Partnership for Transforming Health Systems

Overview of themes

Transforming Health Systems ...............

Theme 1: Improved quality and sustainability of basic services essential to the achievement of MDG's

The following initiatives have been developed:

¨ Improve quality and coverage of

¨ child survival services

¨ safe motherhood services

¨ HAST services (including TB/DOTS)

¨ Malaria services

¨ comprehensive packages of care

¨ Improve quality and access to private sector services

¨ Establish and institutionalise IMPACT, QRI and other quality assurance systems

¨ Strengthen human resources management and development

¨ Strengthen other health support services management systems

Within this theme, a balance is being sought between the immediate service improvement efforts, and the longer term system building.

On both fronts there is progress noticeable. Utilisation rates - especially in Ekiti and Jigawa - are increasing (although it is too early to say whether such higher levels of use can be sustained). At the same time, the PATHS work on service quality improvement, quality assurance and recognition, is gaining increasingly stronger buy-in and government ownership.

Theme 2: Sustainable access to quality essential drugs

Access to affordable, essential drugs is a conditio sine qua non for PHC. Initiatives under this theme are:

¨ Improve access to and quality of drugs in health facilities

¨ Improve access to and quality of drugs in the market place

The availability of quality drugs (or the absence of these) in health facilities is a key factor in shaping the public confidence (or the lack of it). PATHS chosen approach is to support the implementation of Drug Revolving Funds (DRFs); although these have a mixed track record (in Nigeria and elsewhere), there is no real alternative in the short-term. Encouragingly, the initial indications are that some of the past weaknesses in the approach are being systematically addressed - partly through the efforts to ensure community ownership.

The market place activities are at an earlier stage of development,working with NAFDAC and PCN but will receive increasing emphasis over the remainder of PATHS lifespan.

Theme 3: Prioritised, costed, operationalised government health policy and plans, adequately reflected in NEEDS/SEEDS

¨ Health legislation and regulations

¨ Health policies development

¨ Health strategic and business planning

¨ Institutionalise health sector reform

¨ Strengthen budget preparation and expenditure monitoring

¨ Strengthen financial management systems

¨ Consolidate HMIS

¨ Harmonise development partners and donors activities

¨ Ensure financial access to health services for the poorest

Theme 4: Stimulated demand-side and accountability in relation to MDG's.

This is a cross cutting theme. It builds on work in communications and social assessment to identify and support coalitions of civil society and to develop complementary community and household level interventions to address demand side barriers among the poor and women. This focuses particularly on increasing demand for and supply of quality services in maternal and child health. Where appropriate, PATHS will work closely with CSO's and the private sector.

Again, as WDR2004 notes, services fail poor people because they often do not demand them, have given up demanding them or are paying for low quality, unregulated services. Low demand has a number of facets; resulting from supply side failures such as staff absenteeism and attitude, insufficient basic supplies and equipment, from poverty related constraints such as cost and social barriers, from gender discrimination both within and beyond the household, and from information asymmetry. There is need for a check and balance system emanating from consumers through awareness and knowledge of rights and responsibilities. PATHS is addressing these issues under Theme 4 with the following initiatives:

¨ Improve public understanding of rights and responsibilities for better health including home-based prevention and treatment of common illnesses

¨ Improve demand for services for priority health issues

¨ Strengthen BCC interventions development and management

¨ Strengthen the accountability of service providers to clients and communities

§ Strengthen community involvement in health services management and monitoring;

§ Strengthen client and community voice in health appraisal and quality assurance processes;

§ Increase civil society involvement in health policy, strategy development and planning processes;

Abbrivations

The initiatives above are being pursued at both state and federal levels, albeit with different degrees of emphasis. At the Federal level, the national health sector reform (HSR) efforts have provided a ready context, along with the NEEDS process. The FMOH is using PATHS support (inter alia) to roll-out the HSR process, to gain the necessary legislative backing, and to establish and consolidate the foundations for the reform process with further more detailed (sub)policy development work.

At the state level, PATHS has been instrumental in implementing a significant shift in health system approach in Enugu - through the development of a District Health System approach. In other states, strategic planning and policy work is finally beginning to bear fruit, in an attempt to take forward the re-allocation of resources highlighted in the health sections of SEEDS.

Budgetary and financing work is becoming increasingly prominent. During the recently completed 2006 Budget round, tangible headway has been made in Jigawa and Ekiti, in deepening and refining the budgetary processes. This work will be intensified early in 2008, to prepare for the 2007 budget round. In this work, PATHS efforts are closely allied to those of SLGP - working with the Budget and Planning and Finance Ministries.

As World Development Report(WDR2004) notes, services fail poor people partly because resources are either not made available or are misdirected (e.g. they are spent on less essential services and/or benefit the better off). High priority is given to making sectoral planning (focusing on cost effective essential interventions in primary health care) and implementation pro-poor by linking it to macro-economic policy instruments and broader social development policies.

Theme 1: Improved quality and sustainability of basic services essential to the achievement of MDG's

Theme 2: Sustainable access to quality essential drugs

Theme 3: Prioritised, costed, operationalised government health policy and plans, adequately reflected in NEEDS/SEEDS

Theme 4: Stimulated demand-side and accountability in relation to MDG's.

Abbreviations and Acronyms

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