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Health System Review Mission to Pakistan 2007

Health System Review Mission to Pakistan 2007

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Health System Review Mission to Pakistan 2007

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  1. Health System Review Mission to Pakistan 2007 Lessons learnt Werner Bühler

  2. Outline • Introduction: Objectives and Participants • Part I: Lessons on the Health System in Pakistan • Lessons for Stewardship • Lessons for Resource Generation • Lessons for Services Delivery • Lessons for Financing • Part II: Lessons on Health System Review Missions • Lessons for Mission planning • Lessons for Mission making • Lessons for Mission marketing • Food for thought Pakistan Health System Review Mission 2007

  3. Objectives and Participants of the Mission • Objectives • To update knowledge and understanding of the health system within the overall development context based on current evidence • Review reform undertaken by the government with the support of the development partners • To propose strategies to take forward the health system reform agenda and gain the commitment of the government • Participants • WHO HQ (1), EMRO (3), CO (2) • UNICEF (1), World Bank (1), DFID (1) • MoH (0-2) Pakistan Health System Review Mission 2007

  4. Part I: Lessons on the Health System in Pakistan Where to focus

  5. Lessons in Stewardship • Focus on long-term planning at Federal level • HRH, Medical Education, Quality, Social Protection • Focus on systematic generation of evidence • Low demand and output for Policy relevant research • Incomplete and underused HMIS • Focus on organizational shortcomings in the MoH • Non-functional National Health Policy Unit • Communication within MoH, with DoH, P&E etc. • Fragmentation of Health initiatives outside the MoH • Focus on Social Determinants of Health • Formulate comprehensive Health Policy (i.e. incl. SDH) • Integration of rural development projects (RSP, BDN, CCB) Pakistan Health System Review Mission 2007

  6. Lessons in Resource Generation • Focus on HRH development policy • Strategic analysis of HRH needs (numbers, qualifications) • Strategic planning of HRH production • Solve health problems on the lowest possible level (MD’s in BHUs?) • Respond to future needs with today’s planning • Focus on District Health Management training • Capacity building for devolution in Health • Capacity building for addressing SDH & intersectoral issues • Capacity building for “spinal” responses to community health needs Pakistan Health System Review Mission 2007

  7. Lessons in Service Delivery • Focus on Quality of Care • Need for policy, standardization and regulation • Focus on Primary Health Care • Need for a well-defined package of essential care • Disseminate experiences from PHC pilot projects (PRSP, Punjab PM Initiative, President’s Initiative for PHC, NCHD) • Focus on Public-Private Partnership • Legal framework, regulations, standards of care Pakistan Health System Review Mission 2007

  8. Lessons in Financing • Focus on Social Protection/Health Insurance • Feasibility Study • Community based voluntary vs. Provincial (National) based mandatory insurance • Focus on National Health Accounting • National, Provincial Health Accounts • Institutionalization of NHA • Focus on GDP spending on Health • Too low (0.7%) according to official figures • But lack of clarity where to put additional money • Non-rational allocation of existing resources Pakistan Health System Review Mission 2007

  9. Part II: Lessons on Health System Review Missions How to improve

  10. Lessons in Mission Planning • As early as possible (two months before planned start? More?) • In-country stakeholder meeting during the planning phase • Participation of MoH on objective formulation • Choice of reviewers based on transparent criteria and agreed upon with MoH • Desktop review should lead to pre-mission report to be shared with MoH Pakistan Health System Review Mission 2007

  11. Lessons in carrying out the Mission • Atmosphere matters • Constant implication of high-ranking MoH officials (learning by doing) • Daily debriefing to MoH and stakeholders (broadcast email) • Debriefing and discussion workshops with all respondents • More time (if strongly MoH owned) • Less time (if not) Pakistan Health System Review Mission 2007

  12. Lessons for Mission Marketing • Report may be excellent, but may remain largely unread by those who should read it • Planning and carrying out of mission should be owned, requested by MoH • Report should be provided in an easy-to-read, easy-to-understand manner (colours, graphs, photos, CD, multimedia etc.). • Decision makers should actually like reading it. Form matters. Pakistan Health System Review Mission 2007

  13. Food for thought and debate • Whose felt needs do we attempt to satisfy with a Health System Review mission? Who is the client? • How do we engage in a “Policy Dialogue” through a Health System Review mission? • Is a “System Lens” sufficient to trigger a fresh “operational” look on well known issues? • How can a review mission be systematically linked to JPRM planning? • Paradigm Shift in Health Policy: can we go beyond symptomatic treatment of Health Systems? Pakistan Health System Review Mission 2007