1. How to implement and sustain health policies Henry Aloh (Nigeria), Sibon Dhlomo (S. Africa), Wellington Godo (Kenya), Navreet Kang (India), Gillian Leng (UK), Erna Tresnaningsih (Indonesia)

2. Aim To examine how to implement and sustain health policies by identifying:  A country type based on health expenditure  The main challenges and strategies required  Possible unintended consequences and how to avoid them

3. International differences in expenditure on health (2001) Total per capita (US$) Total expenditure (% GDP) Lowest1 (Liberia)1.4 (Tajikistan) Nigeria153.4 Indonesia162.4 India245.1 Kenya297.8 S. Africa2228.6 UK18357.6 Highest4887 (USA)13.6 (USA)

4. Identified – a low income country!

5. Main challenges identified  Insufficient resources – including funding, lack of capacity, governance and data  Resistance to change amongst stakeholder groups and the broader community  Lack of political commitment

6. Strategies to address these challenges

7. Resources and capacity  Identify resources required to achieve objectives  Map available resources, with particular emphasis on workforce

8. Resistance to change  Communicate, communicate, communicate!

9. Political commitment  Engage politicians early on and point out potential boost to electoral prospects economic benefits of health

10. Action points

11. Resources and capacity  Develop a clear implementation strategy, including a resource plan  Identify funding agencies and examine out- sourcing options with capacity building  Develop financial disbursement procedure  Build information and management systems  Focus on “governance”  Examine HR - evaluate available workforce, define role and skill mix and develop long term plan including training

12. Resistance to change  Develop clear communication strategy  Get media support  Identify key stakeholder groups and hold meeting to indicate plans  Identify potential key allies  Use evidence, modelling etc to point out benefits  Deal with misgivings and reservations

13. Political commitment  Lobby parliamentary committee on health  Hold consultation meetings to demonstrate plans and health outcomes  Educate politicians about good health leading to development and health benefits  Remind them that health is in their manifesto!

14. Possible untoward effects What might sink the ship?

15. Possible untoward effects….. and how to avoid them  Negative impact on areas that didn't receive new extra resources, e.g. immunisation programme in India  Carefully consider existing schemes and capacities, and synergise as far as possible

16. Possible untoward effects….. and how to avoid them  Weakening political commitment once scheme gets underway, with implications for sustainability  Maintain political interest with regular reports. Demonstrate “quick wins” wherever possible

17. Key messages Policy with clear health gains Establish implementation plan Gain support from all sectors including politicians and funders Implement and assess progress against plan Communicate widely