National health planning assessment framework

Essential Characteristics of Effective National Health Plan

Regional Consultation on Strengthening NHPs in SEAR countries 4-6 August 2010

Bali, Indonesia

National Health Planning

Group of health planners Health planning becomein 1960s –confined mostly more multidisciplinary internal sector/ mostly led Health and multi-sectoralby Health Ministry Planning Reform become a part of

national, social and economic group

Become a part of overall NHP in the country

Health Planning today is much different from health planning yesterday

National Health Planning Today

Essential characteristics of an effective national health plan

From the perspectives of strengthening National Health plan there are three important aspects:

1. The context in which NHP are developed and implemented 2. The NHP Process3. The content of NHP document

A set of desirable characteristics of a national health plan I. The country context Both the process and content of NHP are bound by the

country’s:• Development context including socio-economic scenario

• Institutions and structures-including administrative &financial structures and legal frameworks

• Capacity to formulate and implement the health agenda

Implication of contextual factors for NHP

Factor Example of Factor Typical questions for the Planning Process

Ideology National self reliance Is the role of donors in the planning process well-defined and appropriate?

Social and political events

Political cycles resulting from elections

Does the planning process allow for a balance between political change and planning continuity?

Economic change and policy

Liberalization and shift to a market economy

Has planning adapted to the changing roles of agencies in the health field?

International Relations between government and international agencies

Can the planning process respond appropriately to changes in the international financing mechanisms such as SWAps?

II. Key Stages in the Planning Process

Analysis and Formulation

Approval

Dissemination

Implementation

Consultation

MonitoringEvaluation &

Updating

A set of desirable characteristics of a national health plan II. National Health Planning Process (A)Situation Analysis• A Planning process is based on a complete and relevant

Situation Analysis and that is made dynamic through consultation and inclusiveness.

• SA are quite complete with respect to the health context in countries –such as – SA of health status, SA of demographic & epidemiological trends.

• Broader health systems and contextual issues - political, economic and social determinants of health - remain less adequately analysed

A set of desirable characteristics of a national health plan Future NHP- Planning process needs be Inclusive and dynamic In most countries planning process is lead by a dedicated government

entity: planning unit, department, ministry or commission.To keep in mind of importance of broad based consensus for advocacy and

national ownership of NHP specifically:– Political support– Commitment from all health sector stakeholders –public & private – Multi-sector buy-in from health related sectors– Overall community confidence in transparent, people-centered health

planning– A basis for aligning country and international health agenda, including

external assistance– Plan time frame usually medium term, 5-10 years “Master Health Plan”

linking to overall development planning cycle and with annual implementation plans.

A set of desirable characteristics of a national health plan

II. National Health Planning Process(B) Health information systems have limited capacity to generate

quality and complete information for evidence-based National Health Planning.

• This impacted not only the situation analysis but monitoring and evaluation of the plan as well.

• Importantly, where evidence-based planning has been institutionalized, it has added credibility and promoted ministry of health's leadership in health

• Future NHP- – Evidence based research on SDH & HSS, other sector’s papers, NHA, etc

A set of desirable characteristics of a national health plan

II. National Health Planning Process(C) Both consultation and dissemination is most

systematically done within Ministry of Health and at higher-levels in the first instance.

• Inclusion of other stakeholders especially beyond MoH is still limited

Future NHP- • consider more on consultation and dissemination to

stakeholders within MoH and beyond MoH

A set of desirable characteristics of a national health plan (D). Linkages• Strong vertical linkages – • downstream to health systems, sub-national and vertical

programme plans • upstream to the national health policy as well as national and

international development agendas

• Strong horizontal linkages to health related activities of other sectors; and, with joint budgeting and expenditure processes

• Linkages beyond health remain persistently weak- with the overall development agenda especially with respect to using this as a common platform to link with health-related sectors, including to initiate joint budgeting; and, with direct horizontal linkages with health-related sectors and national budget/finance aspects (eg in Indonesia-MoE and MoH joint budget for sending fellows abroad)

A set of desirable characteristics of a national health plan

(E). BoundariesContextual issues beyond health • those related to political, economic and social determinants of

health are not adequately accounted for in national health plans

Institution and capacity building • is not focused upon in national health plans

• planning appears to be more for current structures of ministries of health rather than responding to for the institution and capacity needs of population health

A set of desirable characteristics of a national health plan

(F) Use of Appropriate Tools

• Tools available could be used more effectively to inform national health planning e.g. costing of the plan.

• Gaps related to weak information systems mentioned above are a critical constraint but inadequate capacity or use of relevant tools and techniques to process this data for evidence-based planning is equally limiting

III. Components/Contents in National Health Planning

• Situation Analysis / Needs Assessment - including local needs of the people, and

analysis of gaps, socio-economic situation and trends, availability and sources of finance

• Costing of services

Vision, Mission, Goals • Equity • Access • Affordability• Efficiency• Quality• Reduce disparities• Aspire towards Universal

Coverage• Catalytic role in promoting

healthy policy

•Reaching the unreached•Inter-sectoral collaboration•Community participation•Time frame of the plan•Gender sensitive•Special needs of the people •Empowerment of the community, and strengthening institutions

Policy & Strategy

• Focus on Non Communicable Diseases • Need to involve various levels (District /

Provisional level etc.) Multi sectoral endorsement can help avoid

overlapping and strengthen collaboration with other stakeholders.

• Financing the plan• Focus on women’s health• Set targets & goals• Flexibility in planning

Issues & Challenges• High Out of Pocket expenditure at the point of service in many

SEA countries. Countries need to explore various financing mechanisms as suitable to their situation to reduce Out of Pocket Payments.

• Quality of services• Cover and involve the Private Health Sector• Public Private partnership to be included in the NHP • Create good governance in the management of health systems• Promote healthy behavior• People’s centered health plan• Create immunity for diseases and health threats• Pluralistic approach – balance between different approaches to

medical care should be sought (traditional, modern, alternative). • Institutionalization of Health systems research

Programmes & Services

• Expanded Primary Health Care • Distribution of Human Resources for Health• Emergency preparedness and response• Document and disseminate best practices• Supportive supervision

Monitoring and Evaluation

• Monitoring & Evaluation framework • Need to develop indicators• Mid term evaluation• Feedback• Need to be based on outcomes

Problems Encountered by CountriesNHP Contents

• Alignment of National Health Plan with overall National plan• Various planning units • Integration of NHP with other sectors including private sector • Linkages between strategic and operational/annual plan, how

to link between local and central plan• Planning for Human Resources• How to forecast health problems 3 – 5 yrs ahead• Emerging and reemerging of diseases• Technical knowledge to use evidence for allocating budget to

various levels and institutions• Limited staff capacity in priority setting and planning, • Expanded Primary Health Care• Insufficient technical robustness and evidence base

Problems Cont…• Limited capacity in developing financial plans in NHP• Costing for regional / district budgets and priority areas• Costing of benefit packages• Universal Coverage expenditure has increased• National Health Accounts not used to its potential• Strategy on reducing OUP expenditure limited• Constant financial flow especially from external sources• Statistics and information gaps for measuring targets• Weak Health Information Systems• Disparity among groups, regions, services, situation analysis

S

Primary Health Care principles are stated as the guiding policy approach in all plans

Primary Health Care principles are stated as the guiding policy approach in all plans

Leadership of MoH and Health in Public Policy • is not clearly established • Plan documents indicate limited influence on health-related

issues beyond those directly addressed within the health sector.

Universal coverage • is an overarching goal in all NHPs.• However, further details with respect to the linkages

between a selected benefit package and priority populations with focus areas/activities of the plan or related budget items are not clearly evident

Primary Health Care principles are stated as the guiding policy approach in all plans

• Service delivery improvement/scaling-up is a stated priority in all case studies.

• Other areas of health systems strengthening – Human resourcesMedicines and technology and Health information systems are also addressed in all plans.

• However, Health Financing and Governance issues are not similarly covered

• Further, plans do not do explicitly link health systems functions to highlight their reinforcing contributions to PHC oriented service delivery strengthening.