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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

The Responsibility and Authority Mapping Process (RAMP)

Developed by Management Sciences for Health, Inc.

2006

presentation outline
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
why develop the ramp
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
slide4

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

what does the ramp consist of
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
nine functional areas
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
objectives of ramp exercise
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
methodology
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
all functional areas
All functional areas
  • 136 determining questions
  • 82 total respondents across all respondent groups
health service delivery summary charts
Health service delivery:summary charts
  • Number of determining questions: 11
health service delivery key points
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”
public health surveillance and response key points
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
financial resources summary charts
Financial resources: summary charts
  • Number of determining questions: 26
financial resources key points
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
personnel summary charts
Personnel: summary charts
  • Number of determining questions: 33
personnel key points
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
drugs vaccines and supplies summary charts
Drugs, vaccines, and supplies: summary charts
  • Number of determining questions: 15
drugs vaccines and supplies key points
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”
equipment and transport summary charts
Equipment and transport: summary charts
  • Number of determining questions: 13
equipment and transport key points
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%
capital construction and maintenance key points
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”
health and management information summary charts
Health and management information: summary charts
  • Number of determining questions: 11
health and management information key points
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%)
health communication summary charts
Health communication: summary charts
  • Number of determining questions: 4
health communication key points
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
next steps
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