Transcript Dialogue Politique National Wim Van Lerberghe WHO, Geneva Stratégies, Plans, Politiques? • Tous les gouvernements tentent de rèpondre: – A leurs problèmes de santé – Aux.

Dialogue Politique National
Wim Van Lerberghe
WHO, Geneva
Stratégies, Plans, Politiques?
• Tous les gouvernements
tentent de rèpondre:
– A leurs problèmes de santé
– Aux problèmes de leur système
des santé
– Aux défis politiques et de
développemtn
• Bien ou mal, explicite,
implicite ou par défaut
Idealised planning processes
5 year plan
GHI
partn
ers
Annual
Review
Annual
Review
Annual
Review
Bottom-up participatory
planning cycle
CSO
CSO
NGO
NGO
Real-life planning processes
Private
sector
5 year plan
Lobbies
CSO
Government plan
partners
Elections
Political
priorities
Program
mes
Civil service
reform
Operational
plan disease x
Annual
Review
National Health Policy
(vision statement and policy directions)
National Health Strategic Plan
Medium term plan &
expenditure framework
Medium term plan &
expenditure framework
District
Operati
onal
Plan
Medium term plan &
expenditure framework
District
Operati
onal
Plan
District
Operati
onal
Plan
YEARS
Others
Disease specific nat
strategy / plan
HRH
Plan
Disease
specific nat
strategy / plan
•Plan paraplui et plans spécifiques
National Essential
Drugs Policy
(measures and instruments for implementation,
operational implications and budget)
Disease specific nat
strategy / plan
Une confusion
terminologique
Des motifs différents
At country level
·
·
·
Dissatisfaction with fragmentation
Dissatisfaction with inequalities and
progress
Backlash against withdrawal of the
State
At global level
·
·
·
Failure to reach the MDGs
Limitations of “CE interventions”
Recognition of HS bottlenecks and
of adverse effects of global
fragmentation
Recognition of importance of clarity on “broad policy directions (UC, PHC, HiAP, …)
Country interest in national policy
dialogue on health (cfr elections, media,
lobbies)
Global interest in “one plan, one funding
mechanism, one M&E framework)
E.g. China, USA, Switzerland, Thailand...
E.g. IHP+, Common funding platform...
Tout se tient
Health &
health
security
Health
Equity
Including
Including
MDGs
4-5-6
MDGs
4-5-6
Social
inclusion
and
participation
Trust in health
authorities:
● Fairness
● Protection
● Competence
● Accountability
Including
MDG 3
Outcomes
Provide guidance on costeffective interventions
Cost-effective and safe
interventions: clinical &
public health
Comprehensive,
integrated,
continuous and
people-centred
care along the
life-cycle
Including interventions
for MDGs 4, 5, 6
Universal access
to close-to-client
networks,
responsible for a
defined
population
Service Delivery
Financing
Workforce
Adapt service delivery models
(integration, people centredness,
chronic care, access…)
Pharmaceuticals
Technology
Infrastructure
Information
Provide balanced inputs to
support HS
Critical Subsystems
Policy
dialogue
within and
beyond health
sector
Policy Directions
universal coverage, primary
care, health in all policies
Strategies
Plans
Regulation &
Management
institutions,
rules,
incentives
Assist situation analysis
Align programme plans with
National Health Plan
Include stakeholders
Governance
Country leadership
■ Value given to health,
equity, solidarity, social
justice
■ Individual & institutional
capacities
Political
commitment
Effective aid
■ Ownership,
■ Alignment
■ Harmonization
■ Mutual accountability
Mobilise & channel aid
Les principes de Paris
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•
•
•
•
Ownership
Alignment
Harmonization
Results
Mutual accountability
Mainstreaming IHP+ as an approach
•
Donors: Sceptical alignment: Paris, IHP+
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•
•
Validation
→ “assessment”
→ “joint assessment” of desirable attributes:
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•
•
•
•
•
Use for
•
•
•
(i) situation analysis and programming;
(ii) development and endorsement
(iii) financial and auditing systems;
(iv) Implementation and management arrangements; and
(v) results, monitoring and review mechanisms
Making external financing decisions (“don’t give them the criteria”)
Getting better plans
WHO: back as a top (?) priority, “as if there were no donors”
–
–
–
Global
Country
Internal debate: toolboxes, resources, guidance, do’s and don’ts, ….
Common HS Funding Platform
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•
•
•
•
High level task force on innovative financing
TGF & GAVI reaction, + WB
WHO facilitates
Crisis, difficult alignment with IHP+
Options 1, 2a and 2b
A priority without blueprints, but…
Content
Process
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•
•
•
•
•
•
Situation analysis
– Need
– Expectations
– Performance
•
Strategy
– Policy directions
– Implications for BB
– Resource implications & costs
•
Arrangements
–
–
–
–
Financing
Roles
Monitoring
Legal
Broad consultation
Priority setting & detailed design
Active mngmnt political process
Feedback mechanisms
Alignment develpmnt plans
Ownership
Where can we improve things?
1.
2.
3.
4.
5.
6.
Situation analysis and priority setting
Shift from pilots to dealing with the challenge
NHS & Programmes: balance and coherence
Resource planning & costing
M&E + feedback
Process management
1. Situation analysis & priority setting
• Inclusive and
comprehensive
• Needs, expectations
and performance
• Current and anticipated
• Toolboxes
• Bringing it all together:
CHIP:
– Numbers and narrative
– Problems and systems
– Consensus building &
peer review
2. Shift from pilots to dealing with the challenge
60
number of countires
50
40
WPRO
SEARO
EURO
EMRO
AMRO
AFRO
30
20
10
0
2009
2010
2011
2012
2013
2014
2015
3. Balance and coherence
number of countries
45
40
35
30
25
Not synchronized
with the National
Health Plan
20
15
10
5
Synchronized with
the National
Health Plan
ts
ts
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pr
oj
TB
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F
G
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/A
ID
AV
IH
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pr
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0
4. Resource planning & costing
• Resource planning
– Programmes as part of systems
– iHTP or similar tools
• Costing of:
– Resource requirements
– Reaching targets (UN Costing tool)
5. M&E + feedback
• For partners: Chess; single framework
• For domestic use:
– Numbers
– Narrative
– Political intelligence
– Institutions: Observatory model? CSOs as
watchdogs? Others?
6. Process management
• Inclusiveness (trust, presence), particularly
during design phase and for feedback
• Continuity and long term perspective
(presence, legal frameworks)
• Exchange of experience and peer review
Support functions
• Align partners
• Assist negotiation / accountability
• Support inclusive strategy development
• Assist implementation