building block • Develop cross-cutting findings and recommendations • Prepare preliminary report of key findings and recommendations 3 • Data collection and launch workshop • Review background materials and compile data on quantitative indicators • HSA launch workshop for in-country stakeholders • Interview key informants 2 • Shape the assessment • Identify needs and priorities of client • Agree on scope and use of assessment • Choose indicators within each module to answer client’s priority questions 1

7. Documented Uses of HSA Results Ukraine: Inform health reform agenda Lesotho: Inform MOHSW health system activities through Millennium Challenge Account; USG Partnership Framework; National Health Policy and Strategic Plan Eastern Caribbean: Support implementation of US-Caribbean Regional HIV and AIDS Partnership Framework in 6 countries

8. Documented Use of HSA in Senegal

9. Evolution of the HSA Approach 2005 - 2012 • Incorporate assessment of private sector • Build capacity in HSA methodology • Standardize and strengthen stakeholder engagement approach

10. Evolution of the HSA Manual Version 1.75 25 countries Tanzania, Uganda, Ukraine, Mozambique, Ethiopia, Benin, St. Kitts and Nevis, Antigua, St. Vincent and the Grenadines, Grenada, Dominica, and St. Lucia Version 1.5 13 countries Vietnam, Namibia, Nigeria, Senegal, Cote d’Ivoire, Lesotho, Zimbabwe, Angola, Kenya, Guyana Version 1.0 3 pilot countries Benin, Angola, Azerbaijan 2011 – 2012 • 2007 – 2010 2005 – 2007

11. Incorporating Private Sector into HSA Approach Governments face constraints in delivering essential health services Harnessing private sector can help relieve public sector constraints and can result in: Increased efficiencies in management Expanded health workforce and service delivery infrastructure Additional resources Increased responsiveness to consumer preferences Broader market for health promotion messages Better/more creative policymaking Particularly critical to help sustain HIV response as countries face static or declining external aid for HIV/AIDS • Source: International Finance Corporation 2007; Barnes et al. 2009

12. Recognizing Private Sector Role In Health Systems Strengthening Source: Arur A. et al. 2010. Strengthening Health Systems by Engaging the Private Health Sector: Promising HIV/AIDS Partnerships. SHOPS Project, Abt Associates.

13. Strategies for Strengthening Health Systems Through Partnerships with Private Sector Source: Arur A. et al. 2010. Strengthening Health Systems by Engaging the Private Health Sector: Promising HIV/AIDS Partnerships. SHOPS Project, Abt Associates.

14. Building Capacity in the HSA Methodology • Health Systems 20/20’s capacity building strategy aims to transition health system strengthening methodologies to regional partners • Enhance country ownership of HSA process and recommendations

15. Developing Regional Capacity • Health Systems 20/20 has trained HSPI (Vietnam), IRSP (Benin), and Makerere University (Uganda) in HSA approach • These institutions will market their skills and use the HSA methodology without Health Systems 20/20 support

16. Building MOH Capacity in HSA • Guyana • MOH staff shadowed Health Systems 20/20 assessment team and participated in collecting data for each module • Health Systems 20/20 wrote bulk of report • MOH will use the approach to monitor progress over time

17. Building HSA Capacity – Lessons Learned • Participation of MOH staff on HSA enhances country ownership of HSA recommendations • Intensive training needed, particularly in qualitative data collection and analysis • Need for long-term strengthening of regional institutions • Transferring HSA methodology is a long-term process

18. Strengthening and Standardizing HSA Stakeholder Engagement Methodology • Engaging Stakeholders in Health System Assessments: A Guide for HSA Teams

19. Stakeholder Engagement Guide • Guides HSA team in involving a wide range of health system stakeholders – government, nongovernmental and civil society groups, research and academia, and private sector – throughout all phases of the HSA • Describes stakeholder engagement in greater detail than the HSA manual

20. Stakeholder Engagement Guide cont’d • Provides user-friendly job aids, tools, and guidance: • During Planning Phase • Drafting potential list of key stakeholders • Planning and coordinating the HSA team participants • Conducting pre-assessment visits • Assessment Phase • Gathering data • Conducting in-country debriefing session on initial findings • Validation Phase • Validating findings with stakeholders • Prioritizing and action planning key proposed interventions

21. Summary • Health system strengthening is not a result, it’s a process • The HSA methodology sets the stage for health systems strengthening • The HSA approach highlights linkages across the building blocks • As HSAs have been completed, results have fed back into adaption and modification of the methodology

22. Version 1.5 of the HSAA Manual • Available at the following URL: http://www.healthsystemassessment.com/ • You can register on the site for updates as they are made

23. Thank you Thank you! www.HealthSystems2020.org