1. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I BearingPoint I Bitrán y Asociados I BRAC University I Broad Branch Associates I Forum One Communications I RTI International I Tulane University School of Public Health I Training Resources Group Development of the Health Systems Assessment Approach Mursaleena Islam Abt Associates Inc. April 25, 2007

2. Background USAID/Global Health Bureau initiative to systematize health systems assessments Develop a rapid yet comprehensive/integrated health systems assessment approach

3. Purpose Key purpose(s) Inform PHN officers and Missions about health systems functions Allow PHN officers to conduct a rapid assessment of a country s health system, possibly during early phases of program development and project design, as well as program monitoring and evaluation Inform all stakeholders of critical health systems strengths and constraints, help prioritize intervention opportunities, and create consensus and momentum to act

4. Product Development Ladder Develop product concepts, refine and test, replicate nationally, and institutionalize Tool originally defined as fairly mechanical and universally applicable – a way to codify expert knowledge Well documented and transferable Still may take time to apply the tool, compile data, and prepare recommendations – however, should take less time than an ad-hoc/unpackaged process Adapted from: Arias, J., T.Cleland, P. Connell. 2004. Interim Assessment of the Partners for Health Reformplus (PHRplus) project

5. Audience for the Assessment Tool USAID PHN officers Ministries of Health Anyone conducting health systems assessments Health systems specialists or generalists

6. Tool Development Timeline Initial conceptualization: Jan - Mar 2005 First draft of tool: Apr - Jun 2005 First pilot test: Aug 2005 Significant refinement post pilot test: Sep - Dec 2005 Second pilot test: Apr - May 2006 Refinement post pilot test: Jun - Sep 2006 Copyediting and finalizing: Oct - Dec 2006

7. Tool Development Partners USAID/GH PHR plus (now Health Systems 20/20) RPM Plus QAP

8. Conceptual Framework Need an approach that helps to: Diagnose health systems strengths and weaknesses Prioritize key constraints and areas for interventions Identify potential solutions Existing tools (in early 2005) did not offer quantitative comprehensive health systems assessments Some focused on profiles (PAHO, European Observatory) None allowed for integration across health systems functions

9. Conceptual Framework (cont.) Used WHO framework Functions the system performs Stewardship (oversight) Creating resources (investment and training) Financing (collecting, pooling, and purchasing) Delivering services (provision) Source: Adapted from WHO (2001)

10. Conceptual Framework (cont.) Drilled down into each function to structure assessment approach and added link to performance and impact

11. Challenges Priority health service areas Private sector Public health Decentralization Indicator-based approach Quantitative indicators vs. qualitative questions Screening questions Desk review vs. stakeholder interviews

12. Challenges (cont.) Accessible to a generalist Technical approach and operational process needed to be well-documented General overview chapter on health systems Key concepts defined and detailed descriptions of indicators and technical analysis Chapters on operational process

13. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I BearingPoint I Bitrán y Asociados I BRAC University I Broad Branch Associates I Forum One Communications I RTI International I Tulane University School of Public Health I Training Resources Group Thank you Reports related to this presentation are available at www.healthsystems2020.org