Health System Development Programme2006-2011

Objectives1. 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 co-operation 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

StrengthsHealth 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.

StrengthsHealth 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

WeaknessHealth 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.

Weaknesses

Health Financing1. Poor advocacy to high level policy making body on health

financing situation 2. Lack of interest of decision maker on health financing situation3. Limited number of skilled health manpower especially health

economists4. Lack of skilled staff on financing and budgeting in the township

health system5. 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

Health System Gaps identified by HSS GAVI technical working group & consultants

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Service Delivery Gaps Many areas of the country have low service access to MCH and other services due to a range of management, infrastructure, logistics and security barriers.

Program Coordination Gaps Lack of organizational capacity, guidelines and strategic framework on how to coordinate immunization, nutrition, environmental health and RH services is leading to fragmentation and inefficiencies in health service delivery

Human Resource Gaps There is lack of clarity in the roles and functions of basic health staff, and inequities in the distribution of staff, resulting in lack of access to health services in hard to reach areas.

Health System Goal

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Theme 1 Service Delivery Reaching communities with essential health system delivery components of MCH, nutrition, immunization and environmental health, with emphasis on hard to reach areas

Theme 2 Health Program Coordination and Capacity Building Strengthening coordination, management and organization of the health system at all levels with a focus on the Township Level

Theme 3 Human Resource Management and Development Improving distribution, skill, number and mix of health workers with emphasis on hard to reach areas

HSS Goal: Achieve improved service delivery of essential components of Immunization, MCH, Nutrition, Environmental Health by strengthening programme coordination, sub-national micro-planning, and human resources management and development in support of MDG goal 2/3 reduction in under 5 child mortality between 1990 and 2015.

Service Delivery Objective & Activities

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Objective 1: By the end of 4 years of implementation180 selected townships with identified hard-to-reach areas will have increased access to essential componentsOf MCH, EPI, EH and nutrition as measured by increases DPT from70% to 90% and SBA from 67.5% to 80%

Main Activities: • Baseline health systems assessment surveys in each township

• RHC reconstruction/sub RHC construction

• Provision of Logistics and supplies

• Provision of transportation means for BHS at hard-to-reach areas

• Social mobilization of NGOs, local authorities, and Voluntary Health Workers in developing and implementing coordinated township health plan

Outcomes:• National DPT3 coverage increased (%)• Delivery by Skilled Birth Attendants increased (%)

Planning Objective & Activities

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Objective 2: By the end of 4 years of implementation180 selected townships with identified hard-to-reach areas will have developed and implemented a CoordinatedTownship Health Plan

Main Activities: • Research and development of coordinated planning and supervision guidelines •Research and development of financial management capacity and health financing schemes in HSS townships

• Feasibility study for community based health financing scheme • Introduction of Maternal Health Voucher Scheme in community

• Training programme on coordinated management through modified MEP approach

• Development, management and monitoring of CTHP

Outcomes:• Proportion of selected townships implementing guidelines according to national framework

Human Resource Objective & Activities

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Objective 3: By the end of 4 years of implementation 90 selected townships with identified hard-to-reach areas will be staffed by midwives and PHS2 according toNational HR standards

Main Activities: • HR Research planning and proposal development: Motivation and retention of Basic Health Staff in hard-to-reach areas of selected GAVI Health Systems Strengthening Townships • HR finance incentive scheme development for health staff in remote areas

• Continuing capacity building for implementation of CTHP in townships

Outcomes:• Percent of selected townships with identified hard to reach areas staffed with midwives and PHS2 to national standard by the end of year four.

Health system assessment tool kit: one excel book covering areas

1. Health Management and Planning 2. Mapping Hard to reach3. Human resources4. Health Finance and Financial Management 5. Community participation 6. Essential drugs and equipment7. Infrastructure8. Data and Service Quality9. Summary Report

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Figure 8 Making a Summary Report

Summary Report Township X

Availability of ServicesWhat is the general analysis of availability of services in this Township?What are the main factors effecting availability?

Accessibility of ServicesWhat is the general analysis of accessibility of services in this Township?What are the main factors effecting accessibility?

Utilization of ServicesWhat is the general analysis of utilization of services in this Township?What are the main factors effecting utilization?

Utilization of Quality ServicesWhat is the general analysis of quality of services in this Township?What are the main factors effecting quality?

Main conclusions and RecommendationsWhat are the main health system bottlenecks for improvement of maternal and child health services, and what strategies and investments are best placed to remove these bottlenecks?

Linking Health System assessment with Township health planning

• Health system analysis examines gaps in operations across health programmes and service delivery units

• Making the transition from “Management by Project” to “Management through Systems” is a critical step in achieving:– Equity: in distribution– Efficiency: through coordination and reduction of

overlap of resources in favour of hard to reach areas– Effectiveness: improved health coverage – Sustainability: strengthening self reliance and

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Coordinated Township Health Planning Guidelines

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Hospital Care Public Health Disease Control

Systems Analysis Planning & management

Human Resources Finance & Financial Management

Infrastructure Data and Service Quality

Essential Drugs & Equipment Community participation

Hard to reach (equity analysis)

SERVICE DELIVERY FOR COMMUNITIES Township Coordinated Health Plan

Strategic Framework: An example from DPRK

STRATEGIC AREA 2

Non

Communicable Disease

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

STRATEGIC AREA 3

Communicable

Disease

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

STRATEGIC AREA 4

Women’s and

Children Health

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

P R O G R A M S

NATIONAL DEVELOPMENT PRIORITIES, LAW AND INTERNATIONAL AGREEMENTS

MEDIUM TERM DEVELOPMENT PLAN FOR THE HEALTH SECTOR IN DPRK

SYS TEM

STRATEGIC AREA 1

Health System

(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

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