IMPROVING HEALTH SERVICE DELIVERY IN

DEVELOPING COUNTRIES:FROM EVIDENCE TO ACTION

David Peters, Sameh El-Saharty, Banafsheh Siadat, Katja Janovsky, and Marko Vujicic

First Global Symposium on Health Systems ResearchFirst Global Symposium on Health Systems ResearchMontreux, Switzerland, – November 18, 2010Montreux, Switzerland, – November 18, 2010

Health, Nutrition, and PopulationHealth, Nutrition, and PopulationHealth Systems Strengthening GroupHealth Systems Strengthening Group

The Seven Country Case Studies

AFGHANISTAN: ETHIOPIA GHANA RWANDA UGANDA VIETNAM ZAMBIA

RESEARCH OBJECTIVES

Describe strategies to strengthen HSD in the real-life context in which they occurred

Illustrate how adoption and implementation of the HSD strategies relate to their context

Investigate the presumed causal links between program components and program effects in real-life interventions that are too complex for survey research or experimental strategies

RESEARCH QUESTIONS (1/2)

Which strategies to improve HSD were adopted and implemented?

Where did the impetus for the strategy come from?

How has the implementation of the strategies been organized and managed, including political advocacy and management?

What was the pace and degree of implementation, including sequencing and relationships to other concurrent strategies?

RESEARCH QUESTIONS (2/2)

What factors in the health sector and in the broader macro environment, including enabling and inhibiting conditions, have influenced adoption, implementation, and outcomes?

What results have been achieved?

Are there any discernable intended or unintended benefits to the poor?

What lessons have been learned that are likely to be useful for other countries?

RESEARCH METHODOLOGY

Mixed methodologies detailed in standardized terms of reference

Review and analysis of documentation of HSD strategies in the recent past (5 -10 years)

Quantitative analysis of HSD data (outputs and outcomes)

Central- and periphery-level field key informant interviews of critical stakeholders in-country

Identification and analysis of enabling and inhibiting factors and conditions

RESEARCH LIMITATIONS (1/2)

Many of the results observed are highly contextual - largely driven by factors related to the macro and/or the micro environments - and hence generalizations and comparisons across countries are limited.

As the context changes, the health system components also evolve and adapt in response to the changing environment. This dynamic relationship makes it difficult to ascribe some of the enabling and inhibiting factors to constantly adapting health system components.

RESEARCH LIMITATIONS (2/2)

Difficult to attribute the observed results to a specific strategy, particularly when there is usually concurrent implementation of multiple strategies.

The sequencing of the strategies, often in a phased manner, or incrementally but not adhering to plans, further limits the tracing of causal linkages.