Health System Development
Programme
2006-2011
Objectives
1. To promote utilization of health systems research
to improve health systems performance by
enhancing research culture among decision
makers at all level
2. To explore and develop an appropriate and
sustainable financing mechanism for fair
financing of health and equitable delivery of
services
3. To expand and strengthen international cooperation in line with the 30 year long term
health plan by collaborative activities
Project
1. Health Systems Research and Development
Project
2. Developing Alternative Financing Mechanisms
for Health Project
3. International Health Cooperation Project
Health System Research and Development Project
Developing Alternative Financing Mechanism for
Health Project
International Health Cooperation Project
Strength
Health System Research
• Able to disseminate knowledge and skills on heath systems
concepts and health systems research (HSR) methodology to
health managers who provide services to the community.
• Able to develop user friendly HSR tools for health system
strengthening, assessments and quality improvements
•

HSR studies can provide technical know-how for health
systems strengthening, assessment and quality improvements.
Strength
Health Financing
• Health financing assessment and development of new scheme
was initiated in collaboration with WHO Consultants
• Interest of all stake holders and donors after implementing
awareness raising workshops at township level
• Attention of the international donors based on publication of
National Health Accounts and health financing studies
• Appropriate health manpower (Health Economists) posted in
the planning division but still limited number
Weakness
Health System Research
1. There has no financial support for HSR studies conducted by
mid-level health managers.
2. There has weaknesses in dissemination of information to the
higher level health authority to take action based on HSR
findings.
Weakness
Health Financing
1. Poor advocacy to high level policy making body on health
financing situation
2. Lack of interest of decision maker on health financing situation
3. Limited number of skilled health manpower especially health
economists
4. Lack of skilled staff on financing and budgeting in the township
health system
5. No or limited community awareness on health financing issues
6. Current health financing and costing research is not covered all
the area and need more research on alternative health financing
and efficient utilization of limited resources
7. Need more partners on implementing new financing scheme
Requirements to be fulfilled for achieving targets
Health System Research
1. Dedication by project personnel, knowledge, experiences and
skills on research management obtained by actual
implementation of the project contribute achievements of the
targets.
2. Political supports and guidance from Departmental Head, sharing
and discussion of experiences on project implementation among
technical colleagues were contributions for the achievements
3. Close collaboration and coordination with health and health
related departments such as Department of Health, Department
of Medical Sciences, General Administration Department , Central
Statistical Organization, national and international NGOs were the
contributors for achievement
Requirements to be fulfilled for achieving targets
Health Financing
1. High level advocacy meeting on current health financing situation and
options for protecting the poor achieving Universal Coverage
2. Capacity building in the area of health economics to mid level officers
3. Feasibility studies on development of new health financing methods
should be explored
4. Financial management and mobilization of funds in township health
system should be extended to more townships
5. Connecting with more partners on solving the problem of waiving the
poor and vulnerable (technical as well as financial)
6. Awareness raising of community through implementing new
financing scheme in the pilot area (knowing by doing)
7. More research on costing, cost effectiveness for assisting the decision
making (improving efficiency)
Other comments
Health Financing
• Providing more knowledge on advantage of health insurance
especially in the area of fund pooling and risk pooling among the
solidarity group to all levels
• Awareness raising of other countries’ experiences on health financing
situation among different regions of WHO
Health system development2
Health system development2
1.

Identify key barriers / bottlenecks to increase
sustained coverage which are beyond the control of the
service delivery system
HRH shortages,
Distribution,
Quality, motivation etc.
Transport to reach the ‘hard to reach’ (especially for outreach)
Affordability and fund flow issues especially to district level
Infrastructure at periphery,
Logistics
Management monitoring & supervision
Coordination with and between partners

2. Identify what causes lead to these problems
problem analysis

3. Identify how to overcome them
formulate your objectives
identify interventions
At what level are the performance
constraints & bottlenecks?
SYSTEM LEVEL

Policy & sector
analysis: PHC,
PRSP, MDGS

PROGRAM LEVEL

Strategy analysis:
RED, MPA, demand
vs. supply driven

OPERATIONAL
LEVEL

Needs analysis
HR: skills, skills mix,
retention
Capital: stores,
equipment, vehicles
Capacity building
Strengthening interventions
UNICEF
CCM

ISS

GF

Drug
Supply &
Quality

Logistics

Service delivery
3DF

INGOs

Surveillance

Advocacy &
Communication

WHO

NHSC

UNFPA
Strengthening Systems

MoF,
World Bank,
UNICEF

GAVI
HSS

Gov’T,
UNDP,
MNPED
Drug Supply &
Quality

Logistics

HSS

Service delivery

HSS
UNICEF
PRSP

Surveillance

Advocacy &
Communication

SWAp
Policy space

ACCESS

EQUITY
Drug Supply &
Quality

Logistics

Service delivery
Surveillance

STEWARDSHIP

Advocacy &
Communication

PRO-POOR
Strategic Framework: An example from DPRK
NATIONAL DEVELOPMENT PRIORITIES, LAW AND INTERNATIONAL AGREEMENTS
MEDIUM TERM DEVELOPMENT PLAN FOR THE HEALTH SECTOR IN DPRK
S
Y
S
T
E
M

STRATEGIC
AREA 1

STRATEGIC
AREA 2

STRATEGIC
AREA 3

STRATEGIC
AREA 4

Health System

Non
Communicable
Disease

Communicable
Disease

Women’s and
Children Health

(1)Policy, Planning &
Coordination
(2) Health
Information
(3) Human Resources
(4) Drug Supply &
Logistics Systems
(5) Financing &
Financial
management
(6) Service Delivery
Systems
(7) Science &
technology
(8) Community
participation

(1) Chronic Diseases
(2) Injury
(3) Mental health
(4) Aged care &
Disability
(5) Tobacco Control

(1) Immunization
(2) Malaria
(3) TB,
(4) HIV,
(5) Hepatitis B
treatment
(6) Pandemic
Planning and
emerging diseases

(1) Maternal Health
(2) Neo natal Health
(3) Reproductive
Health
(4) Child Health
(5) Nutrition
(6) Adolescent Health

STRATEGIC AREA 5
The Social and Environmental Determinants of Health
(1) Food Safety (2) Health & Hygiene promotion (3) Climate Change (4)
Safe water & Sanitation (5) Health Life Conditions (6) Emergency
preparedness
MULTI SECTOR AND SOCIETY

Health Outcomes and MDG Goals

P
R
O
G
R
A
M
S
Links Between Objectives and Actions
STRATEGIC AREA 1
HEALTH SYSTEM OBJECTIVE

Planning
Sub
Objective
Strategic
Approach

HR Sub
Objective
Strategic
Approach

Finance Sub
Objective
Strategic
Approach

Essential
Medicine Sub
Objective
Strategic
Approach

5 priority actions for each sub objective

Service
Delivery Sub
Objective
Strategic
Approach

Community
Participation
Sub Objective
Strategic
Approach

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Health system development2

  • 2. Objectives 1. To promote utilization of health systems research to improve health systems performance by enhancing research culture among decision makers at all level 2. To explore and develop an appropriate and sustainable financing mechanism for fair financing of health and equitable delivery of services 3. To expand and strengthen international cooperation in line with the 30 year long term health plan by collaborative activities
  • 3. Project 1. Health Systems Research and Development Project 2. Developing Alternative Financing Mechanisms for Health Project 3. International Health Cooperation Project
  • 4. Health System Research and Development Project
  • 5. Developing Alternative Financing Mechanism for Health Project
  • 7. Strength Health System Research • Able to disseminate knowledge and skills on heath systems concepts and health systems research (HSR) methodology to health managers who provide services to the community. • Able to develop user friendly HSR tools for health system strengthening, assessments and quality improvements • HSR studies can provide technical know-how for health systems strengthening, assessment and quality improvements.
  • 8. Strength Health Financing • Health financing assessment and development of new scheme was initiated in collaboration with WHO Consultants • Interest of all stake holders and donors after implementing awareness raising workshops at township level • Attention of the international donors based on publication of National Health Accounts and health financing studies • Appropriate health manpower (Health Economists) posted in the planning division but still limited number
  • 9. Weakness Health System Research 1. There has no financial support for HSR studies conducted by mid-level health managers. 2. There has weaknesses in dissemination of information to the higher level health authority to take action based on HSR findings.
  • 10. Weakness Health Financing 1. Poor advocacy to high level policy making body on health financing situation 2. Lack of interest of decision maker on health financing situation 3. Limited number of skilled health manpower especially health economists 4. Lack of skilled staff on financing and budgeting in the township health system 5. No or limited community awareness on health financing issues 6. Current health financing and costing research is not covered all the area and need more research on alternative health financing and efficient utilization of limited resources 7. Need more partners on implementing new financing scheme
  • 11. Requirements to be fulfilled for achieving targets Health System Research 1. Dedication by project personnel, knowledge, experiences and skills on research management obtained by actual implementation of the project contribute achievements of the targets. 2. Political supports and guidance from Departmental Head, sharing and discussion of experiences on project implementation among technical colleagues were contributions for the achievements 3. Close collaboration and coordination with health and health related departments such as Department of Health, Department of Medical Sciences, General Administration Department , Central Statistical Organization, national and international NGOs were the contributors for achievement
  • 12. Requirements to be fulfilled for achieving targets Health Financing 1. High level advocacy meeting on current health financing situation and options for protecting the poor achieving Universal Coverage 2. Capacity building in the area of health economics to mid level officers 3. Feasibility studies on development of new health financing methods should be explored 4. Financial management and mobilization of funds in township health system should be extended to more townships 5. Connecting with more partners on solving the problem of waiving the poor and vulnerable (technical as well as financial) 6. Awareness raising of community through implementing new financing scheme in the pilot area (knowing by doing) 7. More research on costing, cost effectiveness for assisting the decision making (improving efficiency)
  • 13. Other comments Health Financing • Providing more knowledge on advantage of health insurance especially in the area of fund pooling and risk pooling among the solidarity group to all levels • Awareness raising of other countries’ experiences on health financing situation among different regions of WHO
  • 16. 1. Identify key barriers / bottlenecks to increase sustained coverage which are beyond the control of the service delivery system HRH shortages, Distribution, Quality, motivation etc. Transport to reach the ‘hard to reach’ (especially for outreach) Affordability and fund flow issues especially to district level Infrastructure at periphery, Logistics Management monitoring & supervision Coordination with and between partners 2. Identify what causes lead to these problems problem analysis 3. Identify how to overcome them formulate your objectives identify interventions
  • 17. At what level are the performance constraints & bottlenecks? SYSTEM LEVEL Policy & sector analysis: PHC, PRSP, MDGS PROGRAM LEVEL Strategy analysis: RED, MPA, demand vs. supply driven OPERATIONAL LEVEL Needs analysis HR: skills, skills mix, retention Capital: stores, equipment, vehicles Capacity building
  • 18. Strengthening interventions UNICEF CCM ISS GF Drug Supply & Quality Logistics Service delivery 3DF INGOs Surveillance Advocacy & Communication WHO NHSC UNFPA
  • 19. Strengthening Systems MoF, World Bank, UNICEF GAVI HSS Gov’T, UNDP, MNPED Drug Supply & Quality Logistics HSS Service delivery HSS UNICEF PRSP Surveillance Advocacy & Communication SWAp
  • 20. Policy space ACCESS EQUITY Drug Supply & Quality Logistics Service delivery Surveillance STEWARDSHIP Advocacy & Communication PRO-POOR
  • 21. Strategic Framework: An example from DPRK NATIONAL DEVELOPMENT PRIORITIES, LAW AND INTERNATIONAL AGREEMENTS MEDIUM TERM DEVELOPMENT PLAN FOR THE HEALTH SECTOR IN DPRK S Y S T E M STRATEGIC AREA 1 STRATEGIC AREA 2 STRATEGIC AREA 3 STRATEGIC AREA 4 Health System Non Communicable Disease Communicable Disease Women’s and Children Health (1)Policy, Planning & Coordination (2) Health Information (3) Human Resources (4) Drug Supply & Logistics Systems (5) Financing & Financial management (6) Service Delivery Systems (7) Science & technology (8) Community participation (1) Chronic Diseases (2) Injury (3) Mental health (4) Aged care & Disability (5) Tobacco Control (1) Immunization (2) Malaria (3) TB, (4) HIV, (5) Hepatitis B treatment (6) Pandemic Planning and emerging diseases (1) Maternal Health (2) Neo natal Health (3) Reproductive Health (4) Child Health (5) Nutrition (6) Adolescent Health STRATEGIC AREA 5 The Social and Environmental Determinants of Health (1) Food Safety (2) Health & Hygiene promotion (3) Climate Change (4) Safe water & Sanitation (5) Health Life Conditions (6) Emergency preparedness MULTI SECTOR AND SOCIETY Health Outcomes and MDG Goals P R O G R A M S
  • 22. Links Between Objectives and Actions STRATEGIC AREA 1 HEALTH SYSTEM OBJECTIVE Planning Sub Objective Strategic Approach HR Sub Objective Strategic Approach Finance Sub Objective Strategic Approach Essential Medicine Sub Objective Strategic Approach 5 priority actions for each sub objective Service Delivery Sub Objective Strategic Approach Community Participation Sub Objective Strategic Approach

Editor's Notes

  • #5: W/s on Health systems Research Methodology for Post -Graduate Students from Medical University 2006-2007 IM (1)Ygn, IM(2) Ygn, IM Mdy (430) Participants 2008-2009 IM (1)Ygn, IM(2) Ygn, IM Mdy (639) Participants 2010-2011 IM (1)Ygn, IM(2) Ygn, IM Mdy (350) Participants Training in Research Methodology and Research Management for Health Staff working in S/D 2006-2007 Sagaing, Bago(West), Magwe (78) Participants 2008-2009 Mon, Shan (South) (60) Participants User-friendly HSR tools Quality Assessment on Care of STI Patients Collecting Mortality data among the Community by Verbal Autopsy Method Facility Based Verification of Cause of Death by Hospital Record Examination Service Availability Mapping(SAM) for a Township HSR Studies Community Based Injury Survey Pilot Implementation of verification of Cause of Death with Verbal Autopsy in Pyinmana Tsp. Facility Based verification of Cause of Death by Hospital Record Examination Study on Independent Evaluation of Completeness and Coverage of Mortality Data in Urban Areas of Myanmar
  • #6: Workshop on Health Financing: Workshop on Exploring Mechanism for Financing Health in Myanmar, 2006 Workshop on National Health Accounts, 2007 Workshop on Awareness raising and Capacity Building on Measuring Costs and Effects of Health Intervention and Estimating Economic Consequences of Illness, 2009 Training for financial management: Training Workshop on Financial Planning and Management in Health, Mandalay, 2007 Training Workshop on Financial Planning and Mobilization of Funds in Township Health System (Le We, Pyawbywe, Tatkone), 2009 Training Workshop on Financial Planning and Mobilization of Funds in Township Health System (Yaetarshae, Wundwin, Myitthar), 2009 Training Workshop on Financial Planning and Mobilization of Funds in Township Health System in Mon State, 2010 Developing National Health Accounts: Myanmar National Health Accounts (2002-2005) Myanmar National Health Accounts (2006-2007) Health Economic and Financing Studies: Health Care Financing Methods and Access to Health Care in Myanmar, 2007 Health Financing Situation in Myanmar: Improving Access to Health Care by poor in Township Hospitals, 2009
  • #16: Service delivery: preventive and curative personal health services; primary, secondary services and tertiary services (public/private/voluntary NGOs) Public health service; services for specific population groups such as children and women, or for specific conditions such as tobacco or alcohol problems Resources: trained staff, commodities, facilities and knowledge Financing: sources of funds such as user fees, insurance, tax,
  • #21: Social dialogue on the policy choices that will set the boundaries for strategic options