1. Health System Development
Programme
2006-2011

2. Objectives
1. 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 cooperation in line with the 30 year long term
health plan by collaborative activities

3. Project
1. Health Systems Research and Development
Project
2. Developing Alternative Financing Mechanisms
for Health Project
3. International Health Cooperation Project

4. Health System Research and Development Project

5. Developing Alternative Financing Mechanism for
Health Project

6. International Health Cooperation Project

7. Strengths
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.

8. Strengths
Health 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

9. Weakness
Health 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.

10. Weaknesses
Health Financing
1. Poor advocacy to high level policy making body on health
financing situation
2. Lack of interest of decision maker on health financing situation
3. Limited number of skilled health manpower especially health
economists
4. Lack of skilled staff on financing and budgeting in the township
health system
5. 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

12. Health System Gaps identified by HSS GAVI
technical working group & consultants
Service Delivery Gaps
Many areas of the country
have low service access to
MCH and other services due to
a range of management,
infrastructure, logistics and
security barriers.
Program Coordination Gaps
Lack of organizational capacity,
guidelines and strategic
framework on how to coordinate
immunization, nutrition,
environmental health and RH
services is leading to
fragmentation and inefficiencies
in health service delivery
Human Resource Gaps
There is lack of clarity in the
roles and functions of basic
health staff, and inequities in the
distribution of staff, resulting in
lack of access to health services
in hard to reach areas.
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13. Health System Goal
HSS Goal: Achieve improved service delivery of essential components of Immunization, MCH, Nutrition,
Environmental Health by strengthening programme coordination, sub-national micro-planning, and human
resources management and development in support of MDG goal 2/3 reduction in under 5 child mortality
between 1990 and 2015.
Theme 1 Service Delivery
Reaching communities with
essential health system delivery
components of MCH, nutrition,
immunization and environmental
health, with emphasis on hard to
reach areas
Theme 2 Health Program
Coordination and Capacity
Building Strengthening
coordination, management and
organization of the health system
at all levels with a focus on the
Township Level
Theme 3 Human Resource
Management and
Development
Improving distribution,
skill, number and mix of
health workers with
emphasis on hard to
reach areas
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14. Service Delivery Objective & Activities
Objective 1: By the end of 4 years of implementation180 selected townships with
identified hard-to-reach areas will have increased access to essential components
Of MCH, EPI, EH and nutrition as measured by increases DPT from70% to 90%
and SBA from 67.5% to 80%
Main Activities:
• Baseline health systems assessment surveys in each township
• RHC reconstruction/sub RHC construction
• Provision of Logistics and supplies
• Provision of transportation means for BHS at hard-to-reach areas
• Social mobilization of NGOs, local authorities, and Voluntary Health Workers in
developing and implementing coordinated township health plan
Outcomes:
• National DPT3 coverage increased (%)
• Delivery by Skilled Birth Attendants increased (%)
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15. Planning Objective & Activities
Objective 2: By the end of 4 years of implementation180 selected townships with
identified hard-to-reach areas will have developed and implemented a Coordinated
Township Health Plan
Main Activities:
• Research and development of coordinated planning and supervision guidelines
•Research and development of financial management capacity and health financing
schemes in HSS townships
• Feasibility study for community based health financing scheme
• Introduction of Maternal Health Voucher Scheme in community
• Training programme on coordinated management through modified MEP approach
• Development, management and monitoring of CTHP
Outcomes:
• Proportion of selected townships implementing guidelines according to national
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framework

16. Human Resource Objective & Activities
Objective 3: By the end of 4 years of implementation 90 selected townships with
identified hard-to-reach areas will be staffed by midwives and PHS2 according to
National HR standards
Main Activities:
• HR Research planning and proposal development:
Motivation and retention of Basic Health Staff in hard-to-reach areas of selected
GAVI Health Systems Strengthening Townships
• HR finance incentive scheme development for health staff in remote areas
• Continuing capacity building for implementation of CTHP in townships
Outcomes:
• Percent of selected townships with identified hard to reach areas staffed with
midwives and PHS2 to national standard by the end of year four.
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17. Health system assessment tool kit:
one excel book covering areas
1.
2.
3.
4.
5.
6.
7.
8.
9.
Health Management and Planning
Mapping Hard to reach
Human resources
Health Finance and Financial Management
Community participation
Essential drugs and equipment
Infrastructure
Data and Service Quality
Summary Report
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18. Summary Report Township X
Availability of Services
What is the general analysis of availability of services in this Township?
What are the main factors effecting availability?
Figure 8 Making a
Accessibility of ServicesSummary Report
What is the general analysis of accessibility of services in this Township?
What are the main factors effecting accessibility?
Utilization of Services
What is the general analysis of utilization of services in this Township?
What are the main factors effecting utilization?
Utilization of Quality Services
What is the general analysis of quality of services in this Township?
What are the main factors effecting quality?
Main conclusions and Recommendations
What are the main health system bottlenecks for improvement of maternal
and child health services, and what strategies and investments are best
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placed to remove these bottlenecks?

19. Linking Health System assessment with
Township health planning
• Health system analysis examines gaps in operations
across health programmes and service delivery units
• Making the transition from “Management by Project” to
“Management through Systems” is a critical step in
achieving:
– Equity: in distribution
– Efficiency: through coordination and reduction of
overlap of resources in favour of hard to reach areas
– Effectiveness: improved health coverage
– Sustainability: strengthening self reliance and
management capacity
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20. Coordinated Township Health Planning
Guidelines
SERVICE DELIVERY FOR COMMUNITIES
Township Coordinated Health Plan
Hospital Care
Public Health
Disease Control
Systems Analysis
Planning & management
Human Resources
Finance & Financial Management
Infrastructure
Data and Service Quality
Essential Drugs & Equipment
Community participation
Hard to reach (equity analysis)
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22. Strategic Framework: An example from DPRK
NATIONAL DEVELOPMENT PRIORITIES, LAW AND INTERNATIONAL AGREEMENTS
MEDIUM TERM DEVELOPMENT PLAN FOR THE HEALTH SECTOR IN DPRK
S
Y
S
T
E
M
STRATEGIC
AREA 1
STRATEGIC
AREA 2
STRATEGIC
AREA 3
STRATEGIC
AREA 4
Health System
Non
Communicable
Disease
Communicable
Disease
Women’s and
Children Health
(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
(1) Chronic Diseases
(2) Injury
(3) Mental health
(4) Aged care &
Disability
(5) Tobacco Control
(1) Immunization
(2) Malaria
(3) TB,
(4) HIV,
(5) Hepatitis B
treatment
(6) Pandemic
Planning and
emerging diseases
(1) Maternal Health
(2) Neo natal Health
(3) Reproductive
Health
(4) Child Health
(5) Nutrition
(6) Adolescent Health
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
P
R
O
G
R
A
M
S