Developing Recommendations

After you have summarized findings for your module (as in Section 6.4.1 above), it is now time to synthesize findings across modules and develop recommendations for health systems

interventions. Phase 2 of Chapter 4 suggests an approach for doing this with your team. In this section, we discuss a list of common interventions seen in the area of governance that you may find helpful to consider in developing your recommendations.

A. Information/Assessment Capacity

Data quality or reliability may be poor or data reporting may not be timely because of (1) a lack of capacity or incentive for peripheral units to report data, (2) a lack of resources or capacity to process the data at the national level, or both. Interventions may be required at various levels, including building capacity and demonstrating the applicability of data use at the peripheral level, building capacity of data analysts at the national level, improving information system technology, and providing technical assistance to improve the efficiency and user-friendliness of data reporting formats, according to different audiences.

If data are not sought or used by policy makers, capacity building of policy makers through in-country workshops, one-on-one coaching, and visits or study tours to other countries with highly developed processes for data use for decision-making may be indicated.

Remember to coordinate recommendations in this area with those being developed under the Health Information System Module (Chapter 11).

B. Policy Formulation and Planning

If MOH planning capacity is weak, consider structural changes in the MOH (e.g., creation of a new planning entity, elevation of the planning entity in the organization, or creation of new job titles and job descriptions for key planning personnel) and capacity building of key planning personnel.

If coordination or communication between the executive branch and the legislature (e.g., the Parliamentary Health Committee) is weak or nonexistent, consider creating an ad-hoc inter­

governmental committee with strong leadership to establish dialogue among branches of government. Consultation with project staff of any general governance project that may be present in-country can be useful in identifying interventions that have been successful in other sectors.

If donor coordination is weak, consider helping establish a donor coordination committee and providing support for setting up and helping the committee to begin to function effectively for an initial period until it is generally recognized as being useful and therefore becomes

self-sustainable.

If coordination and dialogue with the private sector is weak or sporadic, consider establishing committees or consultative working groups to bring private sector representatives together for purposes of soliciting inputs on their concerns, such as regulations, taxation, business

opportunities, and potential barriers to private participation in the health sector.

C. Social Participation and System Responsiveness

If civil society participation is weak or absent, assistance may be needed to help in the formation or strengthening of professional organizations and advocacy and watchdog groups (including consumer defense bodies) through establishment of organizational development grant programs, which may be either donor funded or funded by a combination of donor, government, and civil society resources.

If stigmatized groups (such as organizations of people living with HIV/AIDS) are excluded from the health policy dialogue or if the government is not responding to citizen input, special

provisions may be introduced, such as establishing new bylaws for inclusion of these groups in intergovernmental committees and other organizations. Donor organizations can be helpful in identifying such gaps and writing requirements for inclusiveness for countries to qualify for donor funding (vis-à-vis the Global Fund to Fight AIDS, Tuberculosis and Malaria, and requirement for involvement of civil society groups in the Country Coordinating Mechanism).

Citizen participation in the definition of health needs and services can also be encouraged through citizen participation in referendums that allow civil society to select their priority health issues. Such participation is most productive if health officials have agreed, in advance, to incorporate community health priorities into their planning and budgetary process.

D. Accountability

If public documents are not being published or disseminated, assistance may be needed to bring this problem to the attention of policy makers and to help identify sources of funding to ensure that information regarding patient rights, fee schedules, health entitlements, and other issues is made available to the general public.

If the press is not covering important health policy issues, media training and establishment of media liaisons in key positions should be considered.

E. Regulation

If conflicting legislation exists, technical assistance may be useful in pinpointing inconsistencies and formulating clarification.

If regulatory agencies lack resources to enforce legislation or regulations, help may be needed to identify funding sources, beginning with reallocation of MOH resources, to ensure proper enforcement of safety and quality standards.

If no system exists for accrediting health professionals, technical assistance to develop accreditation bodies, standards, and processes should be considered.

Address regulatory and business constraints that impact private sector participation in health sector delivery, such as accreditation, provider regulations, uneven enforcement of provider regulations, taxes and import duties, formation of group practices, restrictions on advertising or promotion of products, user fees, and contracting out of MOH services.

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7.1 Overview

7.1.1 Chapter Outline

This chapter presents the health financing module of the assessment tool. Section 7.1 defines health financing and its key components and describes the process of resource flows in a health system. Section 7.2 provides guidelines on preparing a profile of health financing for the country of interest, including instructions on how to customize the profile for country-specific aspects of the financing process. Section 7.3 presents the indicator-based part of the assessment. Section 7.4 provides guidance on how to synthesize your findings and presents suggestions for possible solutions to the most common problems in health system financing.