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National health planning assessment framework

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  • 1. Essential Characteristics of Effective National Health Plan Regional Consultation on Strengthening NHPs in SEAR countries 4-6 August 2010 Bali, Indonesia
  • 2. National Health Planning Group of health planners in 1960s –confined mostly internal sector/ mostly led by Health Ministry Health Planning Reform Health planning become more multidisciplinary and multi-sectoral become a part of national, social and economic group Become a part of overall NHP in the country Health Planning today is much different from health planning yesterday
  • 3. National Health Planning Today
  • 4. Essential characteristics of an effective national health plan From the perspectives of strengthening National Health plan there are three important aspects: 1. The context in which NHP are developed and implemented 2. The NHP Process 3. The content of NHP document
  • 5. A set of desirable characteristics of a national health plan I. The country context Both the process and content of NHP are bound by the country’s: • Development context including socio-economic scenario • Institutions and structures-including administrative &financial structures and legal frameworks • Capacity to formulate and implement the health agenda
  • 6. Implication of contextual factors for NHP Factor Example of Factor Typical questions for the Planning Process Ideology National self reliance Is the role of donors in the planning process well-defined and appropriate? Social and political events Political cycles resulting from elections Does the planning process allow for a balance between political change and planning continuity? Economic change and policy Liberalization and shift to a market economy Has planning adapted to the changing roles of agencies in the health field? International Relations between government and international agencies Can the planning process respond appropriately to changes in the international financing mechanisms such as SWAps?
  • 7. II. Key Stages in the Planning Process Analysis and Formulation Monitoring Evaluation & Updating Approval Consultation Dissemination Implementation
  • 8. A set of desirable characteristics of a national health plan II. National Health Planning Process (A)Situation Analysis • A Planning process is based on a complete and relevant Situation Analysis and that is made dynamic through consultation and inclusiveness. • SA are quite complete with respect to the health context in countries –such as – SA of health status, SA of demographic & epidemiological trends. • Broader health systems and contextual issues - political, economic and social determinants of health - remain less adequately analysed
  • 9. A set of desirable characteristics of a national health plan Future NHP- Planning process needs be Inclusive and dynamic  In most countries planning process is lead by a dedicated government entity: planning unit, department, ministry or commission. To keep in mind of importance of broad based consensus for advocacy and national ownership of NHP specifically: – Political support – Commitment from all health sector stakeholders –public & private – Multi-sector buy-in from health related sectors – Overall community confidence in transparent, people-centered health planning – A basis for aligning country and international health agenda, including external assistance – Plan time frame usually medium term, 5-10 years “Master Health Plan” linking to overall development planning cycle and with annual
  • 10. A set of desirable characteristics of a national health plan II. National Health Planning Process (B) Health information systems have limited capacity to generate quality and complete information for evidence-based National Health Planning. • This impacted not only the situation analysis but monitoring and evaluation of the plan as well. • Importantly, where evidence-based planning has been institutionalized, it has added credibility and promoted ministry of health's leadership in health Future NHP- • – Evidence based research on SDH & HSS, other sector’s papers, NHA, etc
  • 11. A set of desirable characteristics of a national health plan II. National Health Planning Process (C) Both consultation and dissemination is most systematically done within Ministry of Health and at higher-levels in the first instance. • Inclusion of other stakeholders especially beyond MoH is still limited Future NHP• consider more on consultation and dissemination to stakeholders within MoH and beyond MoH
  • 12. A set of desirable characteristics of a national health plan (D). Linkages • Strong vertical linkages – • downstream to health systems, sub-national and vertical programme plans • upstream to the national health policy as well as national and international development agendas • Strong horizontal linkages to health related activities of other sectors; and, with joint budgeting and expenditure processes • Linkages beyond health remain persistently weak- with the overall development agenda especially with respect to using this as a common platform to link with health-related sectors, including to initiate joint budgeting; and, with direct horizontal linkages with health-related sectors and national budget/finance aspects (eg in
  • 13. A set of desirable characteristics of a national health plan (E). Boundaries Contextual issues beyond health • those related to political, economic and social determinants of health are not adequately accounted for in national health plans Institution and capacity building • is not focused upon in national health plans • planning appears to be more for current structures of ministries of health rather than responding to for the institution and capacity needs of population health
  • 14. A set of desirable characteristics of a national health plan (F) Use of Appropriate Tools • Tools available could be used more effectively to inform national health planning e.g. costing of the plan. • Gaps related to weak information systems mentioned above are a critical constraint but inadequate capacity or use of relevant tools and techniques to process this data for evidence-based planning is equally limiting
  • 15. III. Components/Contents in National Health Planning • Situation Analysis / Needs Assessment - including local needs of the people, and analysis of gaps, socio-economic situation and trends, availability and sources of finance • Costing of services
  • 16. Vision, Mission, Goals • • • • • • • Equity Access Affordability Efficiency Quality Reduce disparities Aspire towards Universal Coverage • Catalytic role in promoting healthy policy •Reaching the unreached •Inter-sectoral collaboration •Community participation •Time frame of the plan •Gender sensitive •Special needs of the people •Empowerment of the community, and strengthening institutions
  • 17. Policy & Strategy • Focus on Non Communicable Diseases • Need to involve various levels (District / Provisional level etc.) • Multi sectoral endorsement can help avoid overlapping and strengthen collaboration with other stakeholders. • Financing the plan • Focus on women’s health • Set targets & goals • Flexibility in planning
  • 18. Issues & Challenges • High Out of Pocket expenditure at the point of service in many SEA countries. Countries need to explore various financing mechanisms as suitable to their situation to reduce Out of Pocket Payments. • Quality of services • Cover and involve the Private Health Sector • Public Private partnership to be included in the NHP • Create good governance in the management of health systems • Promote healthy behavior • People’s centered health plan • Create immunity for diseases and health threats • Pluralistic approach – balance between different approaches to medical care should be sought (traditional, modern, alternative). • Institutionalization of Health systems research
  • 19. Programmes & Services • Expanded Primary Health Care • Distribution of Human Resources for Health • Emergency preparedness and response • Document and disseminate best practices • Supportive supervision
  • 20. Monitoring and Evaluation • • • • • Monitoring & Evaluation framework Need to develop indicators Mid term evaluation Feedback Need to be based on outcomes
  • 21. • • • • • • • • • • • Problems Encountered by Countries NHP Contents Alignment of National Health Plan with overall National plan Various planning units Integration of NHP with other sectors including private sector Linkages between strategic and operational/annual plan, how to link between local and central plan Planning for Human Resources How to forecast health problems 3 – 5 yrs ahead Emerging and reemerging of diseases Technical knowledge to use evidence for allocating budget to various levels and institutions Limited staff capacity in priority setting and planning, Expanded Primary Health Care Insufficient technical robustness and evidence base
  • 22. Problems Cont… • • • • • • • • • • Limited capacity in developing financial plans in NHP Costing for regional / district budgets and priority areas Costing of benefit packages Universal Coverage expenditure has increased National Health Accounts not used to its potential Strategy on reducing OUP expenditure limited Constant financial flow especially from external sources Statistics and information gaps for measuring targets Weak Health Information Systems Disparity among groups, regions, services, situation analysis
  • 23. Primary Health Care principles are stated as the guiding policy approach in all plans S
  • 24. Primary Health Care principles are stated as the guiding policy approach in all plans Leadership of MoH and Health in Public Policy • is not clearly established • Plan documents indicate limited influence on health-related issues beyond those directly addressed within the health sector. Universal coverage • is an overarching goal in all NHPs. • However, further details with respect to the linkages between a selected benefit package and priority populations with focus areas/activities of the plan or related budget items are not clearly evident
  • 25. Primary Health Care principles are stated as the guiding policy approach in all plans • Service delivery improvement/scaling-up is a stated priority in all case studies. • Other areas of health systems strengthening – Human resources Medicines and technology and Health information systems are also addressed in all plans. • However, Health Financing and Governance issues are not similarly covered • Further, plans do not do explicitly link health systems functions to highlight their reinforcing contributions to PHC oriented service delivery strengthening.

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