strengthening policy and systems for improving uhc by dr jill olivier, uct

Health, Policy & Systems at UCTHealth, Policy & Systems at UCT

Strengthening Policy and Systems for Improved Access to SRH Services

…and UHC

Dr. Jill Olivier University of Cape Town, Health Policy and Systems Division

International Religious Health Assets [email protected]

Health Policy & Systems at UCTHealth Policy & Systems at UCT

Multi‐country ethnographic case study 2013‐2014: Ghana, Malawi, Cameroon

• Method: Documentary and policy analysis, stakeholder analysis, individual in‐depth interviews (mainly health workers and managers), ethnography, observation and data analysis

• Outputs: co‐authored reports, 4 articles in press, new research 2015

Approach and Method


CORDAID: The Catholic Organization for Relief and Development Aid

• Long‐term supporter of HSS with FB providers in Africa• Now a mainly European funding base, so increased pressure (around SRH in particular)

• Drew on Engender Health (2003) Informed Decision‐Makingmodel – attempted very loosely framed HS intervention with Catholic partners

• Many findings on HS intervention practice and best‐practice

Reporting here briefly on some key considerations irt UHC

The Broader Study


Unsurprisingly, health systems issues are most important…• 3 countries, very different reactions to intervention (contextual diff)

• The main barriers to SRH access are systemic not theological

• Systems strengthening could be more effective than direct SRH program intervention (e.g. SRH policy less of an access barrier than staffing and referral)

• HS interventions need prior knowledge of specific nature of FBH systems … otherwise can suffer from unintended consequences

• Knowledge gaps make this difficult

The things you know about FB systems that others need to

Main findings from broader study


The challenges of working within ‘policy thickets’

National policies Multiple funder’s policies

systems ‘policy’

social ‘policy’

Religious moral

theology


Complex hierarchical and decentralized governance


Complex governance, info and authority flows


Complex governance, info and authority flows

FEWFEEDBACK LOOPS


Weak operational information systems

e.g. No one has the power to insist … accountability

Weak financial safety nets

e.g. Each facility sinks or swims on own accord

Limited accounting of contribution of FBHPs to routine systems functioning(e.g. immunisation)


For example

• Creative fee structures and mechanisms

• Quietly ‘gaming the system’ to get patients access

• Unique organisational culture and management strategies (e.g. to get staff to work on time, expectation to work on weekends)

• Unique rural staff retention strategies

• Malawi: Surveillance Assistants situated in the Catholic facilities “so long as they don’t hand them out on the premises, the Bishops don’t mind”

• Ghana: the establishment of private wards… (working sometimes)

• Cameroon: full information and (quiet) help with injectables

Towards UHC?Creative strategies for UHC are already being practiced… but rarely evaluated


• Being advocates irt key HS challenges you are facing (e.g. post abortion care)

• Becoming specialists in the provision of care to the (rural) poor (and showing this through evidence)

• Demonstrating explicit financial models for this provision

Towards UHC…?Key issues needing attention from CHAs


More frequent drawing of lessons from systems interventions

• e.g. secondment strategies (placement)

• e.g. poor levels and timing of cost recovery (from government)

• e.g. the current role of CHAs (e.g. CHA capacity vs National Health Desk capacity)

Understanding unique contribution and practices of FBHPs

• E.g. unique governance and leadership capacities and competencies required

Needing attention: Contracting implementation and the role of CHAs


• % contribution is still very important for advocacy

• But in a new UHC‐oriented world, the underlying contribution to UHC will become more important

• Demonstrating contribution to national health system’s resilience and responsiveness

• Not just each facility’s resilience… but contribution to national coverage and access in places and at times there is none

• E.g. Ghana: picking up slack during national strikes

• E.g. Cameroon: picking up slack in Northern region

• E.g. Malawi: supporting during national stockouts

Towards UHC…?Key issues needing attention from CHAs


Thank youAcknowledgements and Affiliations:

University of Cape Town, School of Public Health and Family Medicine, Health Policy and Systems Division: www.publichealth.uct.ac.za

This research was funded by Cordaid: www.cordaid.org

Thanks and acknowledgement to the participants in this study

Related networks and useful websitesIRHAP: www.irhap.uct.ac.zaCHESAI: www.chesai.orgCHEPSAA: www.hpsa‐africa.org

NOTICE OF NEW HPSR RESEARCH…

Systems integration towards universal health coverage: Strengthening the collaborative relationship between faith‐based non‐profit providers and the Ghanaian state system

Research Question: In which respects has the relationship between faith‐based non‐profit providers and the Ghanaian government beenstrengthened (and in which respects undermined) through the series ofhealth systems interventions and mechanisms attempted over the last fiftyyears? If so, how has this been achieved? Can this be said to havestrengthened the system towards UHC in Ghana?

June 2015 ‐May2018Supported by the World Health Organisation AHPSR

‘A historical realist case study’Principal Investigors: Dr .Jill Olivier (UCT) & Dr. Aku Kwamie (UG)Advisors: CHAG Director & Members, Lucy Gilson, Irene Agyepong, Gilbert Buckle

(Similar studies being conducted by colleagues in Tanzania and Uganda)

NOTICE OF NEW HPSR RESEARCH…

Governance, Competencies and Capacity Development for Faith‐based Non‐profit Health Systems Strengthening

Question: What standard or unique core competencies and capacities are required for faith‐based non‐profit systems strengthening – and how can these be better developed?

Method: rapid internal scoping study among CHA members and representatives

Partnering: ACHAP and UCT HPS Division ‐ IRHAP (others welcome!)

Outputs: co‐authored report and articles; implementation practice plan and proposal

Jan 2015 – Dec 2015Supported in‐kind by UCT‐HPSD‐IRHAP & ACHAP

strengthening policy and systems for improving uhc by dr jill olivier, uct

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