1. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane Universitys School of Public Health better systems, better health Better Health Systems: Strategies that Work Presentation Series at the Global Health Council Michael Rodriguez, MA Danielle Altman, MA March 6, 2012 Setting the Stage for Health Systems Strengthening: What We Have Learned from Doing Over 30 Health System Assessments

2. Global Attention to Health Systems Strengthening

3. Health System Assessment Approach Assessment Analysis Recommendations Prioritization Decision-making Programming Scope Broad health system Focused USAIDS Health System Assessment Approach Profiles 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 5

6. Shape the assessment Identify needs and priorities of client Agree on scope and use of assessment Choose indicators within each module to answer clients priority questions 1 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 Analyze findings Analyze findings by building block Develop cross-cutting findings and recommendations Prepare preliminary report of key findings and recommendations 3 Validation/prioritization workshop and final report Validate findings and prioritize recommendations at stakeholder workshop Produce final report 4 Steps in the Health System Assessment Approach

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

8. Documented Use of HSA in Senegal HSA RecommendationHSA Action Item Improve technical coordination at MOH; strengthen the planning unit Create department of planning, research, monitoring and evaluation at the MOH Devise strategies to relieve HRH shortages Change health system at peripheral level, so that health district coordinators do not also head district health centers. Separate district health offices from health centers Strengthen regional health districtsChange design of health system at intermediate level by transforming regional health offices to regional departments of health with more power over human resources management, financial management, and service delivery Improve planning around health insurance Draft a law to enable pooling of funds for free-care services and health insurance

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

11. 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. 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. 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 20/20s 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 Health Systems Assessment - Technical Skill Set Health systems knowledge in six building blocks Stakeholder engagement Qualitative data collection and analysis Technical writing

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 contd 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, its 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. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane Universitys School of Public Health better systems, better health Thank you Thank you! www.HealthSystems2020.org