Tagged: health systems

  • Improving Health System Performance Starts from the Ground Up

    Imagine: a district health official sits at her desk with the results of a country-wide assessment that details 20 pages of vague recommendations to improve the health system. Suggestions range from “increasing use of financing mechanisms” to “providing adequate benefit packages for health workers” to “utilizing budget-neutral retention schemes to improve rural retention of health workforce.”

    She realizes that these issues are potentially important to her work, but she faces more immediate challenges on a day-to-day basis. Just this morning, a local hospital director was in her office discussing the low number of women who attend their antenatal care appointments. Everyday issues such as this seem disconnected from the greater health system — but are they?

    It is widely recognized that failure to reach health care goals can be attributed to constraints on the system, but the relationship between these constraints and specific health issues is not well understood. FHI 360’s Health Systems Strengthening unit has developed a tool to examine the links between the concrete problems in performance experienced at a subnational level and overarching health system issues.

    FHI 360’s Health System Rapid Diagnostic Tool guides identification of bottlenecks and sets the scene for addressing those hurdles. The Rapid Diagnostic Tool provides a step-by-step framework, operational guide and metrics for an in-country team to process to identify and measure the strength of priority health system functions.

    Other health system assessment tools exist, but their results are aggregated into lengthy reports — such as the report on our imaginary district health officer’s desk — full of recommendations that are difficult to act on and not linked to daily work. These other tools focus on assessing what health system problems exist at a high level. In Kenya, for instance, a dozen assessments have been performed in the past decade, and Kenyan health officials are very aware of the issues they face. What is not clear, however, is how to address those issues and how to achieve better outcomes.

    The Rapid Diagnostic Tool dives deep with focused data collection and analysis to identify root issues that lead to poor health-system performance. Its level of detail makes it ideal for assessment at the regional, district or subdistrict level, as opposed to the health sector as a whole. The final diagnostic report serves as a basis for designing health systems strengthening interventions.

    Delving into the root causes of many health system problems is like pulling a thread on a sweater. It quickly becomes clear that one problem is interrelated with many other issues and can be overwhelming for a project or individual to deal with alone. With the Rapid Diagnostic Tool, stakeholders work together to prioritize systems issues and find the root cause of more proximate problems. With this understanding in hand, they are equipped to design initiatives that will improve health system efficiency and effectiveness by addressing the underlying causes of poor performance. For more information on the Rapid Diagnostic Tool, contact the FHI 360 Health Systems Strengthening Unit at HSSD[at]fhi360.org.