Health Equity: 08/25/10

Wednesday, August 25, 2010

[EQ] Innovative health service delivery models in low and middle income countries - what can we learn from the private sector?

Innovative health service delivery models in low and middle income countries
- what can we learn from the private sector?

Onil Bhattacharyya 1, Sara Khor 1, Anita McGahan 2, David Dunne 2, Abdallah S Daar 3 and Peter A Singer 4

1 Li Ka Shing Knowledge Institute Toronto, ON, Canada

2 Rotman School of Management, University of Toronto, ON Canada

3 MaRS Centre, Toronto, ON Canada

4 McLaughlin- Rotman Centre for Global Health, MaRS Centre, Toronto, ON, Canada

Health Research Policy and Systems – July 2010, 8:24doi:10.1186/1478-4505-8-24

Available online at: http://bit.ly/cw6TNo

“……The poor in low and middle income countries have limited access to health services due to limited purchasing power, residence in underserved areas, and inadequate health literacy. This produces significant gaps in health care delivery among a population that has a disproportionately large burden of disease. They frequently use the private health sector, due to perceived or actual gaps in public services.

A subset of private health organizations, some called social enterprises, have developed novel approaches to increase the availability, affordability and quality of health care services to the poor through innovative health service delivery models. This study aims to characterize these models and identify areas of innovation

that have led to effective provision of care for the poor.

An environmental scan of the relevant literature was conducted to select exemplars of innovation. A case series of organizations was then purposively sampled to maximize variation. These cases were examined using content analysis and constant comparison to characterize their strategies, focusing on business processes. After an initial sample of 46 studies, 10 case studies of exemplars were developed spanning different geography, disease areas and health service delivery models.

These ten organizations had innovations in their marketing, financing, and operating strategies. These included approaches such a social marketing, cross-subsidy, high-volume, low cost models, and process reengineering. They tended to have a narrow clinical focus, which facilitates standardizing processes of care, and experimentation with novel delivery models. Despite being well-known, information on the social impact of these organizations was variable, with more data on availability and affordability and less on quality of care.

These private sector organizations demonstrate a range of innovations in health service delivery that have the potential to better serve the poor's health needs and be replicated. There is a growing interest in investing in social enterprises, like the ones profiled here. However, more rigorous evaluations are needed to investigate the impact and quality of the health services provided and determine the effectiveness of particular strategies.

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[EQ] SUPPORT Tools for evidence-informed health Policymaking (STP)

SUPPORT Tools for evidence-informed health Policymaking (STP)

Editors Andrew D Oxman, John N Lavis, Simon Lewin, Atle Fretheim
Report from Norwegian Knowledge Centre for the Health Services
(Nasjonalt kunnskapssenter for helsetjenesten) No 4–2010. ISBN 978-82-8121-334-0 ISSN 1890-1298
Norwegian Knowledge Centre for the Health Services - Oslo, Norway

Available online PDF file [283p.] at: http://bit.ly/95XQyo

“……Knowing how to find and use research evidence can help policymakers and those who support them to do their jobs better and more efficiently.
Each chapter presents a proposed tool that can be used by those involved in finding and using research evidence to support evidence-informed health policymaking.

The book addresses four broad areas:
1. Supporting evidence-informed policymaking
2. Identifying needs for research evidence in relation to three steps in policymaking processes, namely problem clarification, options framing, implementation planning
3. Finding and assessing both systematic reviews and other types of evidence to inform these steps, and
4. Going from research evidence to decisions.

Each chapter begins with between one and three typical scenarios relating to the topic. These scenarios are designed to help readers decide on the level of detail relevant to them when applying the tools described. Most chapters are structured using a set of questions that guide readers through the proposed tools and show how to undertake activities to support evidence-informed policymaking efficiently and effectively. These activities include, for example, using research evidence to clarify problems, assessing the applicability of the findings of a systematic review about the effects of options selected to address problems, organising and using policy dialogues to support evidence-informed policymaking, and planning policy monitoring and evaluation. In several chapters, the set of questions presented offers more general guidance on how to support evidence-informed policymaking.

Additional information resources are listed and described in every chapter. The evaluation of ways to support evidence-informed health policymaking is a developing field

This book is based on a series of articles published in Health Research Policy and Systems, 2009; 7:Supplement 1
www.health-policy-systems.com/supplements/7/S1...............”

Table of contents

Introduction

Supporting evidence-informed policymaking

1. What is evidence-informed policymaking?

2. Improving how your organisation supports the use of research evidence to inform policymaking

3. Setting priorities for supporting evidence-informed policymaking

Identifying needs for research evidence

4. Using research evidence to clarify a problem

5. Using research evidence to frame options to address a problem

6. Using research evidence to address how an option will be implemented

Finding and assessing evidence

Systematic reviews

7. Finding systematic reviews

8. Deciding how much confidence to place in a systematic review

9. Assessing the applicability of the findings of a systematic review

10. Taking equity into consideration when considering the findings of a systematic review

Other types of evidence

11. Finding and using research evidence about local conditions

12. Finding and using research evidence about resource use and costs

Going from research evidence to decisions

Engaging stakeholders

13. Preparing and using policy briefs

14. Organising and using policy dialogues

15. Engaging the public

Using evidence in decisions

16. Balancing the pros and cons of policies

17. Dealing with insufficient research evidence

18. Planning monitoring and evaluation

Glossary of selected terms

SUPPORT structured summaries of systematic reviews:
URL: http://www.support-collaboration.org/

One reason for slow progress in achieving the maternal and child health Millennium Development Goals in low and middle-income countries is the difficulty policymakers and others have in accessing high quality information about potentially effective interventions to improve maternal and child health, and interventions to improve health systems.

The SUPPORT Collaboration is searching global databases for systematic reviews of maternal and child health interventions, and of ways to effectively organise, finance and govern the delivery of effective interventions. To make this information more accessible to policymakers and other stakeholders we are preparing structured summaries of relevant reviews.

We have taken the following steps to ensure the relevance, quality and usefulness of SUPPORT Summaries:

· We conduct extensive searches for systematic reviews that examine the effects of interventions on maternal and child health, and health systems.

· Once an eligible review is identified, we assess its quality using a modified version of a previously validated checklist.

· We judge the quality of evidence for the main comparisons in each included review using the internationally recognised GRADE system.

· Based on our assessment of the quality of the review and the quality of evidence for the main comparisons, we prepare structured summaries of the main findings of each review.

Each summary begins with the key messages derived from the findings of the review and our assessment, and includes

· Key background information needed to understand the findings

· A summary of what the review authors searched for and found

· A detailed summary of the main findings of the review, including our assessment of the quality of evidence for those findings

· Our assessment of the relevance of the review to low and middle-income countries, including

o the applicability of the evidence to low and middle-income countries,

o potential impacts on equity,

o economic considerations, and

o the need for monitoring and evaluation.

· References for additional information

http://www.kunnskapssenteret.no/Publikasjoner/8879.cms

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[EQ] Practical approaches to the aid effectiveness agenda

Practical approaches to the aid effectiveness agenda

Evidence in aligning aid information with recipient country budgets

Samuel Moon with Zachary Mills

ISBN 978 1 907288 26 5 -ODI Working Papers (Online) ISSN 1759 2917

Overseas Development Institute- July 2010

Available online PDF [50p.] at: http://bit.ly/cIDKI4

“………The Paris Declaration and the Accra Agenda for Action emphasise the importance of aligning aid with recipient government priorities and delivering aid through government systems. However, since a significant amount of aid is not delivered through national budgets, the issue of aligning these resources to government systems remains a major challenge. A fundamental concern is the ability to relate aid resources to the expenditure patterns of recipient governments. Too often, that link is not made. Generic donor ‘sector’ categorisations of aid are applied at country level, even though these do not relate meaningfully to recipient governments’ sectoral or administrative budget classifications.

At the core of this problem is the need to produce aid information in a way that can be aligned with the administrative/organisational classification and the functional/purpose classification of a recipient government’s budget. Making aid information available to the recipient country government at the relevant point in their budget calendar is also important. An explicit linkage between the purpose of aid and the government development strategy and budget is fundamental to more effective strategic planning and budgeting. It will also facilitate the implementation of government policies and programmes in the context of a more comprehensive and accurate estimate of the total government and donor resources available for national priorities. …………

Contents

1. Introduction 1

2. Background and problem definition

3. Method of analysis

4. Findings

4.1 General public service

4.2 Defence, justice, law, order and security

4.3 Economic affairs

4.4 Water, natural resource management and environment

4.5 Health

4.6 Recreation, culture and religion

4.7 Education 1

4.8 Social protection, land, housing and community amenities

4.9 Aid that is not supplementary to a government role

4.10 Summary of commonalities between sample budgets and international classifications

5. Conclusions and recommendations

5.1 Constructing a generic functional classification derived from the sample budgets

5.2 Bringing more of aid into the budget planning process

References

Appendix 1: The nature of the budget and aid classification systems and AIMS

Appendix 2: A generic functional structure for the interface of aid and budgets

Appendix 3: Proposal for values in the field of economic expenditure Items

Appendix 4: IATI information

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