After a policy decision has been made, the next key challenge is transforming this stated policy position into practical actions. What strategies, for instance, are available to facilitate effective implementation, and what is known about the effectiveness of such strategies? This article suggests five questions that can be considered by policymakers when implementing a health policy or programme: What are the potential barriers to the successful implementation of a new policy? What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary behavioural changes among healthcare recipients and citizens? What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary behavioural changes in healthcare professionals? What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary organisational changes? What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary systems changes?
Useful Resources
Now in its third phase, the Municipal Services Project (MSP) is exploring and evaluating models of service delivery that are deemed to be successful alternatives to commercialisation, in an effort to understand the conditions required for their sustainability and reproducibility. The focus is on the water, electricity and primary health care sectors in Africa, Asia and Latin America. The project is composed of academic, labour, NGO and social movement partners from around the world. The site features a diversity of publications and materials, from academic journal articles to video and audio documentaries. MSP is an inter-sectoral and inter-regional research project that systematically explores alternatives to the privatisation and commercialisation of service provision in the health, water, sanitation and electricity sectors. Having spent the first two phases of the project (2000-2007) critiquing privatisation, this phase of the project (2008-2013) will analyse service delivery models that are successful alternatives to commercialisation in an effort to better understand the conditions required for their sustainability and reproducibility. The website for the project has been updated and provides new resources on this issue.
It is thirty years since the Alma Ata Declaration which outlined an international consensus on the need to provide universal access to primary health care (PHC). During the ensuing years some countries established and consolidated well-organised government health services in which PHC played an important role. Many others were less successful. Some countries have experienced major reversals in life expectancy after a long period of steady improvement and their health systems have deteriorated. There is a growing concern by national governments and the international community to expand access to PHC and they have committed a lot of money for this purpose. But there have been many major changes in these last three decades that pose big challenges for the future configurations of PHC. This key issues guide unpacks some of the challenges for the future of PHC and highlights promising models of health system arrangement and service delivery that are improving access for the poorest and most marginalised. It focuses on four main areas: the increasing marketisation of health and how governments respond; the challenge of responding to progressive and chronic illnesses; the emergence of new epidemics and the globalisation of public health responses; and the pressure to keep up with new treatments and technologies.
This is an online ten-unit short course on health systems and their functioning. Like organ systems, health systems break down in predictable patterns and lead to syndromes that can be diagnosed and addressed. Dysfunctional health systems are why thousands of effective low-cost health interventions remain on the shelves while people suffer and die. Dysfunctional health systems leave people vulnerable to financial catastrophe. Failure to manage health resources judiciously permits not just waste, but the delivery of inappropriate or harmful services. While many lament how little research addresses the development of ‘new cures’ for the diseases of the poor, the inexcusable tragedy is the world’s failure to deliver affordable and effective ‘old cures’ to treatable and preventable diseases. Diarrhoea, pneumonia, tuberculosis and malaria are all easily and cheaply treatable. Their persistence around the world is a testament to failed health systems more so than a lack of scientific prowess.
The International Budget Partnership (IBP) has released It's our money. Where's it gone?, a new documentary film on the work one of its partners, Muslims for Human Rights (MUHURI), is doing to involve communities directly in monitoring the Constituency Development Fund (CDF) in Mombasa, Kenya. The CDF allocates approximately one million dollars annually to each member of Parliament to spend on development projects in his or her constituency but provides for no meaningful independent oversight. This is the story of ordinary Kenyans stepping in to do something about it. MUHURI uses social audits to involve communities in monitoring and holding their government accountable for managing the public's money and meeting the needs of its people, especially the poor and most vulnerable.
What can be done to ensure that the poorest Africans have access to a healthcare system that charges user fees? A team of researchers from the University of Montreal has produced a thorough compilation of all existing knowledge on this subject in four bilingual policy briefs. The briefs present options that have been shown to promote access to care: abolition of user fees for healthcare services, case-by-case exemptions for the worst-off, health equity funds, and health insurance that includes coverage for the poor. The objective of this project was to give leaders a comprehensive overview of actions that have already been undertaken to evaluate what options are best suited to their context. With the assistance of an international NGO (HELP – Hilfe zur Selbsthilfe e.V.), consultations were carried out in Burkina Faso to strengthen the relevance of these policy briefs. Starting in November, these four documents will be distributed in Burkina Faso as part of a HELP project that will test a trial of user fees abolition.
The World Health Organization (WHO) Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity is currently in the process of updating and expanding its Equity-Oriented Toolkit for Health Technology Assessment (HTA). The toolkit is based on a needs-based model of health technology assessment. It provides tools that explicitly consider health equity at each of the four steps of health technology assessment: burden of illness, community effectiveness, economic evaluation, and knowledge translation and implementation. The Centre has recently received seed funding from the Canadian Institutes of Health Research to update the toolkit via a series of workshops targeting both academics and policy makers. This will allow a debate on the tools to be included – or not – at each step. The Centre is exploring the plausibility of incorporating health impact assessment within the toolkit.
The UK Department for International Development (DFID) works with a wide range of partners from long-term arrangements with partner governments and multilateral organisations to short-term humanitarian aid projects funded through non-governmental organisations. DFID's interest is in ensuring that each is devised and delivered in the most efficient and effective way and links to identified objectives set out in a Divisional Performance Framework or Country/Regional Plan. This guide has been written for DFID project workers and DFID partners, and focuses on helping to make the best use of the Logical Framework (logframe) in designing and managing projects. The new designed format aims to address those weaknesses by encouraging the identification of objectives at the right level, more robust specification of indicators, increased coverage of baseline and target information and better quantification of results. The guide applies to any one involved in the design approval or active use of the logframe and all DFID projects of a value of one million pounds and above. Additional guidance in annexes has been provided to help the reader form a broader picture of what is involved in putting together a logframe.
While written with United Nations Development Programme staff, stakeholders and partners in mind, the handbook provides a useful overview of why and how to evaluate for development results which can be used in other contexts. This handbook concentrates on planning, monitoring and evaluating of results in development and is designed to be used as a reference throughout the programme cycle. The handbook covers the following areas: the integrated nature of planning, monitoring and evaluation, and describes the critical role they play in managing for development results; the conceptual foundations of planning and specific guidance on planning techniques and the preparation of results frameworks that guide monitoring and evaluation; how to plan for monitoring and evaluation before implementing a plan and issues related to monitoring, reporting and review; and an overview of the UNDP evaluation function and the policy framework, including key elements of evaluation design and tools and describe practical steps in managing the evaluation process.
Health Links partnerships have the capacity to make a significant contribution to health system strengthening but only if they are well planned, managed and aligned to needs. Governments and health managers in many countries, including the United Kingdom (UK), Uganda, Malawi, Zambia and Tanzania, are now beginning to look more actively at how these types of partnerships can contribute to health system development in their countries. This manual provides guidance, shares experiences and offers examples of good practice from those directly involved in Links. It aims to help both UK and developing country Link partners to think more strategically about their work. As a reference document for Link partnerships, this manual is aimed at those seeking to form a Link, or already involved in an established Link, such as health professionals, policy makers, health advisors, NGOs and others from the UK or a developing country interested in finding out more about what Links are and what they can offer.