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Integrating Health System into diseases control

Integrating Health System into diseases control. Benefiting from the GF Round 7. Viroj Tangcharoensathien IHPP - Thailand. Community and household. Health Services Delivery. Health Sector Policy and Strategy. Public Policies (across sectors). Environmental & contextual.

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Integrating Health System into diseases control

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  1. Integrating Health System into diseases control Benefiting from the GF Round 7 Viroj Tangcharoensathien IHPP - Thailand

  2. Community and household Health Services Delivery Health Sector Policy and Strategy Public Policies (across sectors) Environmental & contextual Constraints on improving access • Lack of demand for effective interventions • Barriers to the use of effective interventions (physical, financial, social) • Shortages of staff / Weak technical guidance / Poor program management & supervision • Inadequate drugs and supplies, lack of equipment and infrastructure, poor accessibility • Weak policies and management system • Inadequate regulation, lack of inter-sectoral plan & partnership • Weak incentives to efficient use of resource • Government bureaucracies • Poor communications and infrastructure support • Weak government, corruption, low accountability • Low priority to social sectors, political instability • Poor physical environment, geographical factors Source: Hanson et al 2003

  3. Health System vs Disease Specific Approaches: sample of approaches

  4. Example: Constraint 1

  5. Example: Constraint 2

  6. Example: Constraint 3

  7. Example: Constraint 4

  8. Example: Constraint 5

  9. Example: Constraint 6

  10. Limitation of Disease Specific Approaches • disease-specific lens restricts the scope of responses, and not consider broader health system-wide responses • some of the disease-specific strategies may crowd out ongoing activities within the health sector • disease-specific focus might help meet short-term goals, but can crowd out the development of strategies that will sustain those gains Source: Travis et al 2004

  11. Avoiding adverse HS effects from Parallel Programs • Duplications: increase transport costs, reporting, and monitoring systems • Distortions: better paid workers for specific tasks may deplete staff from other key functions and/or demotivate staff of other programs • Disruptions: taking staff from their jobs for specific trainings could disrupt routine services • Distractions: increasing number of forms that health workers need to complete distract them from more productive uses of time Source: Travis et al 2004

  12. System-wide approaches • System-wide approach: increases the range of options and tackles root causes, • Benefits accrue to several, not single, priorities • The disadvantages are that • benefits take longer to accrue • effort may become unfocused and unmanageable, • and the GF does not like it. Source: Travis et al 2004

  13. Integrative horizontal Selective vertical Time When HS becomes stronger: phase out selective vertical towards integrative horizontal appraoches

  14. Features of successful GF proposals on HSS (cases of Malawi & Rawanda proposals) • Strong link to reducing spread and impact of target diseases • Strong health system analyses • National commitment and strategies • Convincing cases  Strong chance of success • Pro-poor and pro-marginalised population • Support from other development partners • Narrow focus within the area of HSS • Address major obstacles for scaling up disease interventions Source: Physicians for Human Rights, 2007

  15. General advice arising from HSS-related proposals, feedback by TRP several rounds • Detailed, realistic budgets • Modest administrative cost • Proposal size: not too small and not beyond applicant’s capacity to implement • Sufficient details on planned activities • Well integration with previous GF grants and other source of funding • Realistic indicators • Realistic pace of activities (not overly ambitious) • Principal recipient has the capacity to carry out responsibilities • A country proposal that is coherence • Regional proposals should demonstrate how they add value to strictly national strategies • Program capacity to manage significant scale-up Source: Physicians for Human Rights, 2007

  16. Cross cutting issues:identified by country presentations 1 • General • Strong CCM representation and processes • Transparent process of proposals selection [LAO, PHI, THA], • Focus on marginalized, hard to reach [THA, LAO, VTN] – easy convincing areas • Strong supports from partners • Site visits: useful to draw lessons on HS barriers • All countries have ongoing GF grants, in the midst of bilateral and multilateral – need harmonization with prior GF grants, and other donor resources, scaling up previous program,

  17. Cross cutting issues:identified by country presentations 2 • HSS related issues • Info system and M&E still major problems • Threats of decentralization and health systems capacity to delivery services [INO, PHI, LAO] • Human resources: adequacy, distribution, skill-mix and motivation [PHI, VTN, THA] • National HRH plan available [THA, PHI] • Reaching the unreachable population – prompt to revisit the role of civil society, volunteers

  18. Thank you very much

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