health system development2
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Health System Development Programme2006-2011
Objectives1. To promote utilization of health systems research
to improve health systems performance by enhancing research culture among decision makers at all level
2. To explore and develop an appropriate and sustainable financing mechanism for fair financing of health and equitable delivery of services
3. To expand and strengthen international co-operation in line with the 30 year long term health plan by collaborative activities
Project
1. Health Systems Research and Development Project
2. Developing Alternative Financing Mechanisms for Health Project
3. International Health Cooperation Project
Health System Research and Development Project
Developing Alternative Financing Mechanism for Health Project
International Health Cooperation Project
Strength
Health System Research
• Able to disseminate knowledge and skills on heath systems concepts and health systems research (HSR) methodology to health managers who provide services to the community.
• Able to develop user friendly HSR tools for health system strengthening, assessments and quality improvements
• HSR studies can provide technical know-how for health systems strengthening, assessment and quality improvements.
StrengthHealth Financing• Health financing assessment and development of new scheme
was initiated in collaboration with WHO Consultants
• Interest of all stake holders and donors after implementing awareness raising workshops at township level
• Attention of the international donors based on publication of National Health Accounts and health financing studies
• Appropriate health manpower (Health Economists) posted in the planning division but still limited number
WeaknessHealth System Research
1. There has no financial support for HSR studies conducted by mid-level health managers.
2. There has weaknesses in dissemination of information to the higher level health authority to take action based on HSR findings.
Weakness
Health Financing1. Poor advocacy to high level policy making body on health
financing situation 2. Lack of interest of decision maker on health financing situation3. Limited number of skilled health manpower especially health
economists4. Lack of skilled staff on financing and budgeting in the township
health system5. No or limited community awareness on health financing issues 6. Current health financing and costing research is not covered all
the area and need more research on alternative health financing and efficient utilization of limited resources
7. Need more partners on implementing new financing scheme
Requirements to be fulfilled for achieving targets
Health System Research1. Dedication by project personnel, knowledge, experiences and
skills on research management obtained by actual implementation of the project contribute achievements of the targets.
2. Political supports and guidance from Departmental Head, sharing and discussion of experiences on project implementation among technical colleagues were contributions for the achievements
3. Close collaboration and coordination with health and health related departments such as Department of Health, Department of Medical Sciences, General Administration Department , Central Statistical Organization, national and international NGOs were the contributors for achievement
Requirements to be fulfilled for achieving targets
Health Financing1. High level advocacy meeting on current health financing situation and
options for protecting the poor achieving Universal Coverage2. Capacity building in the area of health economics to mid level officers3. Feasibility studies on development of new health financing methods
should be explored4. Financial management and mobilization of funds in township health
system should be extended to more townships5. Connecting with more partners on solving the problem of waiving the
poor and vulnerable (technical as well as financial)6. Awareness raising of community through implementing new
financing scheme in the pilot area (knowing by doing)7. More research on costing, cost effectiveness for assisting the decision
making (improving efficiency)
Other comments
Health Financing• Providing more knowledge on advantage of health insurance
especially in the area of fund pooling and risk pooling among the solidarity group to all levels
• Awareness raising of other countries’ experiences on health financing situation among different regions of WHO
1. Identify key barriers / bottlenecks to increase sustained coverage which are beyond the control of the service delivery system
HRH shortages, Distribution,
Quality, motivation etc.Transport to reach the ‘hard to reach’ (especially for outreach)Affordability and fund flow issues especially to district levelInfrastructure at periphery, LogisticsManagement monitoring & supervision Coordination with and between partners
2. Identify what causes lead to these problems
problem analysis
3. Identify how to overcome them formulate your objectivesidentify interventions
At what level are the performance constraints & bottlenecks?
OPERATIONAL LEVEL
PROGRAM LEVEL
SYSTEM LEVEL
Policy & sector analysis: PHC, PRSP, MDGS
Strategy analysis: RED, MPA, demand vs. supply driven
Needs analysisHR: skills, skills mix, retentionCapital: stores, equipment, vehiclesCapacity building
Strengthening interventions
Service deliveryService delivery
Drug Drug Supply & Supply & QualityQuality
LogisticsLogistics
Advocacy &Advocacy &CommunicationCommunication
SurveillanceSurveillance
ISS
3DF
NHSC
CCM
GF
UNFPA
WHO
UNICEF
INGOs
Strengthening Systems
Service deliveryService delivery
Drug Supply & Drug Supply & QualityQuality
LogisticsLogistics
Advocacy &Advocacy &CommunicationCommunication
SurveillanceSurveillance
MoF, World Bank,
UNICEFGov’T, UNDP,MNPED
GAVIHSS
HSS
HSSSWAp
UNICEFPRSP
Policy space
Service deliveryService delivery
Drug Supply & Drug Supply & QualityQuality
LogisticsLogistics
Advocacy &Advocacy &CommunicationCommunication
SurveillanceSurveillance
EQUITY
STEWARDSHIP
ACCESS
PRO-POOR
Strategic Framework: An example from DPRK
STRATEGIC AREA 2
Non
Communicable Disease
(1) Chronic Diseases (2) Injury (3) Mental health (4) Aged care & Disability (5) Tobacco Control
STRATEGIC AREA 3
Communicable
Disease
(1) Immunization (2) Malaria (3) TB, (4) HIV, (5) Hepatitis B treatment (6) Pandemic Planning and emerging diseases
STRATEGIC AREA 4
Women’s and
Children Health
(1) Maternal Health (2) Neo natal Health (3) Reproductive Health (4) Child Health (5) Nutrition (6) Adolescent Health
P R O G R A M S
NATIONAL DEVELOPMENT PRIORITIES, LAW AND INTERNATIONAL AGREEMENTS
MEDIUM TERM DEVELOPMENT PLAN FOR THE HEALTH SECTOR IN DPRK
SYS TEM
STRATEGIC AREA 1
Health System
(1)Policy, Planning & Coordination (2) Health Information (3) Human Resources (4) Drug Supply & Logistics Systems (5) Financing & Financial management (6) Service Delivery Systems (7) Science & technology (8) Community participation
STRATEGIC AREA 5 The Social and Environmental Determinants of Health
(1) Food Safety (2) Health & Hygiene promotion (3) Climate Change (4) Safe water & Sanitation (5) Health Life Conditions (6) Emergency preparedness
MULTI SECTOR AND SOCIETY
Health Outcomes and MDG Goals
Links Between Objectives and Actions
STRATEGIC AREA 1 HEALTH SYSTEM OBJECTIVE
Planning Sub Objective Strategic Approach
HR Sub Objective Strategic Approach
Finance Sub Objective Strategic Approach
Essential Medicine Sub Objective Strategic Approach
Service Delivery Sub Objective Strategic Approach
Community Participation Sub Objective Strategic Approach
5 priority actions for each sub objective