The USAID Health Finance and Governance project works to improve health systems in developing countries. Led by Abt Associates, the project helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. In the Democratic Republic of Congo, the project worked with the Ministry of Health to strengthen governance and management under a decentralization reform. Key accomplishments included establishing and building capacity of new provincial health divisions, developing human resources standards and guidelines, and institutional strengthening of central directorates to support the reform.
The document summarizes USAID's efforts over 3 years to strengthen the organizational capacity of Burundi's National HIV/AIDS Program (PNLS). Through training, workshops, and technical assistance, PNLS improved in key areas like strategic planning, project management, coordination, and monitoring. This enabled PNLS to take on greater leadership of Burundi's HIV response, including becoming the principal recipient of Global Fund grants. The transformation of PNLS from a weak to effective organization illustrates the importance of building both technical and foundational management capacities.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project has worked in Cote d'Ivoire since 2013 to address challenges in human resources, health financing, and governance that were preventing effective delivery of HIV and other health services. Key accomplishments include a six-fold increase in the number of health workers trained to provide HIV treatment through task-sharing policies and curriculum changes.
The document discusses the work of the USAID-funded Health Finance and Governance (HFG) project in Haiti from 2012-2018. It aimed to [1] improve management of Haiti's public and private health workforce, [2] strengthen health financing capacity for more efficient health services, and [3] improve donor coordination for an effective health sector response. Some key accomplishments include developing Haiti's first national human resources for health strategy, establishing a process to regulate private nursing schools, identifying and removing "ghost workers" from payrolls, and helping hospitals strengthen financial management.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to improve health systems. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project provides technical assistance to over 40 countries in areas like improving health financing, governance, management systems, and measuring universal health coverage. In Mali, the project worked with the Ministry of Health from 2015-2018 to address challenges and strengthen the health system through activities like assessing the system, building stakeholder consensus on priorities, improving use of health financing data, and increasing public-private sector engagement.
The USAID Health Finance and Governance project in Angola helped the Ministry of Health develop a costed National Health Plan and monitoring and evaluation system to better advocate for health funding. Specifically:
1) HFG assisted MINSA in calculating a 12-year $6.3 billion budget to implement the National Health Plan, which helped gain approval and political support for increased health funding.
2) An M&E plan was developed and led to the creation of an M&E department at MINSA to track health spending and sector progress.
3) Efforts were made to establish a health accounting system to measure how funds are actually spent, but this was not completed due to a change in government leadership.
The Health Sector Financing Reform/Health Finance and Governance Project aimed to improve health in Ethiopia by expanding access to healthcare. Over its 5-year period, the project worked with the Government of Ethiopia to implement health financing reforms. These reforms included allowing health facilities to retain and utilize the fees they collect, establishing community-based health insurance, and creating the Ethiopian Health Insurance Agency to oversee the transition to a social health insurance system. The project collaborated with multiple levels of government and other partners to support these reforms and strengthen Ethiopia's health system financing.
HFG Dominican Republic Final Country ReportHFG Project
The Health Finance and Governance (HFG) Project worked in the Dominican Republic from 2016-2018 to help strengthen the country's HIV response and move towards sustainability. Through analyses and stakeholder workshops, HFG helped build consensus around including antiretroviral drugs in national health insurance and expanding treatment coverage nationwide. HFG also provided technical assistance to improve HIV service delivery in areas like supply chain management and clinic operations. As a result of HFG's work, financial sustainability is now a priority and plans are in place to transition the HIV response to domestic financing sources by reforming health insurance.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance to improve financing, governance, management systems, and universal health coverage monitoring. In Botswana specifically, the project worked with the Ministry of Health and Wellness to develop a new health financing strategy, update the universal health benefits package, create a blueprint for national health insurance, increase hospital outsourcing efficiencies, analyze HIV treatment costs, and design a framework for setting healthcare service prices.
The document summarizes USAID's efforts over 3 years to strengthen the organizational capacity of Burundi's National HIV/AIDS Program (PNLS). Through training, workshops, and technical assistance, PNLS improved in key areas like strategic planning, project management, coordination, and monitoring. This enabled PNLS to take on greater leadership of Burundi's HIV response, including becoming the principal recipient of Global Fund grants. The transformation of PNLS from a weak to effective organization illustrates the importance of building both technical and foundational management capacities.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project has worked in Cote d'Ivoire since 2013 to address challenges in human resources, health financing, and governance that were preventing effective delivery of HIV and other health services. Key accomplishments include a six-fold increase in the number of health workers trained to provide HIV treatment through task-sharing policies and curriculum changes.
The document discusses the work of the USAID-funded Health Finance and Governance (HFG) project in Haiti from 2012-2018. It aimed to [1] improve management of Haiti's public and private health workforce, [2] strengthen health financing capacity for more efficient health services, and [3] improve donor coordination for an effective health sector response. Some key accomplishments include developing Haiti's first national human resources for health strategy, establishing a process to regulate private nursing schools, identifying and removing "ghost workers" from payrolls, and helping hospitals strengthen financial management.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to improve health systems. It helps countries increase domestic health funding, better manage those resources, and make wise purchasing decisions. The project provides technical assistance to over 40 countries in areas like improving health financing, governance, management systems, and measuring universal health coverage. In Mali, the project worked with the Ministry of Health from 2015-2018 to address challenges and strengthen the health system through activities like assessing the system, building stakeholder consensus on priorities, improving use of health financing data, and increasing public-private sector engagement.
The USAID Health Finance and Governance project in Angola helped the Ministry of Health develop a costed National Health Plan and monitoring and evaluation system to better advocate for health funding. Specifically:
1) HFG assisted MINSA in calculating a 12-year $6.3 billion budget to implement the National Health Plan, which helped gain approval and political support for increased health funding.
2) An M&E plan was developed and led to the creation of an M&E department at MINSA to track health spending and sector progress.
3) Efforts were made to establish a health accounting system to measure how funds are actually spent, but this was not completed due to a change in government leadership.
The Health Sector Financing Reform/Health Finance and Governance Project aimed to improve health in Ethiopia by expanding access to healthcare. Over its 5-year period, the project worked with the Government of Ethiopia to implement health financing reforms. These reforms included allowing health facilities to retain and utilize the fees they collect, establishing community-based health insurance, and creating the Ethiopian Health Insurance Agency to oversee the transition to a social health insurance system. The project collaborated with multiple levels of government and other partners to support these reforms and strengthen Ethiopia's health system financing.
HFG Dominican Republic Final Country ReportHFG Project
The Health Finance and Governance (HFG) Project worked in the Dominican Republic from 2016-2018 to help strengthen the country's HIV response and move towards sustainability. Through analyses and stakeholder workshops, HFG helped build consensus around including antiretroviral drugs in national health insurance and expanding treatment coverage nationwide. HFG also provided technical assistance to improve HIV service delivery in areas like supply chain management and clinic operations. As a result of HFG's work, financial sustainability is now a priority and plans are in place to transition the HIV response to domestic financing sources by reforming health insurance.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance to improve financing, governance, management systems, and universal health coverage monitoring. In Botswana specifically, the project worked with the Ministry of Health and Wellness to develop a new health financing strategy, update the universal health benefits package, create a blueprint for national health insurance, increase hospital outsourcing efficiencies, analyze HIV treatment costs, and design a framework for setting healthcare service prices.
The document summarizes the work of the Health Finance and Governance (HFG) project in Guinea between 2012-2018. The key points are:
1) HFG worked to strengthen Guinea's health system following political instability, economic challenges, and the Ebola epidemic which exposed weaknesses.
2) Some of the results include building institutional capacity at the Ministry of Health, improving governance, and strengthening human resources management.
3) Specific accomplishments include supporting health sector coordination, financial management, use of health research, and oversight from the National Assembly.
The USAID Health Finance and Governance project works with developing countries to improve access to healthcare. Led by Abt Associates, the project helps countries increase domestic health funding, better manage resources, and make wise purchasing decisions. The project has activities in over 40 countries and collaborates with health stakeholders to expand services like maternal and child care, reduce financial barriers, and promote universal healthcare coverage.
The Health Finance and Governance project in Ukraine worked to improve the country's health system through strategic purchasing approaches. It demonstrated the effectiveness of integrating HIV testing into primary care, improving efficiency of the TB hospital system by developing monitoring and simulation tools, and laying the groundwork for strategic purchasing reforms across the broader hospital sector. Key results included increasing HIV testing and detection rates while lowering costs, helping restructure TB hospitals based on data to improve care and achieve savings, and establishing cost accounting methods and a case-based payment system pilot to enhance the performance and efficiency of hospitals nationwide.
The document outlines work conducted from 2012 to 2018 related to health financing and universal health care in USAID's Smiling Sun clinics. It includes analysis of pricing and costs, demand, feasibility of pre-payment options, improving financial protection through reviewing pre-payment mechanisms and targeting the poor, and assessments of health financing and essential service packages.
Responding to Health System Failure on Tuberculosis in Southern AfricaHFG Project
This document discusses health system failures in combating tuberculosis (TB) in Southern Africa, focusing on miners. It applies the Flagship Framework's "control knobs" (financing, payment, organization, regulation, behavior) to analyze TB control programs. Miners in Southern Africa have the highest TB rates in the world due to occupational and socioeconomic risks. While treatment is effective, health systems struggle with social determinants like poverty, multi-sectoral issues, and long treatment times. The analysis recommends a patient-centered approach involving whole-of-government and multi-sectoral cooperation to better address the underlying drivers fueling the TB epidemic.
Public Financial Management, Health Governance, and Health SystemsHFG Project
While the importance of governance in a health system is well recognized, there is an overall lack of evidence and understanding of the dynamics of how improved governance can influence health system performance and health outcomes. There is still considerable debate on which governance interventions are appropriate for different contexts. This lack of evidence can result in avoidance of health governance efforts or an over-reliance on a limited set of governance interventions. As development partners and governments are increasing their emphasis on improving accountability and transparency of health systems and strengthening country policies and institutions to move towards universal health coverage (UHC), the need of this evidence is ever rising.
To address this evidence gap, the USAID’s Office of Health Systems (USAID/GH/OHS), the World Health Organization (WHO), and the Health Finance and Governance (HFG) Project launched an initiative in September 2016 to ‘Marshall the Evidence’ on how governance contributes to health system performance and improves health outcomes.
The overall objective of the initiative was to increase awareness and understanding of the evidence of what works and why in how governance contributes to health system performance, and how the field of health governance is evolving at the country level. This report provides a synthesis of the findings across the four themes. This report presents the findings of the Public Financial Management.
Do Better Laws and Regulations Promote Universal Health Coverage? A Review of...HFG Project
The importance of policies, laws, and regulations (referred to collectively below as “policy instances”) as instruments to support progress towards Universal Health Coverage (UHC) in low- and middle-income countries cannot be understated. However, there has been insufficient focus in the literature on the role of these instruments, leading to a lack of evidence as to what constitutes a supportive legal environment that can consistently provide a strong basis for UHC reform processes. In this review, we explore how policies implemented in different country contexts have had an impact on their achievement of UHC goals.
In order to better differentiate the effect of various policy instances on the achievement of UHC goals, we developed a typology for policy instances and then ascribed the different aspects of governance to the instances identified in the literature, based on how they were designed and implemented. Finally, we considered the success of each policy instance identified, in terms of achieving intended UHC-related outcomes.
Governments may have political and process constraints on the number of policy instances they can design and implement in a period leading up to and during health sector reform. In terms of which health system component to focus such change on, we have more evidence for policy instances focused on health financing, given that designing effective financing mechanisms can shape the entire health
sector. Following this, policy instances that address human resources for health and supply chain management should be prioritized as they appear to have key strengthening effects on the provision of healthcare by increasing efficiency, equity, and quality.
This review of the evidence to date of governments’ policy-making experience highlights the importance of effective policy design and implementation with a clear orientation towards better governance, and in particular increased responsiveness and accountability.
The USAID-funded Health Finance and Governance project worked in Namibia from 2013-2018 to help the country strengthen its health system and progress toward universal health coverage. It did this by supporting the institutionalization of Health Accounts to track health spending, conducting studies to estimate costs of health services and assess quality across public and private facilities, and building the government's capacity to mobilize resources and make evidence-based financing decisions. This evidence helped Namibia explore sustainable domestic financing options and identify its total funding needs for achieving universal coverage of priority health services.
This document summarizes a case study on The Rockefeller Foundation's efforts to support universal healthcare in Bangladesh through its Transforming Health Systems initiative. Some key points:
- THS invested in Bangladesh from 2009-2015, awarding 31 grants totaling $115 million across four work streams, with nearly half focused on UHC policy and advocacy.
- Notable outcomes included increasing awareness and commitment to UHC among government and other stakeholders, contributing to improved and standardized health education training, and supporting technological infrastructure for integrating health information systems.
- Lessons learned included the need for consistent government leadership on UHC, a unified vision and strategy across partners and grants, and a strong local champion to sustain focus on UHC
HFG began working in Namibia in 2013, closely partnering with the Namibian Ministry of Health and Social Services and going on to collaborate with key government agencies, such as the Namibian Social Security Commission and the Universal Health
Coverage Advisory Committee of Namibia. The overarching aim of our technical assistance has been to support Namibia’s progress toward UHC to ensure all can access necessary, quality health care without financial struggle. We emphasized a government-led and -owned approach as we supported the Namibian government in addressing some of the key challenges it faced at the start of the project.
HFG’s support has helped strengthen the government’s capacity to mobilize and manage resources; improve efficiency, quality, and equity of health services; expand access to health care; sustain key health interventions, especially the HIV/AIDS prevention, care, and treatment program; and, ultimately, identify sustainable financing for UHC. We provided technical support to the Namibian government’s Health Accounts team, equipping them with tools and know-how to lead and implement four Health Accounts exercises and analyze and present data for better policy analysis and evidence-based decision making. Our support has helped institutionalize Health Accounts in Namibia and provided the country’s policymakers with evidence to examine health financing options for UHC, advocate for greater resources, and explore financial risk protection options.
Strengthening the larger health system and generating fiscal space through improved efficiency of health services was another important goal for HFG.
Findings of the health facility costing and district hospital efficiency study we undertook will enable the government to identify where it can save resources, how it can improve equity in service distribution, and what Namibia’s total financing requirement is for UHC.
This report highlights some of the major contributions HFG and its key partners have made toward more efficient use of limited health resources, improved sustainability of
health programs, and progress toward UHC in Namibia.
Repositioning the Health Economics UnitHFG Project
The document discusses a proposal to reposition the Health Economics Unit (HEU) within the Ministry of Health and Family Welfare in Bangladesh. The proposal aims to clarify and focus the HEU's mandate on supporting universal healthcare through health economics analysis and policy guidance. It recommends refocusing the HEU's activities, limiting its scope by relocating certain units, renaming it the Directorate General of Health Economics and Policy, and establishing four new technical units. It also addresses staffing limitations and the need to strengthen collaboration to effectively implement the proposed changes.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance in over 40 countries on improving health financing, governance, management systems, and measuring universal health coverage progress.
This document provides an overview of budgeting in health care systems and health care financing. It begins with introducing the need for governments to budget for health care to provide affordable, equitable and quality care. It then discusses different types of budgets, approaches to budgeting including incremental, performance-based and zero-based budgeting. The document outlines India's budgeting process and highlights the Twelfth Five Year Plan's allocations for health care. It also summarizes India's Union Budget for 2016-2017 before concluding with principles of health care financing and different models.
The document provides a health profile of Benue State, Nigeria. It summarizes key health indices like tuberculosis prevalence (13,000+ affected), HIV prevalence (15.4%), and stakeholders involved in health. It describes USAID/HFG project interventions in the state like budget advocacy, capacity building, and establishing a Resource Mobilization Technical Working Group. The project achieved a 62% increased budget allocation and release of previously withheld funds. Challenges included limited time and insecurity, while recommendations focused on ownership, capacity building and longer timelines.
The Health Finance and Governance project works with countries to improve health systems and expand access to healthcare. In Ghana, the project worked with the National Health Insurance Authority to make the National Health Insurance Scheme more sustainable and effective. This included developing dashboards to monitor enrollment and claims data, conducting research to examine challenges, and laying the groundwork for capitation payments to primary care providers. The project helped institutionalize processes for using evidence to guide decision-making and reform policies to strengthen Ghana's progress toward universal health coverage.
Essential Package of Health Services Country Snapshot: UgandaHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Strengthening the Health Workforce to Improve Quality and Achieve Universal H...HFG Project
Universal health coverage (UHC) means anyone can access necessary, good quality health care without suffering financial hardship. A strong health workforce is crucial to achieving UHC, but poor quality pre-service training and governance often weaken the health workforce. In many countries, governments and families alike spend their limited funds on pre-service training institutions that graduate health workers with inadequate skills, which can result in poor patient care and poor health outcomes. Further, some governments do not provide strong stewardship of the health workforce, and miss critical opportunities to improve morale, retention, and skills.
This presentation focuses on three countries that are taking a systems approach to solving these two problems, with help from HFG: Haiti, Côte d’Ivoire, and Swaziland.
In Haiti, HFG is working with the Ministry of Health to bolster its process for accrediting nursing education institutions, known as reconnaissance. More than 40 schools have already received the new accreditation. The government of Côte D’Ivoire identified task-sharing between nurses/midwives and doctors for HIV care as a key strategy to improve HIV outcomes. HFG is supporting the Ministry of Health in developing policies and training programs on task-sharing to integrate into health worker training curricula. In Swaziland, HFG is working with the government to establish standardized hiring and compensation policies for health workers, and to strengthen human resource information systems. HFG also worked with the Swaziland Nursing Council to strengthen their capacity to regulate the nursing profession and expand nursing competencies to incorporate international best practices.
Essential Packages of Health Services: A Landscape Analysis in 24 EPCMD Count...HFG Project
In an effort to better understand what the EPHS are and what they are being used for in the EPCMD countries, USAID requested that HFG conduct an analysis to provide a “snapshot” for each of the priority countries. The activity results enable quick identification of the EPHS for the studied countries, allowing practitioners to identify cross-cutting themes, identify gaps, and better understand practical application of EPHS.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
The document summarizes the work of the USAID-funded Health Finance and Governance (HFG) project in Indonesia from 2012-2018. The project worked with the Government of Indonesia and other stakeholders to:
1) Build capacity for strategic health purchasing to improve the sustainability and efficiency of the national health insurance program, JKN.
2) Conduct implementation research to identify challenges affecting JKN at decentralized levels and inform policy adjustments.
3) Strengthen Indonesia's health financing tracking and analysis through health accounts.
The project facilitated strategic purchasing reforms, provided evidence on bottlenecks in JKN implementation, and improved Indonesia's ability to make resource allocation decisions based on data.
Lessons from pfm in the health sector finalHFG Project
Over the past five years, the Health Finance and Governance (HFG) project has supported over 35 countries and programs in their efforts to strengthen public financial management (PFM) systems. Activities have been tailored to address key priorities within a health system context, and have ranged from improving financial data systems to conducting costing exercises, financial analyses, and capacity-building workshops. Across these activities, several lessons have emerged.
Insights in this brief stem from analysis of over 200 HFG financing activities; interviews with stakeholders from Ukraine and Vietnam; and experience from cross-cutting program activities. These lessons are shared as a resource for fellow implementing partners, country practitioners, and donor agencies. As the project ends, this brief considers the global context and established frameworks for PFM alongside the contributions of the HFG experience, and suggests a way forward.
The document summarizes the work of the Health Finance and Governance (HFG) project in Guinea between 2012-2018. The key points are:
1) HFG worked to strengthen Guinea's health system following political instability, economic challenges, and the Ebola epidemic which exposed weaknesses.
2) Some of the results include building institutional capacity at the Ministry of Health, improving governance, and strengthening human resources management.
3) Specific accomplishments include supporting health sector coordination, financial management, use of health research, and oversight from the National Assembly.
The USAID Health Finance and Governance project works with developing countries to improve access to healthcare. Led by Abt Associates, the project helps countries increase domestic health funding, better manage resources, and make wise purchasing decisions. The project has activities in over 40 countries and collaborates with health stakeholders to expand services like maternal and child care, reduce financial barriers, and promote universal healthcare coverage.
The Health Finance and Governance project in Ukraine worked to improve the country's health system through strategic purchasing approaches. It demonstrated the effectiveness of integrating HIV testing into primary care, improving efficiency of the TB hospital system by developing monitoring and simulation tools, and laying the groundwork for strategic purchasing reforms across the broader hospital sector. Key results included increasing HIV testing and detection rates while lowering costs, helping restructure TB hospitals based on data to improve care and achieve savings, and establishing cost accounting methods and a case-based payment system pilot to enhance the performance and efficiency of hospitals nationwide.
The document outlines work conducted from 2012 to 2018 related to health financing and universal health care in USAID's Smiling Sun clinics. It includes analysis of pricing and costs, demand, feasibility of pre-payment options, improving financial protection through reviewing pre-payment mechanisms and targeting the poor, and assessments of health financing and essential service packages.
Responding to Health System Failure on Tuberculosis in Southern AfricaHFG Project
This document discusses health system failures in combating tuberculosis (TB) in Southern Africa, focusing on miners. It applies the Flagship Framework's "control knobs" (financing, payment, organization, regulation, behavior) to analyze TB control programs. Miners in Southern Africa have the highest TB rates in the world due to occupational and socioeconomic risks. While treatment is effective, health systems struggle with social determinants like poverty, multi-sectoral issues, and long treatment times. The analysis recommends a patient-centered approach involving whole-of-government and multi-sectoral cooperation to better address the underlying drivers fueling the TB epidemic.
Public Financial Management, Health Governance, and Health SystemsHFG Project
While the importance of governance in a health system is well recognized, there is an overall lack of evidence and understanding of the dynamics of how improved governance can influence health system performance and health outcomes. There is still considerable debate on which governance interventions are appropriate for different contexts. This lack of evidence can result in avoidance of health governance efforts or an over-reliance on a limited set of governance interventions. As development partners and governments are increasing their emphasis on improving accountability and transparency of health systems and strengthening country policies and institutions to move towards universal health coverage (UHC), the need of this evidence is ever rising.
To address this evidence gap, the USAID’s Office of Health Systems (USAID/GH/OHS), the World Health Organization (WHO), and the Health Finance and Governance (HFG) Project launched an initiative in September 2016 to ‘Marshall the Evidence’ on how governance contributes to health system performance and improves health outcomes.
The overall objective of the initiative was to increase awareness and understanding of the evidence of what works and why in how governance contributes to health system performance, and how the field of health governance is evolving at the country level. This report provides a synthesis of the findings across the four themes. This report presents the findings of the Public Financial Management.
Do Better Laws and Regulations Promote Universal Health Coverage? A Review of...HFG Project
The importance of policies, laws, and regulations (referred to collectively below as “policy instances”) as instruments to support progress towards Universal Health Coverage (UHC) in low- and middle-income countries cannot be understated. However, there has been insufficient focus in the literature on the role of these instruments, leading to a lack of evidence as to what constitutes a supportive legal environment that can consistently provide a strong basis for UHC reform processes. In this review, we explore how policies implemented in different country contexts have had an impact on their achievement of UHC goals.
In order to better differentiate the effect of various policy instances on the achievement of UHC goals, we developed a typology for policy instances and then ascribed the different aspects of governance to the instances identified in the literature, based on how they were designed and implemented. Finally, we considered the success of each policy instance identified, in terms of achieving intended UHC-related outcomes.
Governments may have political and process constraints on the number of policy instances they can design and implement in a period leading up to and during health sector reform. In terms of which health system component to focus such change on, we have more evidence for policy instances focused on health financing, given that designing effective financing mechanisms can shape the entire health
sector. Following this, policy instances that address human resources for health and supply chain management should be prioritized as they appear to have key strengthening effects on the provision of healthcare by increasing efficiency, equity, and quality.
This review of the evidence to date of governments’ policy-making experience highlights the importance of effective policy design and implementation with a clear orientation towards better governance, and in particular increased responsiveness and accountability.
The USAID-funded Health Finance and Governance project worked in Namibia from 2013-2018 to help the country strengthen its health system and progress toward universal health coverage. It did this by supporting the institutionalization of Health Accounts to track health spending, conducting studies to estimate costs of health services and assess quality across public and private facilities, and building the government's capacity to mobilize resources and make evidence-based financing decisions. This evidence helped Namibia explore sustainable domestic financing options and identify its total funding needs for achieving universal coverage of priority health services.
This document summarizes a case study on The Rockefeller Foundation's efforts to support universal healthcare in Bangladesh through its Transforming Health Systems initiative. Some key points:
- THS invested in Bangladesh from 2009-2015, awarding 31 grants totaling $115 million across four work streams, with nearly half focused on UHC policy and advocacy.
- Notable outcomes included increasing awareness and commitment to UHC among government and other stakeholders, contributing to improved and standardized health education training, and supporting technological infrastructure for integrating health information systems.
- Lessons learned included the need for consistent government leadership on UHC, a unified vision and strategy across partners and grants, and a strong local champion to sustain focus on UHC
HFG began working in Namibia in 2013, closely partnering with the Namibian Ministry of Health and Social Services and going on to collaborate with key government agencies, such as the Namibian Social Security Commission and the Universal Health
Coverage Advisory Committee of Namibia. The overarching aim of our technical assistance has been to support Namibia’s progress toward UHC to ensure all can access necessary, quality health care without financial struggle. We emphasized a government-led and -owned approach as we supported the Namibian government in addressing some of the key challenges it faced at the start of the project.
HFG’s support has helped strengthen the government’s capacity to mobilize and manage resources; improve efficiency, quality, and equity of health services; expand access to health care; sustain key health interventions, especially the HIV/AIDS prevention, care, and treatment program; and, ultimately, identify sustainable financing for UHC. We provided technical support to the Namibian government’s Health Accounts team, equipping them with tools and know-how to lead and implement four Health Accounts exercises and analyze and present data for better policy analysis and evidence-based decision making. Our support has helped institutionalize Health Accounts in Namibia and provided the country’s policymakers with evidence to examine health financing options for UHC, advocate for greater resources, and explore financial risk protection options.
Strengthening the larger health system and generating fiscal space through improved efficiency of health services was another important goal for HFG.
Findings of the health facility costing and district hospital efficiency study we undertook will enable the government to identify where it can save resources, how it can improve equity in service distribution, and what Namibia’s total financing requirement is for UHC.
This report highlights some of the major contributions HFG and its key partners have made toward more efficient use of limited health resources, improved sustainability of
health programs, and progress toward UHC in Namibia.
Repositioning the Health Economics UnitHFG Project
The document discusses a proposal to reposition the Health Economics Unit (HEU) within the Ministry of Health and Family Welfare in Bangladesh. The proposal aims to clarify and focus the HEU's mandate on supporting universal healthcare through health economics analysis and policy guidance. It recommends refocusing the HEU's activities, limiting its scope by relocating certain units, renaming it the Directorate General of Health Economics and Policy, and establishing four new technical units. It also addresses staffing limitations and the need to strengthen collaboration to effectively implement the proposed changes.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance in over 40 countries on improving health financing, governance, management systems, and measuring universal health coverage progress.
This document provides an overview of budgeting in health care systems and health care financing. It begins with introducing the need for governments to budget for health care to provide affordable, equitable and quality care. It then discusses different types of budgets, approaches to budgeting including incremental, performance-based and zero-based budgeting. The document outlines India's budgeting process and highlights the Twelfth Five Year Plan's allocations for health care. It also summarizes India's Union Budget for 2016-2017 before concluding with principles of health care financing and different models.
The document provides a health profile of Benue State, Nigeria. It summarizes key health indices like tuberculosis prevalence (13,000+ affected), HIV prevalence (15.4%), and stakeholders involved in health. It describes USAID/HFG project interventions in the state like budget advocacy, capacity building, and establishing a Resource Mobilization Technical Working Group. The project achieved a 62% increased budget allocation and release of previously withheld funds. Challenges included limited time and insecurity, while recommendations focused on ownership, capacity building and longer timelines.
The Health Finance and Governance project works with countries to improve health systems and expand access to healthcare. In Ghana, the project worked with the National Health Insurance Authority to make the National Health Insurance Scheme more sustainable and effective. This included developing dashboards to monitor enrollment and claims data, conducting research to examine challenges, and laying the groundwork for capitation payments to primary care providers. The project helped institutionalize processes for using evidence to guide decision-making and reform policies to strengthen Ghana's progress toward universal health coverage.
Essential Package of Health Services Country Snapshot: UgandaHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Strengthening the Health Workforce to Improve Quality and Achieve Universal H...HFG Project
Universal health coverage (UHC) means anyone can access necessary, good quality health care without suffering financial hardship. A strong health workforce is crucial to achieving UHC, but poor quality pre-service training and governance often weaken the health workforce. In many countries, governments and families alike spend their limited funds on pre-service training institutions that graduate health workers with inadequate skills, which can result in poor patient care and poor health outcomes. Further, some governments do not provide strong stewardship of the health workforce, and miss critical opportunities to improve morale, retention, and skills.
This presentation focuses on three countries that are taking a systems approach to solving these two problems, with help from HFG: Haiti, Côte d’Ivoire, and Swaziland.
In Haiti, HFG is working with the Ministry of Health to bolster its process for accrediting nursing education institutions, known as reconnaissance. More than 40 schools have already received the new accreditation. The government of Côte D’Ivoire identified task-sharing between nurses/midwives and doctors for HIV care as a key strategy to improve HIV outcomes. HFG is supporting the Ministry of Health in developing policies and training programs on task-sharing to integrate into health worker training curricula. In Swaziland, HFG is working with the government to establish standardized hiring and compensation policies for health workers, and to strengthen human resource information systems. HFG also worked with the Swaziland Nursing Council to strengthen their capacity to regulate the nursing profession and expand nursing competencies to incorporate international best practices.
Essential Packages of Health Services: A Landscape Analysis in 24 EPCMD Count...HFG Project
In an effort to better understand what the EPHS are and what they are being used for in the EPCMD countries, USAID requested that HFG conduct an analysis to provide a “snapshot” for each of the priority countries. The activity results enable quick identification of the EPHS for the studied countries, allowing practitioners to identify cross-cutting themes, identify gaps, and better understand practical application of EPHS.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
The document summarizes the work of the USAID-funded Health Finance and Governance (HFG) project in Indonesia from 2012-2018. The project worked with the Government of Indonesia and other stakeholders to:
1) Build capacity for strategic health purchasing to improve the sustainability and efficiency of the national health insurance program, JKN.
2) Conduct implementation research to identify challenges affecting JKN at decentralized levels and inform policy adjustments.
3) Strengthen Indonesia's health financing tracking and analysis through health accounts.
The project facilitated strategic purchasing reforms, provided evidence on bottlenecks in JKN implementation, and improved Indonesia's ability to make resource allocation decisions based on data.
Lessons from pfm in the health sector finalHFG Project
Over the past five years, the Health Finance and Governance (HFG) project has supported over 35 countries and programs in their efforts to strengthen public financial management (PFM) systems. Activities have been tailored to address key priorities within a health system context, and have ranged from improving financial data systems to conducting costing exercises, financial analyses, and capacity-building workshops. Across these activities, several lessons have emerged.
Insights in this brief stem from analysis of over 200 HFG financing activities; interviews with stakeholders from Ukraine and Vietnam; and experience from cross-cutting program activities. These lessons are shared as a resource for fellow implementing partners, country practitioners, and donor agencies. As the project ends, this brief considers the global context and established frameworks for PFM alongside the contributions of the HFG experience, and suggests a way forward.
HSFR/HFG End of Project Regional Report - TigrayHFG Project
The document summarizes health care financing reforms supported by the USAID-funded HSFR/HFG project in the Tigray region of Ethiopia. Key achievements include:
1) Increasing the number of health facilities with functional governing boards and management committees to improve governance and use of retained revenue.
2) Doubling the amount of revenue retained and utilized by health facilities over three years through the revenue retention and utilization reform.
3) Expanding community-based health insurance (CBHI) to cover 69% of woredas and over 1 million beneficiaries, increasing resources mobilized through the program to over 141 million birr.
Lessons Learned in Institutional Capacity BuildingHFG Project
The objective of this document is to present lessons learned based on HFG’s ICB experience, and to provide practical guidance that will inform future work in health systems strengthening. Ultimately, improved health system governance and management lead to improvements in the quality of essential health services and in expanding universal health coverage (UHC).
The document summarizes an interview with the Chief of Party/Project Director of the HSFR/HFG Project in Ethiopia.
In the past fiscal year, the project focused on consolidating first generation health care financing reforms and preparing for universal health coverage through activities like building implementation capacity and expanding community-based health insurance. The project performed well, with achievements like graduating supported health facilities, expanding CBHI to more areas, and conducting evaluations.
Looking ahead, the project will focus on further expanding CBHI, launching social health insurance, strengthening supported health facilities, and generating health financing evidence to support policymaking. The Chief of Party expressed gratitude for partnerships while noting ongoing challenges like staff turnover and expanding initiatives to new areas
Health System Reforms to Accelerate Universal Health Coverage in Côte d'IvoireHFG Project
The document summarizes health system reforms in Côte d'Ivoire to accelerate progress toward universal health coverage. Key reforms include improving funding and financial management through increased domestic resource mobilization and transparency measures. Service delivery is being strengthened by expanding maternal and child health services and ensuring drug availability. Governance is also being strengthened through audits of management risks and training inspectors to apply standardized financial controls at local levels.
The Department of Health and the Strategic Health Authorities have implemented changes to the Care Services Improvement Partnership's role and way of working. This document gives a summary of the changes agreed following a thorough review of CSIP's eight regional development centres and nationally coordinated programmes that come under its auspices.
Uganda: Governing for Quality Improvement in the Context of UHCHFG Project
The document discusses quality improvement initiatives in Uganda's health sector, including establishing a Quality Assurance Department within the Ministry of Health to coordinate quality improvement activities. The Quality Assurance Department develops policies and strategies, provides training, and works with partners to conduct coaching across the country. Governance structures are in place to monitor and evaluate quality, plan improvement activities, and coordinate financing from the government and other partners.
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
The HSFR/HFG project worked with the Government of Ethiopia from 2013-2018 to improve Ethiopia's health care financing system and expand access to health services. Key achievements included increasing the proportion of health facilities managing funds and services through boards representing communities, expanding revenue retention at health centers and hospitals, and piloting community-based health insurance. The project aimed to increase utilization of primary health services, enroll more people in insurance, and reduce out-of-pocket costs through technical support across Ethiopia's decentralized health system. Challenges remained in expanding reforms and improving health indicators, but the project strengthened sustainability by building local capacity and engaging stakeholders.
This document summarizes a case study on The Rockefeller Foundation's efforts to support universal healthcare in Bangladesh through its Transforming Health Systems initiative. Some key points:
- THS invested in Bangladesh from 2009-2015, awarding 31 grants totaling $115 million across four work streams, with nearly half focused on UHC policy and advocacy.
- Notable outcomes included increasing awareness and commitment to UHC among government and other stakeholders, contributing to improved and standardized health education training, and supporting technological infrastructure for integrating health information systems.
- Lessons learned included the need for consistent government leadership on UHC, a unified vision and strategy across partners and grantees, and a strong local champion to sustain focus on U
This document provides an overview of the USAID/India REFORM Project which aimed to strengthen fiscal management capacity in selected Indian states. It did so through hands-on skills transfer in 4 areas: revenue management, expenditure planning, debt/investment management, and project appraisal. Guides and tools were developed for each along with training. Institutional structures like the Fiscal Policy Analysis Cell were also established to sustain the efforts by mainstreaming new analytical capacity into state practices. The objective was to help states make more informed fiscal decisions in a transparent, accountable manner.
Assessment of Local Governance and Development Performance in IndonesiaDr. Astia Dendi
1. The document discusses performance measurement models implemented in Indonesia following its decentralization in 2001. It explores challenges with current central-government driven models.
2. A nested model is proposed that integrates three spheres of evaluation: financial/budget performance, governance performance, and development performance. This aims to make evaluation more attainable and useful for local governments.
3. The paper also discusses lessons learned and suggestions for an effective process to implement the nested performance evaluation model, including collaborative efforts between central and local governments.
The Health Finance and Governance Project developed a Health Management Toolkit containing 17 tools to support health service delivery in Peru. The toolkit was designed based on tools previously created by USAID projects. It was officially transferred to the San Fernando School of Medicine and the Regional Government of Lima to be hosted and disseminated. The toolkit was also presented at national and international forums to publicize the tools and gauge interest. Surveys found that regional health directors highly valued having access to the tools and were very interested in tools for human resources management, health promotion, and project formulation. Most directors expressed interest in hosting the toolkit on their institutional websites.
The USAID Health Finance and Governance project helps developing countries expand access to healthcare through improving health financing, management of resources, and purchasing decisions. Led by Abt Associates, the project works with partner countries in over 40 countries to mobilize domestic funding for health, enhance governance and accountability, improve management systems, and advance universal health coverage. The project is funded by USAID from 2012-2018 and involves several organizations.
Systems Thinking: Getting Research into Policy and Practice through Embedded TARebekah McKay-Smith
This document summarizes the work of an embedded technical assistance (TA) programme in Malawi's health sector from 2018-ongoing. The key points are:
1) The embedded TA programme worked within the Malawi Ministry of Health to strengthen areas like performance monitoring, financial management, health service planning, and civil society accountability.
2) The TA programme embedded advisors in key departments to work on planning, budgeting, decentralization reforms, and health financing reforms.
3) Through working closely with government staff and stakeholders, the TA programme was able to provide evidence and recommendations that influenced policies around expanding service level agreements between districts and health facilities.
This document outlines the responsibilities and key achievements of a position providing technical assistance to a State Government on health financing programs. The responsibilities include designing, implementing, and evaluating health financing programs; conducting training; supporting strategic planning; overseeing budgets; and collaborating with stakeholders. Some of the key achievements are facilitating a health expenditure review, costing analyses, developing policies and strategies, establishing exemption schemes, and supporting strategic and operational planning.
Case Study: Rwanda’s Twubakane Decentralization and Health ProgramHFG Project
The Twubakane Decentralization and Health Program in Rwanda aimed to strengthen the country's health system through decentralization and capacity building efforts. The project supported six components: family planning and reproductive health, child survival programs, decentralization policy and management, district-level capacity building, health facility management, and community engagement. While the project scope originally focused on health financing and decentralization, after Phase II of Rwanda's decentralization was initiated, the project shifted its top priority to district-level capacity building. Key factors in the project's success included aligning with existing government policies, collaborating across stakeholders, and increasing district ownership over resources and planning. The project contributed to reductions in infant mortality and increases in contra
HFG leaves a legacy of strengthened health systems management and oversight i...HFG Project
The Ministry of Public Health and Population in Haiti held a debriefing session to discuss the accomplishments of the Health Governance Project as it concluded. The project strengthened MSPP's leadership, human resources management, health financing, and internal management over six years. It updated Haiti's health workforce database, launched an accreditation system for nursing schools, improved coordination between MSPP directorates and donors, and established a performance evaluation system. The MSPP now regulates the health sector through policies on ghost workers and an HRH strategy. HFG helped transition implementation and tools to MSPP to sustain its support for a stronger health system in Haiti.
Championing Sustainability, Namibia Funds Health AccountsHFG Project
In Namibia, donor funding for health dropped by 47 percent between 2009 and 2013. This sharp decline could have broad implications for the health sector—particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. In light of declining donor resources for health, the Government of Namibia (GRN) is positioning itself to sustain health sector progress to-date, through investing in Health Accounts.
Similar to HFG Democratic Republic of Congo Final Country Report (20)
This document outlines a training manual for a hospital costing workshop. It provides an agenda for the 3-day workshop covering topics like the fundamentals of costing, the MASH costing tool, and calculating unit costs. The workshop aims to teach participants how to conduct costing exercises to understand their hospital's costs and improve management. Sessions include introductions, an overview of costing concepts, the costing process, and a demonstration of the MASH tool which is an Excel-based framework for tracking and analyzing hospital resources, services, and costs.
Trinidad and Tobago 2015 Health Accounts - Main ReportHFG Project
This document summarizes the key findings of the 2015 health accounts report for Trinidad and Tobago. It finds that total health expenditure was 4.5 billion TT dollars in 2015, equivalent to 4.1% of GDP. The government financed 41% of health spending, while households financed 35% through direct out-of-pocket payments. Noncommunicable diseases accounted for the largest share of recurrent health spending at 42%. Out-of-pocket payments remain high, comprising over a third of total health expenditure. The report recommends strengthening government commitment to health financing, increasing risk pooling to reduce out-of-pocket spending, improving access to services, and institutionalizing ongoing health accounts estimations.
Guyana 2016 Health Accounts - Dissemination BriefHFG Project
The 2016 Guyana Health Accounts study found that:
1) Total health expenditure in Guyana was $28.6 billion (Guyanese dollars), with the government contributing 81% of funding.
2) The majority (71%) of health funds were spent on public health facilities like hospitals and clinics.
3) Most funds (64%) were spent on curative care services, while non-communicable diseases received the largest share (34%) of funds.
4) Government funding represents the largest source of financing for HIV/AIDS programs and services in Guyana, providing 62% of funds.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Guyana 2016 Health Accounts - Main ReportHFG Project
The document summarizes the key findings of Guyana's first Health Accounts exercise for fiscal year 2016. It found that total health expenditure was G$ 28.6 billion, with the government contributing 81% of funding. Household out-of-pocket spending accounted for 9% of total spending. Non-communicable diseases received the largest share of spending at 34%. The analysis aims to inform strategic health financing decisions and assess domestic resource mobilization as external donor funding declines. Recommendations include increasing prevention spending and strengthening financial commitment to HIV programs.
The Next Frontier to Support Health Resource TrackingHFG Project
The document discusses challenges and opportunities for institutionalizing health resource tracking (HRT) in low- and middle-income countries. It identifies three key elements needed for institutionalization: strong demand for HRT data; sustainable local capacity to produce HRT data; and use of HRT results in policy and decision making. It outlines remaining challenges in each area and suggestions for future investments to address challenges, such as building understanding of HRT's value, maintaining local expertise, improving health information systems, and strengthening communication and use of HRT findings.
Rivers State has a population of over 7 million people from various ethnic groups. The main occupations are fishing, farming, and trading. The state has high rates of tuberculosis, neonatal and under-5 mortality, and HIV prevalence. Key stakeholders in health include the Ministry of Health, Ministry of Finance, and various agencies. The USAID Health Finance and Governance project worked to increase domestic health financing through advocacy, establishing a health insurance scheme, and capacity building. These efforts led to increased health budgets, establishment of healthcare financing units, and improved sustainability of health financing in Rivers State.
ASSESSMENT OF RMNCH FUNCTIONALITY IN HEALTH FACILITIES IN BAUCHI STATE, NIGERIAHFG Project
This document summarizes an assessment of reproductive, maternal, newborn and child health (RMNCH) services in health facilities in Bauchi State, Nigeria. It found that infrastructure like electricity, water and toilets were lacking in many facilities. There were also shortages of skilled healthcare workers, especially midwives, and staff training. While many facilities offered antenatal care and immunizations, availability of emergency obstetric and newborn care and services like postnatal care and post-abortion care were more limited. Supplies of essential medicines, equipment and guidelines were also often inadequate. Community outreach was provided by some facilities but could be expanded.
BAUCHI STATE, NIGERIA PUBLIC EXPENDITURE REVIEW 2012-2016 HFG Project
This document summarizes a public expenditure review of health spending in Bauchi State, Nigeria from 2012 to 2016. It finds that while Bauchi State's health budget increased over this period, actual health spending lagged behind budgeted amounts. Specifically, health spending accounted for a small and declining share of the state's total budget and expenditure. The review recommends that Bauchi State increase and better target public health funding to improve health outcomes and progress toward universal health coverage goals.
HEALTH INSURANCE: PRICING REPORT FOR MINIMUM HEALTH BENEFITS PACKAGE, RIVERS ...HFG Project
This document provides a pricing report for a Minimum Health Benefit Package (MHBP) being developed by Rivers State government in Nigeria. It analyzes the cost of 6 scenarios for the package, including individual and household premiums, based on medical claims data from hospitals in Rivers State from 2014-2017. The recommended annual premiums range from N14,026 to N111,734 for individuals and N79,946 to N636,882 for households, depending on the benefits included and the percentage of the state's population covered. The report provides context on data sources and actuarial assumptions used to determine the premiums.
The document is an actuarial report for Kano State's contributory healthcare benefit package in Nigeria. It analyzes 4 scenarios for the package - a basic minimum package alone or plus HIV/AIDS, tuberculosis, or family planning services. The report finds that the estimated annual premium per individual would be between N12,180-N12,600 depending on the scenario, while the estimated annual premium per household of 6 would be between N73,081-N75,595. It provides these estimates by analyzing the state's population data, healthcare facilities, utilization rates, and costs to determine the risk premiums, administrative costs, marketing costs, and contingency margins for each scenario. The report recommends rounding the premium estimates and includes
Supplementary Actuarial Analysis of Tuberculosis, LAGOS STATE, NIGERIA HEALTH...HFG Project
This document provides an actuarial analysis of including tuberculosis (TB) coverage in the Lagos State Health Scheme in Nigeria. It analyzes 3 different TB treatment regimens and estimates the additional premium required. Based on historical TB case data from 2013-2016, it projects the number of cases and costs for the next 3 years. The analysis finds the additional premium to be 488.79 Naira on average per person to cover TB screening tests and the 3 treatment regimens. It acknowledges limitations in the source data and outlines key assumptions made in the projections.
Supplementary Actuarial Analysis of HIV/AIDS in Lagos State, NigeriaHFG Project
This document provides a supplementary actuarial analysis of including HIV/AIDS coverage in the Lagos State Health Scheme benefit package in Nigeria. It estimates the total additional medical cost to cover HIV/AIDS services would be 209.40 Naira per person per year, broken down into costs for HIV testing and counseling (13.60), antiretroviral therapy (133.05), and preventing mother-to-child transmission (15.96). The analysis is based on HIV service data from 2012-2016 and projected population and drug cost data from the Lagos State Ministry of Health. It assumes a 90% continuation and conversion rate for antiretroviral therapy and a 6.5% annual medical cost trend.
About Potato, The scientific name of the plant is Solanum tuberosum (L).Christina Parmionova
The potato is a starchy root vegetable native to the Americas that is consumed as a staple food in many parts of the world. Potatoes are tubers of the plant Solanum tuberosum, a perennial in the nightshade family Solanaceae. Wild potato species can be found from the southern United States to southern Chile
Synopsis (short abstract) In December 2023, the UN General Assembly proclaimed 30 May as the International Day of Potato.
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.Christina Parmionova
The best available, up-to-date information on all fishing and related vessels that appear on the illegal, unregulated, and unreported (IUU) fishing vessel lists published by Regional Fisheries Management Organisations (RFMOs) and related organisations. The aim of the site is to improve the effectiveness of the original IUU lists as a tool for a wide variety of stakeholders to better understand and combat illegal fishing and broader fisheries crime.
To date, the following regional organisations maintain or share lists of vessels that have been found to carry out or support IUU fishing within their own or adjacent convention areas and/or species of competence:
Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR)
Commission for the Conservation of Southern Bluefin Tuna (CCSBT)
General Fisheries Commission for the Mediterranean (GFCM)
Inter-American Tropical Tuna Commission (IATTC)
International Commission for the Conservation of Atlantic Tunas (ICCAT)
Indian Ocean Tuna Commission (IOTC)
Northwest Atlantic Fisheries Organisation (NAFO)
North East Atlantic Fisheries Commission (NEAFC)
North Pacific Fisheries Commission (NPFC)
South East Atlantic Fisheries Organisation (SEAFO)
South Pacific Regional Fisheries Management Organisation (SPRFMO)
Southern Indian Ocean Fisheries Agreement (SIOFA)
Western and Central Pacific Fisheries Commission (WCPFC)
The Combined IUU Fishing Vessel List merges all these sources into one list that provides a single reference point to identify whether a vessel is currently IUU listed. Vessels that have been IUU listed in the past and subsequently delisted (for example because of a change in ownership, or because the vessel is no longer in service) are also retained on the site, so that the site contains a full historic record of IUU listed fishing vessels.
Unlike the IUU lists published on individual RFMO websites, which may update vessel details infrequently or not at all, the Combined IUU Fishing Vessel List is kept up to date with the best available information regarding changes to vessel identity, flag state, ownership, location, and operations.
AHMR is an interdisciplinary peer-reviewed online journal created to encourage and facilitate the study of all aspects (socio-economic, political, legislative and developmental) of Human Mobility in Africa. Through the publication of original research, policy discussions and evidence research papers AHMR provides a comprehensive forum devoted exclusively to the analysis of contemporaneous trends, migration patterns and some of the most important migration-related issues.
Contributi dei parlamentari del PD - Contributi L. 3/2019Partito democratico
DI SEGUITO SONO PUBBLICATI, AI SENSI DELL'ART. 11 DELLA LEGGE N. 3/2019, GLI IMPORTI RICEVUTI DALL'ENTRATA IN VIGORE DELLA SUDDETTA NORMA (31/01/2019) E FINO AL MESE SOLARE ANTECEDENTE QUELLO DELLA PUBBLICAZIONE SUL PRESENTE SITO
Donate to charity during this holiday seasonSERUDS INDIA
For people who have money and are philanthropic, there are infinite opportunities to gift a needy person or child a Merry Christmas. Even if you are living on a shoestring budget, you will be surprised at how much you can do.
Donate Us
https://serudsindia.org/how-to-donate-to-charity-during-this-holiday-season/
#charityforchildren, #donateforchildren, #donateclothesforchildren, #donatebooksforchildren, #donatetoysforchildren, #sponsorforchildren, #sponsorclothesforchildren, #sponsorbooksforchildren, #sponsortoysforchildren, #seruds, #kurnool
Preliminary findings _OECD field visits to ten regions in the TSI EU mining r...OECDregions
Preliminary findings from OECD field visits for the project: Enhancing EU Mining Regional Ecosystems to Support the Green Transition and Secure Mineral Raw Materials Supply.
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
HFG Democratic Republic of Congo Final Country Report
1. USAID’s Health Finance and Governance (HFG)
project helps to improve health in developing
countries by expanding people’s access to health care.
Led by Abt Associates, the project team works with
partner countries to increase their domestic resources
for health, manage those precious resources more
effectively, and make wise purchasing decisions.
HFG DRC
FINAL REPORT
3. HFG DRC FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012–2018) 3
CHALLENGES
The Health Finance and Governance project began working
in the Democratic Republic of Congo (DRC) in 2015 as the
country was in the process of implementing major institutional
reforms towards decentralization. These reforms included
increasing the number of administrative provinces from 11
to 25 provinces plus the city of Kinshasa, and empowering
the provinces with greater political, administrative, financial,
and economic autonomy. The reforms affected all areas of
government, but as we will discuss in this report, these changes
had tremendous impact on the health system in DRC.
Under decentralization, the central Ministry of Health’s
(MOH) role is limited to setting norms and standards,
oversight, leadership, national level planning, coordination of
partners, and management of the reform process itself. Newly
assigned provincial mandates, most of which were previously
the responsibilities of the central MOH, included hiring and
management of the health workforce; development, support,
and supervision of health programs consistent with the
national development health plan; management of hospital,
laboratory, and pharmaceutical services; promotion of primary
health care services at facility and community levels; and
dissemination and enforcement of health laws and regulations.
Transformational change such as this requires a long-term
investment of time and effort and a focus on institutional
capacity building. An independent evaluation of the
National Health Development Plan 2011-2015 noted the
following challenges:
• Central level: inadequate regulatory framework;
weak implementation of the structural reforms; lack of
awareness and information about the reform; and lack of
integration of the vertical specialized programs into the
provincial structures.
• Provincial level: except for the top managers, staff
were not yet in place; weak implementation of the
annual operational plan; inefficient implementation of the
single contract (contrat unique), a device all provinces
use to clarify expectations of the provincial health
divisions (DPS) and its partners; and a lack of alignment
of the planning calendar with the budget cycle.
• Both levels: weak coordination as a result of sub
optimal performance of the national and provincial
steering committees and their technical working groups.
CHANGE
HFG provided technical support to two central MOH
directorates and two DPS in Lualaba and Haut Katanga to
define, operationalize, and build the capacity of these new
organizational structures and to assume their new roles and
responsibilities under decentralization. HFG also conducted
targeted institutional strengthening for other national
level structures including the Kinshasa School of Public
Health (KSPH), the Faculty of Medicine in the University of
Kinshasa, MOH General Health Inspectorate, Directorate
for the Fight Against Disease, National Reproductive Health
Program, National TB Program, and the National Reference
Hospital in Kinshasa.
As a result of this technical support, the organizational
foundation is now in place for two of the eight central
directorates, and MOH staff are more aware of the reforms.
The two DPS of Lualaba and Haut-Katanga are established
and carrying out their core functions, although further
institutional strengthening is needed for these bodies to
perform at a high level.The process for developing the
strategic and annual operational plan consistent with the
budget cycle is in place. Critical governance structures
including the Provincial Steering Committee and its working
groups are functioning. In Lualaba DPS, the single contract
and the quarterly performance reviews have resulted in a
transparent process of assessing DPS performance.
HFG has demonstrated a model for institutional capacity
building that can be replicated across DRC’s other 23
provinces and other six central directorates. In fact, in the
final year of the HFG project, replication had already started
with two other central directorates and two disease-based
programs asking for additional HFG assistance. HFG’s
efforts have clearly generated a demand for institutional
capacity building using an organizational development
approach. The MOH now has a greater appreciation for the
type of institutional capacity building needed to continue
implementing the reform.
In addition, KSPH now has the tools in place for a
financial management system that meets the criteria for
receiving funds directly from the United States Agency for
International Development (USAID).
HFG OVERVIEW IN DRC
4. HFG DRC FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012–2018)4
“The approach to start with an organizational analysis and the
implementation of the resulting capacity building plan to address the
weaknesses and highlight the strengths was appreciated.What has
made the Directorate successful is the support in the development of
the Strategic Plan and the implementation of some activities in the
operational plans, such as the human resources procedures manual
used by all the structures of the Ministry of Health.”
- Epiphane Ngumbu, Director, DRH
MAKING A DIFFERENCE
RESULT AREA 1.
Directorate of Human Resources and Directorate for the
Organization and Management of Healthcare Services better
able to Carry out Core Functions
At the central level, USAID requested HFG to focus on
strengthening the institutional capacity of the Directorate
of Human Resources (DRH) and the Directorate for the
Organization and Management of Healthcare Services
(DOGSS). DRH is responsible for the development of human
resources policies and guidelines and to assist the DPS in
their use. The DOGSS is responsible for the development of
policies, strategies, guidelines, and norms for the functioning
and management of health care services and for assisting the
DPS in their implementation.
To achieve this result, HFG conducted an institutional
assessment of DRH in 2015 to identify performance gaps.
Based on the results, HFG developed institutional strengthening
plans to improve the operational capabilities of the two
directorates in line with the reform.The capacity strengthening
plans identified a range of interventions needed to strengthen
each directorate.Text Box 1 provides an illustrative list of the
key interventions that were implemented.
To comply with the Ministry of Civil Service’s human
resource management standards, HFG facilitated a process
that resulted in an organizational framework that defined
the roles and responsibilities of each unit in DRH that
provided the basis for developing job descriptions for
each job/position defined in the framework.As the final
step in the process, HFG organized a workshop, chaired
by the Secretary General of Health and attended by all
central directors, to officially validate the changes in the
organizational framework.This resulted in recommendations
that were transmitted to the Joint Commission established
by the ministers of Civil Service and Health for the purpose
of reaching agreement on the revised framework of the
central MOH administration.
Without the formal endorsement of the framework and
employee reference document, the formal restructuring
could not go forward.The development of the employment
reference system for the Human Resources Directorate
was such a huge success that other central directorates—
including the General Health Secretariat, the General
Directorate for the Fight against Disease, and the General
Health Inspectorate—requested a similar exercise.
Illustrative Interventions
• Leadership and management training
• Team building
• Development of five-year strategic plan
and one-year operational plans
• Training in results-based management
• Design of new organizational structure
• Development of employee reference
document (i.e., job descriptions)
• Training of trainers
• Strengthen ICT capacity
6. HFG DRC FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012–2018)6
RESULT AREA 2.
Provincial Health Divisions of Haut Katanga and Lualaba are in Place
and Functioning
In 2015, the former DPS system based on 11 provinces
was still in place and staff had not been named to the new
DPS. They were in effect start-up organizations. Under
the reform, the DPS have significantly increased roles and
responsibilities for the planning, management, and delivery of
health programs and services.
In April 2016, HFG conducted a survey of the two DPS
and their respective health zones to better understand
their expectations and to identify priority governance and
management problems at the provincial and health zone levels.
The institutional analysis, performed with USAID’s Participatory
Institutional Capacity Assessment and Learning (PICAL) index,
confirmed the weaknesses of these emerging structures and
the threats and opportunities resulting from the reform.
To address these challenges and place the DPS on a firm
organizational foundation, HFG supported a range of
activities including training in leadership and management,
team building, change management, coaching, results-based
management, financial management, and the provision of
computers and furniture. HFG also built DPS capacity in
using MOH systems and procedures needed to operate
in a decentralized system.These interventions included
the development of Provincial Health Development Plans
aligned with the National Health Development Plan for
2016-2020 and annual operational plans in 2016, 2017, and
2018; strengthening DPS capacity to supervise and monitor
performance of the health zones; and training in primary
health care management.
HFG provided ongoing technical support through a
combination of trainings, coaching, and workshops for DPS
managers and the procurement of IT equipment.The table
below shows the progress made in selected dimensions as
evidenced by the baseline institutional assessment in 2016
in Lualaba and a second assessment in 2017. Scoring is on a
scale from zero to five with five representing the highest.
As the table on the next page shows, leadership and
management have improved due to the application of
skills learned in HFG training courses.The delegation of
skills and tasks is becoming standard procedure, and the
planning process is more inclusive and involves the various
DPS offices and stakeholders.Active listening and feedback
have become common in the DPS, and the engagement
of stakeholders is evidenced by the regular meetings
convened by the DPS and partners management teams.
In a stocktaking exercise at the end of the HFG activity
to determine lessons learned, a sampling of health zones
reported that the DPS were providing much improved
assistance and in turn the DPS reported improved
performance in the health zones, citing financial management
and planning as two areas of improvement.The coordination
system has improved significantly due to the meetings of
the Health Sector Provincial Steering Committees (CPP-
SS), during which partners freely give their opinions and
perceptions on the operation of the DPS.
“The Lualaba DPS has made noticeable steps, starting from a top-down
organization to an organization more and more open and which builds
bridges with structures to which it is attached, including my Ministry.
I have noticed improvement in communication and increasingly shared
leadership (delegation, team work based on clarified roles).These are
all qualitative results of the partnership with HFG that I recognize and
for which I say thank you.” ”
- Samy KAYOMBO, Provincial Minister of Health and Education, Lualaba
7. HFG DRC FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012–2018) 7
Decentralization of the strategic and
operational planning process and the
development of the 2018 budget by
the provincial polyvalent supervisors
without any support by experts at the
national level
HFG supported the DPS in the development of the 2016-
2020 Provincial Health Development Plan aligned with
the 2016-2020 National Health Development Plan and
the Annual Operational Plans (AOPs). In the first-year,
national supervisors had to visit the DPS to brief and/
or train the provincial polyvalent supervisors (EPPs) on
the planning tools and, after this briefing and/or training,
the national supervisors helped the EPPs develop the
AOPs of the health zones and consolidate all the AOPs
into a provincial plan.After three years of support and
supervision for this strategic and operational planning
exercise, the EPPs developed the 2018 AOP without the
support of central level experts.
Integration of specialized, vertical
programs into the DPS structure
In an effort to rationalize vertical programs and allow the
DPS to effectively fulfill their mandates, the MOH wanted to
consolidate and integrate 52 specialized programs into the
central directorates and transfer the functions of the provincial
coordinators of these programs into the DPS structure.
“With the support of HFG, the DPS is now more functional, especially
with the partner coordination meeting, the signing of the decree for
the Provincial Steering Committee, which is an important governance
body at the provincial level, the establishment of thematic groups, the
improvement of the planning process, which is now done on time, and
finally the process of drawing up the single contract.All these elements
are assets that could not be achieved without the support of HFG.”
- Dr. ErickTshikamba, Provincial Monitoring and Evaluation Advisor, Measure Evaluation
DIMENSION 2016 2017
ADMINISTRATIVE CAPACITY
Leadership 2 3
Roles and responsibilities 2 3
Communications and reporting 2 3
Physical space and equipment 1 2
ORGANIZATION LEARNING
Leadership in capacity building 2 3
Organization planning 2 3
Evaluation and learning 2 3
SYSTEM STRENGTHENING
Resource mobilization 2 2
Logistical systems 1 3
Information sharing 2 3
DEMAND FOR ORGANIZATIONAL PERFORMANCE
Internal accountability 2 3
Inclusion 2 3
Transparency 2 2
Understanding the mandate 3 4
RESULTS OF INSTITUTIONAL ANALYSIS IN LUALABA IN 2016 AND 2017
8. HFG DRC FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012–2018)8
RESULT AREA 3.
Improved Understanding of Basic Principles of Health
Sector Decentralization
Senior MOH staff are regularly called upon to make
decisions relating to the decentralization process, yet many
have never been trained in the basic principles and concepts
underlying decentralization including how to make it work
in practice.To address this knowledge gap, USAID asked
HFG to support the development and delivery of a course
on decentralization for high level MOH and provincial staff.
HFG worked through the KSPH to plan and deliver the
course with the aim of institutionalizing it within KSPH.
USAID also requested that HFG engage an international
decentralization expert to work with KSPH in designing and
delivering the course.
The one-week course focused on understanding and
using the following basic principles of decentralization: the
analytical framework of decision space; the identification of
challenges and obstacles in the implementation of laws and
regulations related to decentralization; analysis of funding
mechanisms; HRH within the context of decentralization;
development of institutional capacity; and decentralization
policies.This course was delivered three times from 2016
to 2018, the first two courses with the assistance of the
external expert and the third successfully delivered by
KSPH without external assistance, thus institutionalizing the
capacity to deliver the course.
Virtually all senior health staff at the central and provincial
levels, approximately 180 officials, have attended the course.
The end-of-course evaluations were extremely positive
and showed the participants’ deep interest in the course.
Participants appreciated the exposure to different
decentralization approaches, identified the challenges they
are facing, and discussed the gap between the expectations
tied to decentralization and the actual state of progress. The
overarching result of this training is a common framework
for discussing and ultimately reaching agreement among
national and provincial decision makers on various aspects
of decentralization.
HFG in partnership with the Directorate of Disease
Control assisted in the development of the Integration
Roadmap for the two DPS.The ultimate goal was to
systematically integrate the three functions carried out
by the coordinators of the specialized programs into the
DPS. Namely, these functions are: technical support of
the health zones, management of resources, and health
information. The Roadmap highlighted the specific activities
to be carried out jointly with the provincial coordinators:
(1) the development of AOPs and their adoption by the
CPP-SS; (2) the creation of integration subgroups within
existing working groups and the development of their
terms of reference; (3) the establishment of a pool of EPPs;
(4) the strengthening of the capabilities of the EPPs to
assume responsibility for the specialized programs; and (5)
joint technical oversight of the health zones. In 2017 and
2018, HFG and the central MOH evaluated progress in the
implementation of the roadmap. While more remains to be
done, the evaluation showed that the specialized programs
are now better integrated into the DPS AOPs, that a pool
of EPPs has been created and trained, that joint missions to
the health zones are taking place, and that quarterly reviews
happen regularly. At the same time, the evaluation indicates
that the complete integration of these vertical programs will
take time. The Disease Control Directorate has asked the
General Secretariat of Health to adopt the process used in
the two Haut Katanga and Lualaba DPS as a model for the
integration of specialized programs.
Development of the Provincial Steering
Committee
The CPP-SS is an intra-sectoral and cross-sectoral
consultation structure, whose mission is to coordinate the
development of the Provincial Health Development Plan
and to monitor the implementation of national policies and
strategies while ensuring the alignment of the interventions
carried out in the provinces. HFG provided financial and
organizational support for the validation and adoption of the
AOPs of the two DPS during these meetings for the period
2015-2018.
HFG also supported the CPP-SS Working Groups, which
serve to review documents and technical tools and to prepare
periodic reports on activities.Working Groups have been
major contributors in the organization of the CPP-SS in their
preparation of all the issues and questions on the agenda.
HFG financed the meetings of three Working Groups in each
DPS to ensure the success of the meetings of the CPP-SS, in
which the governor (as chair), provincial ministers, and the
technical and financial partners all participate.
10. HFG DRC FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012–2018)10
SUSTAINABILITY
The institutional improvements described in this report have
had a significant impact on the reform process.The results
of a second institutional assessment indicate that the Human
Resources Directorate and both provincial health divisions
have much enhanced capacity to carry out their core functions
under a decentralized system. These operating units have a
defined organizational framework, strategic and operational
plans, more clearly defined roles and responsibilities, improved
internal management, strengthened capacity in key areas,
and some modest but improved capacity in information and
communication technology (ICT).
Equally important, the MOH currently has models and
examples for institutional improvement that can be used to
strengthen other central directorates and other provinces.
HFG has demonstrated the usefulness of the PICAL tool
for institutional assessment and for developing capacity
LOOKING FORWARD
RESULT AREA 5.
Strengthened Financial Management Capabilities ofThe Kinshasa
School of Public Health.
KSPH is the premier school of public health in the DRC,
created with funding from the Government of the United
States of America. It is part of the University of Kinshasa and
operates autonomously under the umbrella of the Faculty of
Medicine. In addition to the core academic programs, KSPH
currently has 18 research projects that operate under the
KSPH umbrella but have traditionally managed their own
finances independently. KSPH, a partner for USAID, has
struggled to establish strong financial management practices,
which are essential in order to qualify for direct USAID funding.
At the start of HFG’s work, KSPH’s weaknesses in financial
management included the lack of a functioning automated
accounting system, lack of regular financial reporting, and
inadequate staff capacity in the Finance Department.The full
support of the KSPH Management Committee as well as the
academic faculty would be necessary to address these challenges.
HFG initiated the activity by conducting an assessment
of KSPH financial management capacity using the
Organizational Capacity Assessment Tool and developing a
capacity strengthening plan. Over a three-year period, HFG
implemented the plan with periodic adjustments and KSPH
has achieved the following noteworthy results.
1. Updated financial procedures manual based on the
OHADA chart of accounts for use by the core academic
programs and all research projects.All accounting staff
participated in the updating of the financial procedures
manual to assure understanding and buy-in.
2. Obtained 24 licenses for using the accounting
software Quick Books, training all accounting staff
in its use. KSPH now uses Quick Books throughout
the school with a noticeable improvement in financial
reporting.
3. Consolidated the accounting system covering all
management units of the school.
4. Produced regular monthly, year-end financial reports,
and annual budgets.
5. Produced the financial information needed to
determine the indirect cost rate. KSPH is now using
this indirect cost rate in developing budgets for
donor-funded projects.
6. Strengthened the finance team by hiring two
additional people – a Finance Officer and an Internal
Auditor – in addition to the three previous members.
HFG assisted in the development of the terms
of reference for these two positions and in the
recruitment process.
Going forward, KSPH has the tools in place for an effective
financial management system.The key to sustaining these
gains is the unwavering and strong support from the KSPH
five-person management committee.
“Without the support of HFG, the implementation of the reform risked
being thrown off course by turbulences.The support of HFG allowed for
a smooth landing of the reform.”
- Mbombo Kabantu Marie Louise, Director, Directorate of Health Care Facilities
11. HFG DRC FINAL REPORT | HEALTH FINANCE AND GOVERNANCE PROJECT (2012–2018) 11
LESSONS LEARNED
• Demand for institutional capacity building is
a pre-condition for success. In the DRC, both
USAID and the MOH strongly supported institutional
capacity building from the beginning despite some
initial resistance in the MOH. However, as HFG
worked with the staff of the client institutions and built
credibility, the staff became highly supportive. Energy
and enthusiasm for institutional capacity building
activities were high throughout the HFG activity. It
is obvious that the needs differ among organizations,
but the extension of the practice of institutional
analysis helps to reduce this resistance and leads to
the establishment, especially at the central level, of a
collective understanding of the organization’s needs.
• Aligning institutional capacity building efforts
with MSP priorities, systems, and processes is
likely to result in increased ownership. One of
the hallmarks of HFG’s approach was to align activities
carefully with MOH priorities and processes and use
MOH resources to the maximum extent possible. For
example, when HFG asked the provinces to develop
annual operating plans, central MOH staff familiar
with the process and templates facilitated the planning
process. In a number of technical areas, such as results-
based management and financial management, HFG
used MOH staff to conduct training on these topics to
ensure that MOH procedures were the basis for the
content. HFG worked through MOH in all activities to
bring about this alignment.
• An institutional capacity building approach
grounded in the principles and practice of
organizational development can be highly
effective in bringing about improvements and
lasting change. From the beginning, HFG grounded
the approach in the principles of organizational
development.This meant using a systematic approach
to conduct institutional assessments and using the
findings to develop capacity strengthening plans. In
addition, the approach required constant engagement
with the client organization and a comprehensive
view of what it takes to be a functioning organization.
Principles of functional organizations include a defined
mandate, a strategy, clear organizational structure,
clearly defined roles and responsibilities, sound internal
leadership management, and skills for working in
teams. HFG was fortunate to have identified a number
of skilled Congolese organizational development
consultants to put these principles into action.
• A systems approach in which the national,
provincial, and health zone levels are
strengthened simultaneously is effective.
Decentralization is inherently a systems activity that
requires working on all levels and across ministries,
especially the Civil Service Ministry, the Ministry of
State and Decentralization, and the Ministry of Higher
Education.The Civil Service Ministry was a particularly
important stakeholder because it had to approve the
organizational framework and engaged in a number of
HFG activities.
• Institutional capacity building requires a multi-
year time horizon. In the case of DRH and the two
DPS, HFG had time to make noticeable improvements. In
the case of the DOGSS, delays in approving the revised
organizational framework and selecting senior leaders
were challenges to making progress on institutional
strengthening. In the last two years of the HFG activity,
HFG conducted limited but useful institutional capacity
building with five other organizations. Bringing about
required changes requires follow-up.
• PICAL offers great promise as a standard
methodology for measuring institutional
performance. The results from an assessment using
PICAL were well accepted by the client organizations.
The results will become more powerful over time
as stakeholders repeat the assessments at regular
intervals, annually or bi-annually.
strengthening plans as well as extensive documentation for
specific capacity strengthening interventions.
The demand for institutional strengthening has increased
since HFG initiated technical assistance activities in 2015
as evidenced by requests for HFG assistance from other
directorates and the level of interest by senior MOH
officials. The MOH’s ownership of the HFG activity bodes
well for the sustainability of HFG’s efforts.This ownership
is due to a number of factors. First, HFG worked in a
highly collaborative way and aligned its support to MOH
priorities and processes. Second, HFG took a systems
approach by taking into account the three levels of the
health pyramid – national, provincial, and health zone –
and working with other central agencies such as the Civil
Service Ministry in the development of employee reference
documents.Third, HFG called upon central MOH staff, to
jointly implement activities to ensure the link between
central processes and guidelines and strengthening at
the provincial level. MOH staff served as trainers and
coaches on numerous activities. Finally, HFG developed and
distributed materials that other directorates and provinces
can use to replicate interventions.
The capacity strengthening process is far from finished.
While both central directorates and both DPS have made
significant progress, all organizations require additional
support. Foundational institutional capacity building requires
adequate time (usually three to five years of sustained
support) to ensure sustainability.This is especially true
in a weak institutional setting in a resource constrained
environment as is the case in DRC.
11