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Chapter 1 Introduction: Strategizing national health in the 21st century

November 2016

In book: Strategizing national health in the 21st century: a handbook (pp.36)
Chapter: Chapter 1 - Introduction
Publisher: World Health Organisation
Editors: Gerard Schmets, Dheepa Rajan, Sowmya Kadandale

Project: Strategizing national health in the 21st century: a handbook

Authors:

Gerard Schmets

World Health Organization WHO

Denis Porignon

World Health Organization WHO

Dheepa Rajan

World Health Organization WHO

The global health environment is becoming increasingly complex. Social, demographic and epidemiological transformations fed by globalization, urbanization and ageing populations pose challenges of a magnitude that was not anticipated three decades ago. In addition, recent global health security threats such as the Ebola virus disease or Zika virus outbreak, and the growing mismatch between the low performance of health systems and the rising expectations of societies, are increasingly becoming a cause for political concern. This often leads to countries prioritizing, or re-prioritizing, efforts towards strengthening health systems, moving towards universal health coverage (UHC) and implementing the idea of health in all policies. Countries recognize that these calls for efficiently strengthening health systems and improving health security must be translated into robust, realistic, comprehensive, coherent and well balanced health policies, strategies and plans. In the post-Millennium Development Goals (MDGs) era, they also recognize that in pluralist, mixed, public-private health systems, these policies, strategies and plans have to relate to the entire health sector and cannot be limited anymore to “command-and-control” plans for the public sector. Functional health systems that deliver high quality services to the population are the main priority for governments. Achieving this requires permanent, well-structured and dynamic processes, with a true consensus between the demand and supply of services, as well as between governments, services providers and the population. A solid, evidence-informed policy dialogue is the only real way to achieve this in the 21st century. Rationale for this handbook Furthermore, it is now widely understood that national health policies, strategies and plans (NHPSPsI) extend much beyond “health care”, i.e. clinical personal services, and cover the broad public health agenda, including disaster preparedness, risk management and the International Health Regulations, encompassing action on the social determinants of health and the interaction between the health sector and other sectors in society. In the face of both these gradual and acute changes over the past decade, NHPSPs, and more importantly the process of developing the NHPSP, need to be adapted and given a different focus. This handbook aims to make the case that strategizing – meaning designing plans and policies to achieve a particular goal related to the health of a nation – is absolutely critical in the 21st century. It is not only recommended by the Member States of the World Health Organization (WHO), but is also feasible for all countries in all settings. This handbook builds on the experiences gathered by WHO and its partners during the MDGs era. It presents the way of developing NHPSPs from a new pluralistic perspective, and it advocates for policy dialogue as a means to ensure inclusiveness and the participation of both service providers and the population in debates and the decision-making process with the government, as well as in the follow-up, monitoring and evaluation of NHPSP implementation.

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Strategizing national health in the 21st century: a handbook Chapter 1 Introduction 1

1PC

Strategizing national health in the 21st century: a handbook

Chapter 1

Introduction

Gerard Schmets

Sowmya Kadandale

Denis Porignon

Dheepa Rajan

1PC

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

1PC

DHC

SNL

I CHAPTER 1 Introduction: strategizing national health in the 21st century

P C CHAPTER 2 Population consultation on needs and expectations

S A CHAPTER 3 Situation analysis of the health sector

P S CHAPTER 4 Priority-setting for national health policies, strategies and plans

S P CHAPTER 5 Strategic planning: transforming priorities into plans

O P CHAPTER 6 Operational planning: transforming plans into action

CHAPTER 7 Estimating cost implications of a national health policy, strategy or plan

B CHAPTER 8 Budgeting for health

ME CHAPTER 9 Monitoring and evaluation of national health policies, strategies and plans

Cross-cutting topics relevant to national health planning

LR CHAPTER 10 Law, regulation and strategizing for health

CHAPTER 11 Strategizing for health at sub-national level

IP CHAPTER 12 Intersectoral planning for health and health equity

CHAPTER 13 Strategizing in distressed health contexts

SNL

DHC

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

1PC

WHO Library Cataloguing-in-Publication Data

Strategizing national health in the 21st century: a handbook / Gerard

Schmets … [et al].

Contents: 13 individual chapters

1.Health Policy. 2.National Health Programmes. 3.Health Planning.

4.Handbooks. I.Schmets, Gérard. II.Rajan, Dheepa. III.Kadandale,

Sowmya. IV.World Health Organization

ISBN 978 92 4 154974 5 (NLM classiﬁcation: WA 540)

available on the WHO website (http://www.who.int) or can be purchased

from WHO Press, World Health Organization, 20 Avenue Appia, 1211

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The named editors have overall responsibility for the views expressed

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The document has been produced with the ﬁnancial assistance of

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of the European Union nor the Grand Duchy of Luxembourg.

Graphic design by Valerie Assmann.

Suggested citation: Schmets G, Kadandale S, Porignon D, Rajan D.

Chapter 1. Introduction. In: Schmets G, Rajan D, Kadandale S, editors.

Strategizing national health in the 21st century: a handbook. Geneva:

World Health Organization; 2016.

Introduction

Gerard Schmets

Sowmya Kadandale

Denis Porignon

Dheepa Rajan

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

1PC

iii

Contents

Acknowledgements iv

1.1 Rationale for this handbook 1

1.2 Context in the 21st century 2

1.2.1 Sustainable development goals, strengthening health systems and universal

health coverage 2

1.2.2 The ﬁscal gap and the importance of domestic resources 6

1.2.3 A whole-of-government and a whole-of-society approach to policy dialogue 8

1.2.4 Different contexts, different countries, different strategies for strengthening

a health system 14

1.3 NHPSPs in the 21st century 17

1.3.1 Good practice for the development of robust NHPSPs 17

1.3.2 Dynamic 21st century process 27

1.4 The handbook scope and content 29

1.4.1 Scope 29

References 33

Acknowledgements

We would like to give special thanks to Agnes Soucat for overall guidance.

Thanks are also due to Alyssa Muggleworth Weaver for overall background research

support.

Information and graphs for boxes were provided by Maryam Bigdeli, Jim Campbell,

David Clarke, Carmen Dolea, Edward Kelley, Marie-Paule Kieny and Nuria Toro Polanco.

English language editing was provided by Dorothy van Schooneveld and Thomson Prentice.

We gratefully acknowledge ﬁnancial support from the European Union and the Grand

Duchy of Luxembourg.

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

1PC

The global health environment is becoming

increasingly complex. Social, demographic and

epidemiological transformations fed by globali-

zation, urbanization and ageing populations pose

challenges of a magnitude that was not anticipated

three decades ago. In addition, recent global

health security threats such as the Ebola virus

disease or Zika virus outbreak, and the growing

mismatch between the low performance of health

systems and the rising expectations of societies,

are increasingly becoming a cause for political

concern. This often leads to countries prioritizing,

or re-prioritizing, efforts towards strengthening

health systems, moving towards universal health

coverage (UHC) and implementing the idea of

health in all policies.1

Countries recognize that these calls for efﬁciently

strengthening health systems and improving

health security must be translated into robust,

realistic, comprehensive, coherent and well

balanced health policies, strategies and plans.

In the post-Millennium Development Goals

(MDGs) era, they also recognize that in pluralist,

mixed, public-private health systems, these

policies, strategies and plans have to relate to

the entire health sector and cannot be limited

anymore to “command-and-control” plans for

the public sector.

Functional health systems that deliver high quality

services to the population are the main priority for

governments. Achieving this requires permanent,

well-structured and dynamic processes, with a

true consensus between the demand and supply

of services, as well as between governments,

services providers and the population. A solid,

evidence-informed policy dialogue is the only

real way to achieve this in the 21st century.2,3,4

1.1 Rationale for this handbook

Furthermore, it is now widely understood that

national health policies, strategies and plans

(NHPSPsI) extend much beyond “health care”,

i.e. clinical personal services, and cover the

broad public health agenda, including disaster

preparedness, risk management and the Inter-

national Health Regulations, encompassing

action on the social determinants of health and

the interaction between the health sector and

other sectors in society.

In the face of both these gradual and acute

changes over the past decade, NHPSPs, and

more importantly the process of developing the

NHPSP, need to be adapted and given a different

focus. This handbook attempts to address that

need.

In the context of the Paris, Accra and Busan

principles of effective development cooperation,

it is also widely recognized that in countries

that receive signiﬁcant external aid, NHPSPs

are increasingly seen as crucial for making aid

more effective.

It is recognized that, during the MDGs era,

plans or policies did not always fulﬁll their

promises; this was often because of design

deﬁciencies or implementation failures. It was

common to observe that national plans were

not inclusive, not comprehensive enough, often

imbalanced and incoherent with the wide variety

of health problems to be tackled. Often, there

was a disconnect between national plans and

the broader national development policies or

policy frameworks, health ﬁnancing strategies

and macroeconomic policies.

I The terms “policy”, “strategy” and “plan” are used interchangeably

by WHO, following a WHO Global Policy Group meeting and decision

in 2009.

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

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This handbook aims to make the case that

strategizing – meaning designing plans and

policies to achieve a particular goal related to

the health of a nation – is absolutely critical in

the 21st century. It is not only recommended

by the Member States of the World Health

Organization (WHO), but is also feasible for all

countries in all settings.

This handbook builds on the experiences gathered

by WHO and its partners during the MDGs era.

It presents the way of developing NHPSPs from

a new pluralistic perspective, and it advocates

for policy dialogue as a means to ensure inclu-

siveness and the participation of both service

providers and the population in debates and the

decision-making process with the government,

as well as in the follow-up, monitoring and

evaluation of NHPSP implementation.

UHC will only be achieved by its target date of

2030 if consistent and comprehensive health

systems are developed, ones which are able to

deliver on health outcomes and the well-being of

the populations they serve. In particular, strong

health systems are essential to ensure both

individual and global public health security. As

sharply illustrated during recent health emer-

gencies in West Africa, or natural disasters in

Nepal and the Philippines, health systems must

also be prepared to guarantee the health security

of the population and the resilience of societies.

Health system strengthening (HSS) efforts thus

must be scaled up immediately. HSS is the

process of identifying and implementing the

changes in policy and practice in a country’s

health system (institutions, people and actions),

so that the country can respond better to its

health and health system challenges.

HSS

implies mobilizing or better prioritizing the

allocation of ﬁnancial resources for health, as

well as building the capacities of health systems

in a variety of institutional, economic, ﬁscal, and

political contexts.

1.2.1 Sustainable development

goals, strengthening

health systems and

universal health coverage

As the world shifts from the MDGs to the Sustain-

able Development Goals (SDGs), governments

are afforded a tremendous opportunity to better

engineer the development of their countries. This

is particularly relevant in the health sector, as

countries make progress towards universal health

coverage (UHC), i.e. ensuring that all people have

access to needed promotive, preventive, curative

and rehabilitative health services, of sufﬁcient

quality to be effective, while also ensuring that

people do not suffer ﬁnancial hardship when paying

for these services.5 In other words, this entails

reducing the gap between access, need for and

use of services, improving quality, and improving

ﬁnancial protection (see Fig. 1.1).

1.2 Context in the 21st

century

reduce cost

sharing and

fees include

other

services

Direct

costs:

proportion

of the

costs

covered

Services:

which services

are covered?

Population:

who is covered?

Extend to

non-covered current pooled funds

Fig. 1.1 Moving towards UHC6

Strategizing means

designing plans

and policies to

achieve a particu-

lar goal related

to the health of a

nation.

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

1PC

Health systems and their strengthening are seen

as the foundational set of policies, institutions,

actions, approaches and tools, required to achieve

the goals of UHC and the SDGs. Attaining these

goals will, in turn, make essential contributions

to global health security and resilient societies,

equitable health outcomes and well-being, and

inclusive economic growth —a dynamic further

illustrated in Fig. 1.2 below. Realistically, strate-

gizing for health needs to build on solid ﬁnancial

evidence and a stable ﬁnancial perspective, as

discussed in the next section.

Fig. 1.2 A framework for UHC as part of the SDGs

Box 1.1

Key concepts for the HSS agenda

A health system is the aggregate of

all public and private organizations,

institutions, and resources mandated

to improve, maintain or restore health.

This includes both personal and pop-

ulation services, as well as activities

to inﬂuence the policies and actions of

other sectors to address the political,

social, environmental, and economic

determinants of health.

Health system strengthening is the

signiﬁcant and purposeful efforts to

improve the performance of existing

health systems.

Resilience reﬂects the ability of health

systems and institutions and societies

to absorb disruptions, adapting and

responding as needs evolve and the

wider context changes. Resilience is

a dynamic objective, captured over

time as systems progressively build

capacities to effectively respond to

future shocks.

Health security has two separate

dimensions—individual and collective.

Improving individual health security

aims at reducing individual vulnerability

to health risks through trusted access

to safe and effective health services,

products, and technologies. Collective

health security at the global level

involves reducing the vulnerability of

societies to health threats that spread

across national borders.

Universal health coverage: all peo-

ple and communities receive needed

quality health services (including

prevention, promotion, treatment,

rehabilitation, and palliation) without

ﬁnancial hardship.

Strategizing for

health relates to

SDG 3 but also to

other SDGs such

as SDG 1 (Poverty),

SDG 4 (Education,

SDG 5 (Gender

equality) or SDG

8 (Inclusive eco-

nomic growth and

decent jobs).

Adapted from a presentation by Kieny, MP, Category Network

Meeting, Geneva, January 2015

Determinantsofhealth



Determinantsofhealth



HealthSystemsStrengthening

UniversalHealthCoverage

Allpeopleandcommuni.esreceivethequality

healthservicestheyneed,withoutﬁnancialhardship

Globalpublic

healthsecurityand

resilientsocie.es

Inclusiveeconomic

growthandhealth

sectorjobs

Equitablehealth

outcomesand

wellbeing

ACTIONS

GOAL

RESULTS

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

1PC

1.2.2 The ﬁscal gap and

the importance of domestic

resources

Estimates of the resources required to strengthen

health systems point to a stark ﬁnancial gap.

In 2015, WHO estimated that the minimum

investment required in the health sector for

countries to attain the SDGs by 2030 is USD 55

billion per year.II Of this annual amount, according

to the The Taskforce on Innovative International

Financing for Health Systems, between two thirds

and three quarters— USD 40 billion—must be

spent on HSS efforts.8

The global HSS gap of USD 40 billion per year

demands additional resources, as well as a

realignment of existing resources. One cannot

expect that this gap, mainly located in low and

middle income countries, will be covered by

external aid. Indeed, in 2013, the total combined

amount of funding for HSS from all international

sources was just over USD 2.3 billion, whereas

funding for disease-speciﬁc programmes such

as HIV/AIDS, tuberculosis or malaria amounted

to USD 34 billion.9 It is unrealistic to expect a

twenty-fold increase in external aid for HSS

to reach the required annual funding targets.

Consequently, this gap will need to be covered

by domestic funding (government and household

contributions).

As echoed in the 2015 Addis Ababa Action

Agenda,

the growing use of domestic resources

for ﬁnancing the health sector signiﬁes that

governments must make smart choices in

determining how and where investments are

made. In 2013, domestic resources represented

75% of total health spending in fragile states

and low-income countries, and more than 95%

in middle-income countries.

Notably, however,

these domestic resources are often not optimally

distributed, neither geographically nor among

various income quintiles. Out-of-pocket expendi-

tures remain unacceptably high.

III

This trend also

suggests the need to reduce fragmentation and

duplication among the different programmes,

thereby increasing efﬁciency within and outside

the health sector.

These issues of misallocation and inefﬁcient

use of domestic resources in many low- and

middle-income countries underline the crucially-

important role of better strategizing and planning

domestic resources in order to improve the health

and well-being of populations. NHPSPs need

to be guided by a better and more efﬁcient use

of existing domestic resources, and by a very

strategic and very well reﬂected allocation of the

expected additional future domestic resources.

This requires increased accountability of all

concerned stakeholders, with strong policy

dialogue at the highest level. As discussed in

the next section, to achieve these objectives,

strategizing national health in the 21st century

clearly needs to be inclusive of all relevant

actors and sectors.

III In 2013, out-of-pocket expenditures represented 49% of total

health expenditures in this group of countries, while public

expenditures represented only 39% of total health expenditures.

II WHO estimates 2016, based on the 2009 Financing for Development

Conference.

Box 1.2

Why are sound NHPSPs so important?

The evidence from Africa

In the 2016 WHO report Public ﬁnancing for

health in Africa: from Abuja to the SDGs,12

WHO concluded that “For every USD 100

that goes into state coffers in Africa, on

average USD 16 is allocated to health, only

USD 10 is in effect spent, and less than

USD 4 goes to the right health services.”

The authors assessed that four key areas

need to be addressed to overcome this situa-

tion: (1) the de-prioritization of health in the

context of increasing revenues; (2) funding

inconsistency and the lack of predictability

of both domestic and external resources for

health; (3) budget underspending; and (4)

misallocation of resources.

The development of sound health poli-

cies and strategies through intersectoral

(whole-of-government) and intrasectoral

inclusive policy dialogue with all health

stakeholders (whole-of-society) is the way

forward. In other words, to address the

above-mentioned key issues, robust NHPSPs

that reﬂect the vision, formalize the agree-

ments, and put implementation aspects down

on paper, need to be developed. They must

be well prioritized and reﬂect the needs and

the demand for health services, with resource

allocation orientated towards UHC objectives.

They need to clearly specify health sector

goals and be anchored in strong political

agreements to improve consistency and

predictability. NHPSPs must be well trans-

lated into operational plans and budgets that

will allow for full implementation. They also

need to be well monitored and transparently

evaluated for increased accountability and

transparency.

NHPSPs need

to be guided by

better and more

efﬁcient use of

existing domestic

resources, and by a

very strategic and

very well reﬂected

allocation of the

expected addition-

al future domestic

resources. This

requires increased

accountability

of all concerned

stakeholders,

with strong policy

dialogue at the

highest level.

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

1PC

Linked to the evolution of democratic and

human right values in national debates, and

supported by more rapid, real-time commu-

nication offered by the media in the age of the

internet, governance has evolved towards a

whole-of-government and a whole-of-society

approach: improving health and well-being is

no longer the role of the public health sector

only, and no longer only under the purview of

Box 1.3

Policy dialogue: a fundamental process for

the development of truly “whole-of-society”

and “whole-of-government” NHPSPs?13

Policy dialogue can be deﬁned as the “set

of formal and informal exchanges aimed at

facilitating policy change, inﬂuencing policy

design and fostering further processes for

decision-making where stakeholders of the

different health system levels participate and

contribute”. It is an iterative inclusive process

connecting the technical to the political,

addressing the aspirations of the people,

involving multiple stakeholders aimed at

questioning and changing formal or informal

policy, strategy and plans or addressing

speciﬁc health issues to have maximum

(public) health impact through a face-to-face

and interactive discourse.

In the health sector, the entry points for policy

dialogue can be very diverse. The entry point

may be an issue that has arisen in the course

of a policy process that provokes dialogue,

often (but not always) due to the sensitivity

or the wide-reaching consequences of the

policy. It can be the emerging need for reforms,

national or sub-national political debates,

technical challenges, or even operational

problems related to health systems or disease

control activities. Examples of such entry

points are health system reform, ﬁscal policy,

health ﬁnancing strategies, coordination of

stakeholders within and outside of the health

sector, health accounts, human resources

for health, service delivery models, and drug

pricing strategy, among many others.

Ideally, a robust policy dialogue leads to key

policy decisions with the buy-in and ownership

of a wide range of stakeholders – this is crucial

because policy implementation is directly

dependent on buy-in from at least those

stakeholders who are involved in implemen-

tation. Stakeholder ownership is invaluable

and is, among other things, a consequence of

having a voice in the policy process. It includes

any communication (informal consultations,

electronic correspondence, corridor meetings,

among others) or contact between people

who are ultimately contributing in some way,

shape, or form to a process which culminates

in a policy decision. Policy dialogue provides

a means to enhance mutual understanding

of problems and to expand trust between

partners by providing a platform to clarify

expectations and agree on commitments.

Policy dialogue also offers a way to increase

accountability, more effectively implement

policies, and more rapidly respond to barriers

or challenges that are ideally addressed in a

collective and collaborative manner.

Ensuring continued participation of all the

actors necessitates innovation to allow

dialogue outside the formal frameworks

and spaces that constitute formal dialogue

processes.

the ministry of health (see Box 1.4). In other

words, all sectors are part of the UHC road to

success, and all stakeholders, beneﬁciaries,

providers and the state must be involved in its

design, implementation and follow-up. By thus

taking on an increased role in deﬁning the “what”

and the “how”, health actors accept increased

responsibility and accountability for delivering

results on agreed targets.

1.2.3 A whole-of-government and a whole-of-society approach to

policy dialogue (see Box 1.3)

Recent policy

dialogue processes

at country level

have demonstrated

that ﬂexibility is

key to supporting

strategic interven-

tions. A Ministry of

Health should be

capable to adapt its

policy orientations

to the evolution

of the national

situation as well as

to the transforma-

tion of the outside

world.

Fig. 1.3 Structuring the policy dialogue14

State:

Politicans and

Policy Makers

Providers

Clients/

Citizens

Client Power: Technical Input and Oversight

Services

Compact: Directives,

Oversight, and Resources

Information,

Reporting, and Lobbying

Responsiveness

Voice:

Preference Aggregation

Political

Parties

Programmes

Private

sector

ELECTIONS

Professional

associations

CSOs

NGOs

CSOs

NGOs

CSOs

NGOs

LOBBIES

Partners

institutional

reform

Governement

Policy

Decentralisation

Clients

Patients

Political

Parties

Programmes

Private

sector

ELECTIONS

CSOs

NGOs

Partners

institutional

reform

Governement

Policy

Clients

Patients

Decentralisation

professional

associations

LOBBIES

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

10 11

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Box 1.4

Overview of health system governance in Cabo Verde 201614

How do participation and inclusiveness play out

in practice? A recent analysis of health stake-

holders and major health governance issues in

Cabo Verde demonstrates the sheer plethora of

actors involved in the health sector. The graph-

ical and visually “busy” representation above

makes it strikingly clear how overwhelming

the health policy arena can be. The illustration

elucidates how complex a simple stakeholder

analysis can be, with multiple actors, multiple

interests and a multiplicity of relationships and

connections between them. It also drives home

the point that the health policy playing ﬁeld is

no longer necessarily dominated by the public

sector, and that participation and inclusiveness

must be structured and managed.

State and

decision makers

Service

providers

Citizens

HMYS, accounts

Performance indicators

Public hospitals

Regional hospitals

Health centres

Private clinics

Services

Patients’

power

Citizen voice

Patients

Unions

ADECO

Parliamentary

group

Other ADECO activities

incl media relations

ADECO on Conselho

National de Soude

Health issues in assembly

Union rep on INSP board

Complaints (hospitals, INPS)

Patients satisfaction surveys

ADECO dialogue with

hospitals and RS

Reporting

Lobbying

Essential package of

health services

Other health

services

Private pharmacies

Medical, nursing

and other schools

EMPROFAC

INPHARMA

MSSS

Prime Minister’s Ofﬁce

M of Economy

M ﬁnance

Ad-hoc commissions:

EML, Pricing of services

Constitution

Lei de Base

Other laws and regulations

Programma do Governo

Health sector strategic plan

Health budget

INPS lump sum INPS

reimboursements

Human resources

training and

deployment

INPSARFA IGS

IGAE

DGF

NQI

DNS

Responsiveness

Directives

Resources

Supervision

Orders of

M and F

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The national and in some cases international

stakeholders need to agree on baselines and

targets, on methods and strategies to achieve the

targets, on plans to implement the strategies,

on mechanisms and process to monitor and

correct strategies in a dynamic environment

where external conditions will guide and reshape

initial strategies to keep the objectives on track

all along the journey.

They will need to be present at all levels, wherever

a decision-making process is needed. In highly

decentralized countries, it may mean a pluralistic

participation in various facility boards or other

steering, management or health committees.

In all cases, it is clearly a dynamic process that

needs to be sustained: in order to be effective

and ensure accountability, this policy dialogue

is not a “one shot” exercise; it is a permanent

process to guide countries towards UHC (Box 1.5).

Box 1.5

Using crises to improve health planning

The 2014-15 Ebola Virus Disease (EVD)

outbreak in West Africa exposed signiﬁcant

gaps in the health systems of the affected

countries. Prior to that period, Sierra Leone

had embarked on a series of efforts to

improve national health planning: the National

Health Sector Strategic Plan 2010-2015,

which provided the overarching framework

for informing the strategic orientations

of the country; the Joint Programme of

Work and Funding 2012-2014, which aligned

interventions to key sector priorities; the

Basic Package of Essential Health Services

2010-2015, which provided the platform

for guiding delivery of health services and

a Results and Accountability Framework

2010-2015, which articulated the monitoring

and evaluation requirements to support

health services management. With the EVD

epidemic, the implementation of many of

these measures was hindered. However,

the post-Ebola environment has provided a

fertile ground for improved national health

planning, incorporating the lessons learnt

from the past as well as during the outbreak

to enhance the health and well-being of the

population. The Government of Sierra Leone,

with support from partners, has identiﬁed a

series of targeted, prioritized interventions

across all sectors to revitalize the country.

In health, this has meant a sustained effort

in the 6-9 month period following Ebola to

tackle patient safety and revive essential

services, while in the medium-term 10-24

months, there have been identiﬁed key

result areas to reduce maternal and child

mortality, maintain a ‘resilient zero’ – i.e. no

new cases of Ebola, and provide care to EVD

survivors. These prioritized interventions

have enabled the Government and partners

to rationalize limited resources, allowing for

focused planning, budgeting and monitoring.

Similarly, the lessons from Tunisia illus-

trate the impetus crises can provide to

strengthen planning processes. During the

post-revolution period, in 2012, the Govern-

ment launched a “societal dialogue”, which

was instrumental in providing the basis for

sector’s health priorities.IV

These two experiences – from Sierra Leone

and Tunisia – highlight the growing recognition

by countries to move towards innovative ways

of better planning for health, particularly,

as they emerge from challenging situations.

IV For more information, please see chapter 2 “Population

consultation on needs and expectations” in this handbook

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1.2.4 Different contexts,

different countries,

different strategies for

strengthening a

health system

In national planning and policy dialogue, con-

text is of prime importance and thus blueprint

approaches are unlikely to provide sufﬁcient

support. Fortunately, enough knowledge has

been accumulated to identify good practice

elements. Experience shows that the policy

dialogue for building comprehensive NHPSPs

is as much a political process as a technical

one. The balance between vision and policy,

and operational detail and implementation

arrangements, varies considerably from country

to country, as well as within the same country

over time.

Some countries are more advanced in the

process, while others are still facing fatal gaps

that need to be addressed in order to improve

population health. The way systems are strength-

ened will be different in every country context,

and subsequently reﬂected as such in each

NHPSP. WHO has categorized three broad

country contexts from the speciﬁc vantage point

of strengthening health systems as a means to

achieve UHC (see Fig. 1.4).

These are further described below, and are

pertinent with regard to the NHPSP content.

1. Strategy 1: “F”: Strengthening health sys-

tems foundations in least-developed and

fragile countries with poor health system

performance and negligible ﬁscal space to

increase public spending on health.

Strategy 2: “I”: Strengthening health systems

institutions in least-developed countries

where the health system foundations are

in place.

Strategy 3: “T”: Supporting health systems

transformation in countries with mature

health systems where reaching UHC and

health security is still challenging.

Building

Foundations

Health system development towards UHC

Fig. 1.4 Health systems contexts and the WHO FIT strategies16

Context is of prime

importance in na-

tional planning and

policy dialogue.

UHC

Strengthening

Institutions

Supporting

Transformation

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1.3.1 Good practice for the

development of robust

NHPSPs

The various contextual factors summarized

above have translated into a renewed focus

on strengthening countries’ capacity to strate-

gize their health and develop robust, efﬁcient,

evidence-informed NHPSPs that can:

respond to growing calls for strengthening

health systems as a means towards achieving

UHC;

guide and steer the entire pluralist health

sector rather than being limited to command-

and-control plans for the public sector alone;

go beyond the boundaries of health systems,

addressing the social determinants of health

and the interaction between the health sector

and other sectors in society;

be used as the key element for governmen-

tal negotiations regarding ﬁscal space and

budget execution;

be used, mainly in countries with “founda-

tional” problems, where external aid plays a

signiﬁcant role, as the key element to improve

development effectiveness.

The current context favours getting more value

from NHPSPs, with a growing expectation that

they will be informed by a realistic assessment

of capacities and a bold vision of the future,

1.3 NHPSPs in the 21st century

with much more emphasis on stakeholder

accountability. In addition, in a globalized world,

expectations are growing that NHPSPs will

support the development of resilient health

systems leading to more security, more equity

and more health.

Based on this, elements of good practice for

developing robust national health policies,

strategies and plans are outlined below.17

(a) UHC as an overarching vision

While UHC is generally accepted as an overall

objective to strive for, in practice this means

that all debates and discussion take place with

the following in mind:

ensuring coverage of the population – leaving

no one behind;

ensuring ﬁnancial health protection and

avoiding catastrophic expenditures;

providing a comprehensive package of

high-quality integrated and people-centred

health services (see Box 1.6).

A robust, efﬁcient,

evidence-informed

NHPSP should be

able to guide and

steer the entire

pluralist health

sector, and form

a key element for

ﬁscal space and

budget negotia-

tions in govern-

ment.

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Box 1.6 Box 1.7

Framework on integrated people-centred health services The International Health Regulations

Globally more than 400 million people lack

access to essential health care. Longer

lifespans and the growing burden of long-term

chronic conditions requiring complex inter-

ventions over many years are also changing

the demands on health systems.

Adopted by Member States at the World Health

Assembly in May 2016, the Framework on

integrated people-centred health services

(IPCHS) aims to address these issues by call-

ing for a fundamental shift in the way health

services are funded, managed and delivered.

The Framework presents a compelling vision

of a future in which all people have access to

health services that are provided in a way that

is coordinated around their needs, respects

their preferences, and is safe, effective,

timely, affordable, and of acceptable quality.

It proposes ﬁve interdependent strategies:

The International Health Regulations (IHR

(2005)) represent a binding international legal

agreement involving 196 countries, including

all the Member States of WHO. The purpose

and scope of the IHR (2005) is to prevent,

protect against, control and provide a public

health response to the international spread

of disease in ways that are commensurate

with and restricted to public health risks,

and which avoid unnecessary interference

with international trafﬁc and trade.

The IHR (2005), which entered into force on

15 June 2007, establish the procedures that

WHO and States Parties must follow to uphold

global public health security. Under the IHR

(2005), States Parties are required to assess

and notify to WHO public health events that

may constitute a public health emergency of

international concern, on the basis of deﬁned

criteria, which include the seriousness of the

event, its unusual or unexpected features, the

risk of its international spread and the risk

of international travel or trade restrictions.

(1) empowering and engaging people and

communities; (2) strengthening governance

and accountability; (3) reorienting the model

of care; (4) coordinating services within and

across sectors; and (5) creating an enabling

environment.

Developed as a universal vision – the Frame-

work can be adapted to all countries whether

high-, medium- or low-income, with mature

or fragile health systems.

Related links:

WHO Website on IPCHS:

http://www.who.int/servicedeliverysafety/

areas/people-centred-care/en/

Integratedcare4people web platform:

http://www.integratedcare4people.org

WHO is obliged to request veriﬁcation of

events that it detects through its surveillance

activities with the countries concerned,

who must respond to such requests in a

timely manner. Notiﬁcations and information

are communicated by a National IHR Focal

Point to a WHO IHR Contact Point which,

together, establish a unique and effective

communications network between countries

and with WHO. States Parties are further

required to ensure that their national health

surveillance and response capacities meet

certain functional criteria, and to report

annually to the World Health Assembly on

the implementation of the IHR.

Building synergies between IHR core capac-

ities, strengthening health systems and

essential public health functions is key to

ensure a coordinated and effective response

to global public health threats.

WHO website on IHR: http://www.who.int/

topics/international_health_regulations/en/

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Box 1.8

High-Level Commission on Health Employment

and Economic Growth

The High-Level Commission on Health

Employment and Economic Growth was

launched by the UN Secretary-General in

March 2016 with the aim of stimulating and

guiding the creation of 40 million new jobs in

the health and social sector, and to reduce

the projected shortfall of 18 million health

workers, primarily in low- and lower-middle

income countries, by 2030. The Commission,

chaired by the Presidents of France and South

Africa, submitted its report Working for health

and growth: Investing in the health workforce to

the UN Secretary-General on 20 September

2016. The Commission is a strategic political

initiative that lends momentum to implemen-

tation of the WHO Global Strategy on Human

Resources for Health: Workforce 2030.

The Commission’s vision is an expanded,

transformed and sustainable health work-

force that will deliver beneﬁts across the

Sustainable Development Goals (e.g. poverty

elimination, good health and well-being,

quality education, gender equality, and decent

work and economic growth). The Commission

proposes six recommendations to transform

the global health workforce to address SDG

needs, focusing on the following areas: job

creation, gender equality, education training

and competencies, health service delivery

and organization, technology, and crisis and

humanitarian settings. An additional four

recommendations, in the areas of ﬁnancial

and ﬁscal space, partnerships, international

migration, and data, information and account

ability, are presented as enabling factors for

this transformation.

Stressing the urgency for action, the Com-

mission identiﬁes ﬁve immediate actions to

be taken between October 2016 and March

2018, aligned with national, regional and

global processes. These include accelerated

actions on technical and vocational educa-

tion and training, labour mobility, national

health workforce accounts, and enhanced

accountability. Moreover, ILO, OECD, and

WHO, the Vice-Chairs of the Commission,

are tasked with bringing together relevant

stakeholders by the end of 2016 to develop a

ﬁve-year implementation plan to give effect

to the Commission’s ten recommendations.

All stakeholders are invited to integrate the

Commission’s recommendations in their

national, regional and international plans.

WHO website on the Commission: http://

www.who.int/hrh/com-heeg/en/

One recent example is the United Nations

Secretary

General’s 2016 High-Level Commission

on Health Employment and Economic Growth

(see Box 1.8); the co-chairs, French President

Francois Hollande and South African President

Jacob Zuma, in their speech to the UN General

Assembly in September 2016, invited “all stake-

holders to join … in implementing … [the] ten

recommendations [of the Commission’s ﬁnal

report] and to integrate these in their national,

regional and international plans. We need to align

our efforts with other related plans if we are to

achieve the Sustainable Development Goals.”

NHPSP content

The emphasis given to policy, strategy formu-

lation and planning must be based on a broad

and inclusive consultation on what affects the

health sector, in order to ensure balanced and

coherent choices of what to address and what

not to address in the given context. The follow-

ing range of elements and structures deserve

consideration.

A comprehensive analysis should be under-

taken of current and future challenges in the

health sector, ideally covering: stakeholder

positions; social determinants of health and

health needs; demand for services and social

expectations; health system performance

and shortfalls, including the system’s ability

to respond and anticipate.

NHPSP content should be well-balanced in

terms of ﬁnances and inputs, as well as depth

of analysis on the principal health issues of

the country. In other words, each strategic

direction needs to be developed with the same

level of detail as the others, and with a level

of resources that rightly corresponds to its

extent and scope. On ﬁnances, this implies

that the resources and costs necessary to

implement the NHPSP is reasonable and

within the given ﬁscal space for health.

Coherence should be assured with: other

sectors and the national development plan;

with programme-speciﬁc or sub-sector plans;

with the epidemiological and socioeconomic

context; and with the available current and

estimated future resources.

Scenarios and policy directions should

move towards universal coverage, shifting

health-care delivery towards integrated

people-centred health services,

protecting

and promoting the health of communities

and building capacity to deal with future

challenges.

Intersectoral mindset should be fostered,

implying that governments and other stake-

holders proactively address the determinants

for health inequities by identifying and pro-

moting intersectoral action as an integral

and vital component of the national health

planning process.

The associated costs and resource mobi-

lization implications should be carefully

considered.

Attention should be devoted to the lead-

ership and governance arrangements for

implementing the strategy in terms of the

role of various institutions and stakeholders,

regulatory and legal frameworks to ensure

sustainability, working with other sectors,

dealing with the donor community and mon-

itoring performance.

(d) Sound process

As explained in Box 1.3, policy dialogue is more

likely to lead to better results, such as improved

service delivery and better outcomes, if it is inclu-

sive of all relevant social, technical and political

stakeholders in and beyond the health sector.

The quality of the process of policy dialogue is

crucial to formulating the goals, values and

overall policy directions that will guide strategy

Policy formulation

must be based on

broad and inclusive

consultation in

order to ensure

balanced and

coherent choices

of what to address

by priority in the

given context.

(b) The international context

An NHPSP should be compliant with the Interna-

tional Health Regulations

(Box 1.7), the Global

Framework Convention on Tobacco Control19

as well as other WHO recommendations or UN

resolutions.

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formulation, planning and decision-making.

The process must support consensus building

at different stages of the planning process,

including situation analysis, priority-setting,

NHPSP design, implementation and review. A

sound process encompasses mechanisms for

obtaining feedback on implementation, and

initiating corrective measures, as well as high-

level endorsement of these policy directions.

Smart timing is crucial for alignment with

broader development frameworks and country

political and institutional cycles.

(e) Realism

NHPSPs are more likely to be implemented if

they are realistic and compatible with the health

sector’s capacities, resources and constraints.

They are more likely to lead to sustained results

if political commitment and policy directions

are translated into legal frameworks. They are

more likely to be effective if the link between

strategic and operational planning is sufﬁciently

ﬂexible to allow for adaptation to unforeseen

economic, political and health events. Finally,

greater commitment is likely to be achieved if the

concerns of the people who are at the forefront

of implementation are adequately reﬂected.

(f) Linkage with operational plans

NHPSPs must be linked to regional or district-

level operational plans. The extent of linkage

depends on the level of detail in the NHPSP

and the degree of autonomy at decentral-

ized level. Some countries choose a more

centralized approach with explicit, tight links

between the national and sub-national plans;

the advantage is coherence between the plans

at different levels, but this may be at the price

of being overly controlling and insufﬁciently

adaptable to context. Other countries opt for

a more decentralized approach leaving much

more freedom of interpretation at decentralized

levels; this allows for ﬂexibility and creativity,

but may affect coherence. Many countries link

the national strategic plan with operational

plans through rolling medium-term plans and

expenditure frameworks.

(g) Linkage with programmes

The extent to which NHPSPs address the con-

cerns and operational plans of the country’s

disease-speciﬁc or life-cycle programmes varies

greatly. In many countries the disconnect to the

NHPSP leads to imbalance or lack of coherence

between health sector planning efforts and

subsequent problems in implementation. The

causes are complex and include: (i) inadequate

situation analysis and priority setting; (ii) the

programme’s operational planning is often

conducted in a different arena, with different

constituencies and with different planning cycles;

and (iii) donors’ earmarking of funds, leading to

fragmentation, competition for scarce resources,

and imbalances in national priority-setting.

Balance and coherence can be improved by

ensuring realistic assessments of how pro-

grammes can draw on shared resources and

capacities, and of the impact they will have on

these shared resources and capacities, and by

adequate reﬂection of programme concerns in the

comprehensive NHPSP. Ideally, the integration

of programmes in the national planning need to

be fully harmonized and aligned, as expressed

in Fig. 1.5.

National Health Policy

Health Vision, and policy directions

National Health Strategic Plan

Strategic Objectives Health System Investments Programmes descriptions

Expenditure Framework Budget

1st annual

Operational

Plan/review

2nd annual

Operational

Plan/review

3rd annual

Operational

Plan/review

Malaria

Strategy

Child Health

Strategy

RH Strategy

(Roadmap)

EPI Strategy

NCD Strategy

HIV Strategy

Other

Strategies

Fig. 1.5 Integration of programmes in NHPSPs

NHPSPs must be

linked to regional

or district-level

operational plans.

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(h) Linkage with the political agenda

The policies, strategies and plans for the health

sector have major political and budgetary impli-

cations, well beyond their direct implications

for the public sector. Eventually they have to be

endorsed as part of the government programme.

As health takes increasing political space in how

countries view their future, the legitimacy of, and

political commitment to, the sector’s policies,

strategies and plans depends on integration with

the broader national development dialogue. In

order for arguments to carry the most weight,

they need to make the linkage by insisting on

the role of health as a factor of development,

rather than relying solely on statements about

expected health beneﬁts.

(i) Strong accountability

Strengthening the institutional base for progress

and performance review, information use and

accountability is essential. This requires con-

siderably improving the quality of the situation

analysis on which policies, strategies and plans

are based; bringing coherence and balance to

priority-setting; facilitating the adoption of a

single country-led monitoring and evaluation

framework; facilitating alignment of international

partners (see Box 1.9); and ensuring accounta-

bility through progress and performance reviews

integrated with country planning processes.

(j) Sustainability

Some countries have been striving to develop

more inclusive approaches to policy dialogue.

However, in most countries, the process remains

largely unsystematic. In some cases, this sit-

uation is partly due to a high turnover of plan-

ners, which constrains the skill base and the

institutional memory. In others, this relates to

successive waves of externally driven prior-

ities and reform agendas. There is a need to

increase the robustness of the process through

a combination of: investing in institutional and

individual capacities for conducting meaningful

policy dialogue; promoting the framework for

guiding the policy dialogue process; assisting

with better synchronization of planning cycles

and better guidelines for programme planning;

and helping to broaden the policy dialogue

beyond the public sector and to align national

health strategies with national development

plans and ﬁnancial policy cycles.

(k) Redeﬁning the role of the Department of

Planning, Ministry of Health

In the 21st century, the role and functions of the

MoH Department of Planning needs to evolve

from a pure planner’s role to a planning and

brokering role, from a top-down approach to a

bottom-up approach and from a monolithic to

an inclusive pluralistic approach.

This department must have adequate human

resources and budget to fulﬁll its new role,

to enable the regular convening of different

stakeholders for a true bottom-up and plural-

istic process.

This department must also be well-connected to

all modern forms of media to ensure transpar-

ency and proper communication to the citizens.

Regular communication requires dedicated

staff time and a budget as well which must

be foreseen. In countries where resources

are scarce, this might need additional support

from donors.

The EU-Luxembourg-WHO Universal Health

Coverage Partnership is an example of a tar-

geted approach to support ministries of health

to more smoothly transition to its more modern

convening & brokering role (see Box 1.10)

In the 21st century,

the role and func-

tions of the MoH

Department of

Planning needs to

evolve from a pure

planner’s role to a

planning and bro-

kering role, from a

top-down approach

to a bottom-up

approach and from

a monolithic to an

inclusive pluralis-

tic approach.

Box 1.9

Health Data Collaborative

The Health Data Collaborative (HDC), launched

in March 2016, is an inclusive partnership of

international agencies, governments, phi-

lanthropies, donors and academics, with the

common aim of improving health data. The

approach is to ensure that different stake-

holders in national, regional and global health

are able to work together more effectively to

make better use of resources, and by doing so

help to accelerate impact of investments and

improvements in country health information

systems. The Health Data Collaborative

aims to put the IHP+ principles of country

ownership and alignment into practice by

translating them into a joint operational plan

that speciﬁes concrete collective actions at

country and global levels.

The work of the Collaborative is facilitated by

a small core team hosted within WHO with

dedicated focal points within key partner

institutions.

One of the ﬁrst countries where this is being

operationalized is Kenya. In to support of the

health ministry’s leadership in integrating

monitoring and evaluation (M&E) systems into

a uniﬁed, more efﬁcient framework, global

health partners are now working together

to harmonize their ﬁnancial and technical

resources to ensure they are in line with

country priorities.V During a four-day meeting

in Nairobi in May 2016, various stakeholders

signed a joint statement of commitments to

support a uniﬁed “One M&E Framework” and

launch the Kenya Health Data Collaborative.

The MoH has drafted a detailed costed

roadmap to be implemented by technical

working groups focused on data analytics,

quality of care, a new national health data

observatory, civil registration and vital sta-

tistics, and informatics. This collaborative

approach is expected to strengthen Kenya’s

health information system through a united

front supporting and investing in one national

M&E plan.

HDC Website:

http://www.healthdatacollaborative.org/

V Please see chapter 9 “Monitoring, evaluation and review of national

health policies, strategies and plans’ in this handbook

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Box 1.10

EU-Luxembourg-WHO UHC partnership

The focus on national health planning and

universal health coverage has gained momen-

tum on the global agenda during the last

few years, leading to more intensiﬁed WHO

country support for health planning, health

ﬁnancing and policy dialogue.

In 2011-2012 the European Union, the Gov-

ernment of Luxembourg and the World Health

Organization entered into a collaborative

agreement to support policy dialogue on

national health policies, strategies and plans

(NHPSP) and universal health coverage

(UHC).

The Partnership was made operational in

28 countries by 2016, with a diverse and

numerous set of activities directly supporting

health policy, health ﬁnancing and effective

development cooperation at country level.

Seed monies are provided to all countries to

actively foster inclusive policy dialogue and

ensure a stronger convening and brokering

role for ministries of health.

The Partnership is an integral part of WHO’s

support to countries’ endeavours to steer

towards universal health coverage, with a

lucid recognition that it can only happen if

ministries of health take on their new and

changing role with conﬁdence. The Partner-

ship provides dedicated WHO Country Ofﬁce

staff to accompany MoH in this ambition,

acknowledging that the new MoH role will

take time to become the norm.

For example, in Moldova, the WHO Country

Ofﬁce and MoH jointly organized a series of

policy dialogue events over the course of 5 years

2012-2016. These events focused on speciﬁc

topics highly relevant to universal health

coverage. The topics were pushed high on the

policy agenda through the inclusive dialogue

process supported by the Partnership. Exam-

ples of some of these topics are: strengthening

public health services, performance-related

pay and service delivery access.

Currently, the Partnership targets the fol-

lowing countries: Burkina Faso, Burundi,

Cape Verde, Chad, Democratic Republic of

the Congo, Guinea, Guinea-Bissau, Kyrgyz

Republic, Lao PDR, Liberia, Mali, Morocco,

Mozambique, Niger, Republic of Moldova,

Senegal, Sierra Leone, South Africa, South

Sudan, Sudan, Tajikistan, Timor-Leste, Togo,

Tunisia, Ukraine, Viet Nam, Yemen, Zambia.

UHC Partnership web site:

www.uhcpartnership.net

1.3.2 Dynamic 21st century

process

The renewed interest in using NHPSPs to enhance

health sector performance and improve the health

and well-being of populations differs substan-

tially from the planning approaches employed in

the 1980s and 1990s (see Fig. 1.6). Indeed, the

poor performance of health systems in many

countries, as well as the rising expectations of

citizens regarding their health, are increasingly

becoming causes of political concern, which in

many countries lead to reforms to put in place

integrated and people-centered health services,

UHC and health in all policies.

That being said, this handbook advocates for

a ﬁnal element of good practice: moving away

from a command and control planning process

towards a process focused on dialogue and debate

(Fig. 1.7), and from a more static planning cycle

mainly owned by department of planning of the

ministry of health towards a dynamic, ﬂexible,

open and pluralist planning process towards

UHC, owned by the community of stakeholders.

This handbook

advocates for a

planning process

focused on dia-

logue and debate

which is dynamic,

ﬂexible, open and

pluralist.

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IPC

DHS

I Introduction: Strategizing national health in the 21st century

PC Population consultation on needs and expectations

SA Situation analysis of the health sector

PS Priority setting for national health policies, strategies, and plans

SP Strategic planning: Transforming priorities into plans

OP Operational planning in the health sector

C Costing a national health policy, strategy, or plan

B Budgeting for health

ME Monitoring and evaluation of national health policies, strategies, and plans

Situation

analysis

Population

consultation

Priority

Setting

Operational

Planning

Budgeting

Monitoring

& Evaluation

Costing

Strategic

Planning

Fig. 1.7 A dynamic policy dialogue-led process

1.4.1 Scope

The handbook covers the main steps of a national

health plan, deﬁned for the purposes of this

book as a medium-term national strategic plan

of approximately 3–7 years. The handbook is

not intended to serve as a classical technical

planning textbook, but rather seeks to capture

the innovative realities of national planning at

the country level, taking into account the policy

dialogue process in ensuring the success of the

plan. It takes the health plan as a living, dynamic

document, with all its associated sub-plans, that

guides overall strategic reforms in a country

rather than as a static, monolithic paper.

Furthermore, the handbook provides a concrete,

practical picture of the different aspects of plan-

ning and develops on existing work, literature

reviews and country experiences. By building on

multisectoral participatory approaches, while

covering all the key elements of national health

planning, the handbook links the conceptual

with the pragmatic – thereby, for the ﬁrst time,

consolidating essential guidance to countries in

one place. It emphasizes the role of democratic

structures and the importance of political will,

while reﬂecting the signiﬁcance of international

legally binding treaties.

1.4 The handbook scope and content

Lastly, recognizing the prominence of vertical

disease programmes and global health initi-

atives in certain settings, the handbook gives

feasible advice in tackling such issues, drawing

on country case studies.

The target audience of the present handbook is

health ministries and other relevant stakeholders

involved in national health planning.

1.4.2 Content

Although national health planning is often viewed

as linear or cyclic in nature, in reality, it is a

complicated, difﬁcult, challenging process (as

illustrated in Fig. 1.8). Therefore, the handbook

can be read in its entirety, but each chapter is

also stand-alone, so it can be easily understood

and used by relevant stakeholders. There is a

clear conducting line among the chapters, with

the main concepts reinforced.

5 year plan

Annual

Review

Annual

Review

Annual

Review

Annual

Review

Bottom-up

participatory

planning cycle

partners

NGO

CSO

GHI

Fig. 1.6 1980s and 90s technocratic planning process

This handbook

links the concep-

tual with the prag-

matic by building

on multisectoral

participatory

approaches,

consolidating

essential guidance

to countries in one

place.

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

30 31

1PC

Fig. 1.8 National health planning in action

In Chapter 2 “Population consultation on needs

and expectations (PC)”, Rohrer and Rajan make

a strong case for including citizens’ voices in

planning processes, providing concrete ways in

which people can be engaged during the devel-

opment of a national health plan. The chapter

outlines the aims of a population consultation, its

speciﬁc added value to national health planning,

and how to undertake a consultation from the

methodological and conceptual perspectives.

In Chapter 3 “Situation analysis of the health

sector (SA)”, Rajan emphasizes the compre-

hensive nature of undertaking a detailed health

sector assessment, taking into account different

methodological options while ensuring broad

stakeholder input. The latter is especially high-

lighted, since a balanced analysis will include

technical analysis as well as opinions, viewpoints

and experiences of health system users.

Similarly, in Chapter 4 “Priority-setting for

national health policies, strategies and plans

(PS)”, Terwindt, Rajan and Soucat guide the

reader through the critical choices that must be

made to determine the strategic directions of

the national health plan. Priority-setting being

a shared responsibility between the ministry of

health (MoH) and the entire health stakeholder

community, a case is made for a structured and

inclusive exercise elaborated upon in the chapter.

In Chapter 5 “Strategic planning: transforming

priorities into plans (SP)”, Terwindt and Rajan

provide guidance on developing a relevant NHPSP

that is referred to, consulted and used. Steps are

proposed to manage the NHPSP development

process, and common challenges and mistakes

are pointed out with suggested solutions.

This leads to “Operational planning: transforming

plans into action (OP)”, Chapter 6, by Shuey,

Bigdeli and Rajan, where implementation issues

linked to strategic planning are explored. They

make the case that operational plans should

not be under the sole remit of professional

planners or managers. The best operational

plans, and certainly the ones most likely to be

implemented, are those that are developed with

the people who will carry them out.

In Chapter 7 “Estimating cost implications of

a national health policy, strategy or plan (C)”,

Stenberg and Rajan provide guidance on costing

options for a NHPSP. They advocate for a process

of estimating costs as a crucial step within

the NHPSP formulation process, as it allows

decision-makers to consider the extent to which

policy objectives and strategic orientations are

feasible and affordable.

In Chapter 8 “Budgeting for health (B)”, Rajan,

Barroy and Stenberg examine health budgets,

national budgeting processes and ﬁscal space for

health. This chapter discusses the speciﬁc role

of the MoH and other health sector stakeholders

within the budgeting process and examines how

they can provide timely inputs.

The main “cycle” of national health planning

concludes with Chapter 9 “Monitoring, evaluation

and review of national health policies, strate-

gies and plans (ME)” by O’Neill, Viswanathan,

Celades and Boerma. This chapter outlines

how monitoring, evaluation and review require

an integrated approach that builds on a single

country-led monitoring and evaluation platform.

In addition, four cross-cutting chapters provide

guidance on critical issues that inﬂuence all

stages of national health planning.

In Chapter 10 “Laws, regulation and strategizing

for health (LR)”, Clarke explores how regulation

represents a key means by which a government

gives effect to its health policy preferences,

especially through the exercise of a government’s

law-making powers.

Given the signiﬁcance of sub-national structures

and functions in health planning, Rohrer unpacks

the key elements of “Strategizing for health at

sub-national level (SNL)” in Chapter 11, going

through each step in the health policy and

planning cycle. The chapter aims at supporting

policy-makers with speciﬁc recommendations

strategizing for health in a decentralized system.

Blas, Roebbel, Rajan and Valentine tackle the

work across sectors to address health deter-

minants in Chapter 12 “Intersectoral planning

for health and health equity (IP)”. They outline

the need and practical action for including

intersectoral planning for health and health

equity as a mindset within the overall process

of strategizing for health.

Finally, in Chapter 13 “Strategizing in distressed

health contexts (DHC)”, Pavignani and Colombo

consider the challenges posed by policy and

strategy formulation in health systems under

stress, highlighting the main differences with

these processes in more stable environments.

The chapters contain country illustrations

throughout the document along with, where

relevant, annexes on relevant tools, documents

and references.

Strategizing national health in the 21st century: a handbook Chapter 1 Introduction

32 33

1PC

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A, Schmets G. Policy dialogue: what it is and how it

can contribute to evidence-informed decision-making.

Geneva: WHO; 2015 (Brieﬁng Note; https://www.

researchgate.net/publication/297698707, accessed

11 October 2016).

3 Nabyonga-Orem J, Dovlo D, Kwamie A, Nadege A,

Guangya W, Kirigia JM. Policy dialogue to improve

health outcomes in low income countries: what are

the issues and way forward? BMC Health Serv Res.

2016;16(4):217 (https://www.ncbi.nlm.nih.gov/pmc/

articles/PMC4959394/, accessed 11 October 2016).

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A. Policy dialogues: the “bolts and joints” of poli-

cy-making: experiences from Cabo Verde, Chad and

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en/index5.html, accessed 11 September 2016).

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October 2016).

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asp?symbol=A/RES/69/313, accessed 11 October

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database] Geneva: WHO; 2016 (http://apps.who.int/

nha/database, accessed 11 October 2016).

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the SDGs. Geneva: World Health Organization; 2016

(Health Financing toward UHC; http://www.who.int/

health_ﬁnancing/documents/public-ﬁnancing-africa/

en/, accessed 11 October 2016).

Rajan D, Adam T, El Husseiny D, Porignon D, Ghaffar

A, Schmets G. Brieﬁng Note: Policy dialogue: What

it is and how it can contribute to evidence-informed

decision-making. Geneva: World Health Organization;

2015 (Brieﬁng Note; https://www.researchgate.net/

publication/297698707, accessed 11 October 2016).

14 Original design, adapted from World Development

Report 2004: Making services work for poor people.

World Bank; 2004. and Brinkerhoff D, Bossert T.

Governance: concepts, experience and program

options. Bethesda: Health Systems 20/20 Project;

2008

adapted by Bigdeli M and Clarke D, from World

Development Report 2004: Making services work

for poor people. World Bank; 2004. and Brinkerhoff

D, Bossert T. Governance: concepts, experience

and program options. Bethesda: Health Systems

20/20 Project; 2008

Foundations Institutions Transformation. World

Health Organization; 2016.

17 Health systems strengthening: improving support

to policy dialogue around national health policies,

strategies and plans: report by the Secretariat to

the Sixty-fourth World Health Assembly. Geneva:

WHO; 2011 (Document A64/12; http://apps.who.

int/gb/ebwha/pdf_ﬁles/WHA64/A64_12-en.pdf,

accessed 12 October 2016).

International Health Regulations (2005), Second

Edition. Geneva: WHO; 2008 (http://www.who.int/

ihr/publications/9789241596664/en/, accessed 11

October 2016).

19 WHO Framework Convention on Tobacco Control.

Geneva: WHO; 2005 (http://www.who.int/fctc/en/,

accessed 11 October 2016).

Framework on integrated, people-centred health

services: report by the Secretariat. Sixty-ninth

World Health Assembly. Geneva: WHO; 2016 (Doc-

ument A69/39; http://apps.who.int/gb/ebwha/

pdf_ﬁles/WHA69/A69_39-en.pdf?ua=1, accessed

12 October 2016).

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34 35

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SNL

DHC

Strategizing national health in the 21st century: a handbook

1PC

Health System Performance Assessment: A framework for policy analysis

Book

Full-text available

Jun 2022

9.I. Workshop: Health systems performance – making the links between what we do and what we want to achieve

Article

Oct 2021

In this session, WHO together with the UHC2030 Technical Working Group on Health System Assessment and the European Observatory on Health Systems and Policies discuss the main elements of their joint approach to HSPA. The workshop intends to propose a common and practical framework that links descriptive health system analysis with evaluation, focussing on health system outcomes. The framework's approach to uncovering health system challenges and bottlenecks and the sources of variation will be discussed - showcasing how Health System Performance Assessment can be used as a means to uncover sources of health system inefficiencies and inequities. The workshop intends to identify the links between intermediate and ultimate goals and relate these to specific actions and actors within a health system, thus providing policy makers with an actionable tool to assess performance. The session is structured into two parts. In the first part the process of developing the HSPA framework and the framework itself will be introduced. The presentation will provide insights into the joint framework based on health system functions and emphasise the links to the intermediate and final goals of the HSPA framework. This will be followed by four short case studies pertaining to the four functions - governance, financing, resource generation and service delivery - and linking specific assessment areas to intermediate and final goals. The second part is an interactive discussion, to be kicked off by the input of Kanitsorn Sumriddetchkajorn and moderated by Josep Figueras, to jointly identify the strengths and weaknesses in performance of a given health system. Key messages • Health Systems Performance Assessments should focus on what health systems do and how well, rather than on what they are. • Health System Performance Assessment should focus on performance and use their evaluative angle to get to the root causes of not achieving final health system goals.

Priority Setting for Collaborative Health Systems Research in India: A Method and the Way Forward

Article

Mar 2022
J Health Manag

A comprehensive and collaborative knowledge translation and decision-making approach can help reduce the longstanding barriers to using research in policy and practice. Regular interaction between researchers and decision-makers increases the likelihood of using research knowledge. This interaction continuing over the entire research cycle is critical for developing research directions and potential use of the research outputs that benefit the health system. The India Health Systems Collaborative and ACCESS Health International have conducted a rigorous exercise to arrive at the priority research topics. A consensus-based method customised to the existing need was created, adapting from the Child Health and Nutrition Research Initiative (CHNRI) method for research priority setting. In this method, conducting literature reviews, key informant interviews and survey-based stakeholder consultations are critical steps for identifying policy-relevant research topics that demand utmost attention in the Indian setting. This article documents the processes followed to develop a preliminary list of core research priorities requiring urgent attention to facilitate policy development. Additionally, the article is about the essential and immediate next steps and the critical actions taken to undertake collaborative research on the identified research topics. The special issue of the Journal for Health Management dedicated to strengthening the Indian health system sets the foundation for promoting collaborative research, its dissemination for broader use by researchers and ensuing policy dialogues.

Optimising antimicrobial use in humans – review of current evidence and an interdisciplinary consensus on key priorities for research

Article

Full-text available

Jun 2021

Addressing the silent pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting. A major driver of AMR and poor clinical outcomes is suboptimal antimicrobial use. Current research in AMR is inequitably focused on new drug development. To achieve antimicrobial security we need to balance AMR research efforts between development of new agents and strategies to preserve the efficacy and maximise effectiveness of existing agents. Combining a review of current evidence and multistage engagement with diverse international stakeholders (including those in healthcare, public health, research, patient advocacy and policy) we identified research priorities for optimising antimicrobial use in humans across four broad themes: policy and strategic planning; medicines management and prescribing systems; technology to optimise prescribing; and context, culture and behaviours. Sustainable progress depends on: developing economic and contextually appropriate interventions; facilitating better use of data and prescribing systems across healthcare settings; supporting appropriate and scalable technological innovation. Implementing this strategy for AMR research on the optimisation of antimicrobial use in humans could contribute to equitable global health security.

A Global SWOT Analysis of Advanced Practice Nursing: Policy, Regulation, and Practice

Preprint

Full-text available

Nov 2020

Background: The advanced practice nursing role has been characterized as task sharing between physicians and nurses, and commonly is a part of national or health system schemes to expand healthcare access and/or to improve efficiencies. However, lack of regulatory uniformity can lead to inconsistent qualifications, competencies, and a limitation of expansion of healthcare services, based on regulated scope of practice. Methods: The SWOT analysis technique (strengths, weaknesses, opportunities, threats) was used to assess the current state of advanced practice nursing worldwide, with specific focus on regulation, education, licensure, and practice. Data were collected broadly from peer reviewed, governmental and regulatory sources, as well as grey literature. Results: Key regulatory elements that frame advanced practice nursing vary significantly by country and region and remain dynamic. However, practice and educational models are outpacing regulatory standards in all six WHO regions. Overall, advanced practice nursing is expanding at an accelerated pace in order to meet population and health system needs, despite weaknesses of the regulatory system, or threats from systems that are not ready to accept innovative strategies. Conclusion: Advanced practice nursing is an innovative role that is progressing broadly in response to the global drivers of an aging population, workforce shortages, the increasing prevalence of non-communicable disease, and the need to develop system-based efficiencies for cost containment. The role is developing organically, driven by local needs, but still lags in terms of the formal regulatory legitimization in many countries. Notably, it is being buoyed by the global movement toward universal health coverage.

Using Open Public Meetings and Elections to Promote Inward Transparency and Accountability: Lessons From Zambia

Article

Full-text available

Jun 2020
IJHPM

Background: Community-led governance can ensure that leaders are accountable to the populations they serve and strengthen health systems for maternal care. A key aspect of democratic accountability is electing respective governance bodies, in this case community boards, and holding public meetings to inform community members about actions taken on their behalf. After helping build and open 10 maternity waiting homes (MWHs) in rural Zambia as part of a randomized controlled trial, we assisted community governance committees to plan and execute annual meetings to present performance results and, where needed, to elect new board members. Methods: We applied a principally qualitative design using observation and analysis of written documentation of public meetings to answer our research question: how do governance committees enact inward transparency and demonstrate accountability to their communities. The analysis measured participation and stakeholder representation at public meetings, the types and purposes of accountability sought by community members as evidenced by questions asked of the governance committee, and responsiveness of the governance committee to issues raised at public meetings. Results: Public meetings were attended by 6 out of 7 possible stakeholder groups, and reports were generally transparent. Stakeholders asked probing questions focused mainly on financial performance. Governance committee members were responsive to questions raised by participants, with 59% of answers rated as fully or mostly responsive (showing understanding of and answering the question). Six of the 10 sites held elections to re-elect or replace governance committee members. Only 2 sites reached the target set by local stakeholder committees of 50% female membership, down from 3 at formation. To further improve transparency and accountability, community governance committees need to engage in advance preparation of reports, and should consult with stakeholders on broader measures for performance assessment. Despite receiving training, community-level governance committees lacked understanding of the strategic purpose of open public meetings and elections, and how these relate to democratic accountability. They were therefore not motivated to engage in tactics to manage stakeholders effectively. Conclusion: While open meetings and elections have potential to enhance good governance at the community level, continuous training and mentoring are needed to build capacity and enhance sustainability.

A qualitative study on a novel peer collaboration care programme during the first COVID-19 outbreak: A SWOT analysis

Article

Full-text available

Nov 2021

The pandemic has forced nursing teams to incorporate new programmes that modify the organization of care and the use of material resources. Aims: The purpose of this study was to describe the perspectives of the nursing team about the strengths/opportunities and weaknesses/threats of a novel peer collaboration care programme during the first outbreak of the pandemic. Design: A qualitative case study with focus groups was conducted in June 2020. Methods: We included 23 participants (seven nurses, seven assistant nursing care technicians and nine charge nurses). Thematic and strengths/opportunities and weaknesses/threats analysis were performed. Results: The strengths of the peer collaboration care programme are the optimization of care and protective equipment. Its weaknesses are that veteran nurses carry the entire burden, and the lack of personal protective equipment makes it difficult to implement the peer collaboration care programme. Finally, misinformation, lack of facilities and time to teach the peer collaboration care programme are considered threats. Conclusion: This strengths/opportunities and weaknesses/threats analysis has led to a comprehensive new project to improve the nursing care. Impact: The incorporation of the peer collaboration care programme contributed to the development of new organizational and management programmes for the COVID-19 pandemic. This study has gave empirical evidence to nurses and care managers to optimize and organize care, work, human and material resources during the pandemic.

From the Patient’s Point of View: An Anthropological Response to Medicine’s Social Responsibility in Canadian Medical Education

Chapter

Mar 2021

William H. Mckellin

In Canada, where both health care and medical education are publicly funded, medical curricula reflect educators’ social responsibilities to their communities and patients. During curriculum renewal in the 1990s and 2000s, MD programs responded to these social obligations by developing and implementing Problem-Based Learning (PBL) and Evidence-Based Medicine (EBM). At the University of British Columbia, this wave of curriculum change was an opportunity to include anthropological perspectives and ethnographic methodologies in the MD program in a set of two new required, multi-disciplinary courses in Doctor, Patient, and Society. These courses brought together medical anthropology, epidemiology, community health, and medical ethics. Anthropology, community medicine, and medical ethics, in combination with PBL provided a more community and patient-centered orientation to complement epidemiology and EBM. By enabling students to conduct anthropological, ethnographic research in communities, and interview patients in their homes, students confronted the tension between epidemiological evidence and individual patient experiences. This ethnographically-based, patient and person-oriented approach helps prepare students for clinical interactions with patients who are also community members. It also equips them to meet the growing demands for personalized chronic care, and prepares them for emerging clinical fields including targeted cancer therapies and genomic medicine.

Development of a composite indicator to prioritize districts for implementation of human immunodeficiency virus programmes in Maharashtra, India

Article

Aug 2020

A key recommendation of the National AIDS Control Programme‐IV of India was to develop new strategies for geo‐prioritization of the human immunodeficiency virus (HIV) epidemic. We conducted this study to categorize the districts in Maharashtra (India) based on a multidimensional framework for geo‐prioritization of services. Programmatic data on trends of HIV prevalence, coverage of marginalized populations and vulnerability factors were included. A composite indicator based on these was developed, and the cumulative score was calculated for each district. HIV prevalence among general population has declined steadily from 0.60% in 2007 to 0.33% in 2017. The programme coverage was stable but inadequate for men who have sex with men (MSM). The coverage for female sex workers (FSWs) was inadequate and reduced over time. Nine districts were categorized as high priority, 13 as moderate priority and 11 were classified as low‐priority districts based on burden and vulnerability for HIV. The high‐priority districts were Pune, Solapur and Yavatmal for FSW interventions and Pune, Thane and Latur for MSM interventions. This multidimensional indicator is based on existing programmatic data, dynamic and can be made state‐specific. It is useful to categorize and prioritize districts for allocation of resources and geo‐prioritization of services in resource limited settings.

Health systems governance: The missing links

Article

Full-text available

Aug 2020

Over the past decades, health systems have experienced major transformation. The role of ministries of health has changed, progressively shifting from direct provision of health services to overall stewardship of the health sector, including financing and oversight of private providers.1 Health reforms have triggered that shift, fostering new institutions, such as national medicines agencies, public health agencies, disease control agencies (eg, National Cancer Agencies) or health financing organisations responsible for risk and fund pooling, purchasing of health services, or targeting the poor or vulnerable groups. Shocks such as political or financial crises, natural disasters or epidemics have also ffected the governing of the health system in many countries. In this changing environment, exercising stewardship2 requires balancing the interest of a wide range of actors, particularly when decentralisation multiplies the number of actors involved in health services delivery, usually with greater autonomy. Health systems processes must move from a top-down to inclusive policy, planning and implementation processes, increasingly adopting a people-centred approach.3 Democratic rights, human rights, equity and ethics values have become prominent in national policy debates. In response to this call, twenty-first century health systems need to be participatory, inclusive and pluralist, following Whole of Society and Whole of Government principles.3 4 People's voice is a core driver of health systems' performance towards Universal Health Coverage.5 In such a context, governance arrangements are changing and rely more on inclusion, participation and co-production. 6 This paper presents a framework to help understand health systems governance; examine what we know about this important health system function, and what has been less explored, leaving an important gap in our health system knowledge and practice. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Policy dialogue to improve health outcomes in low income countries: What are the issues and way forward?

Article

Full-text available

Jul 2016
BMC HEALTH SERV RES

Background This paper has three objectives: to review the health development landscape in the World Health Organization African Region, to discuss the role of health policy dialogue in improving harmonisation and alignment to national health policies and strategic plans, and to provide an analytical view of the critical factors in realising a good outcome from a health policy dialogue process. Discussion Strengthening policy dialogue to support the development and implementation of robust and comprehensive national health policies and plans, as well as to improve aid effectiveness, is seen as a strategic entry point to improving health sector results. However, unbalanced power relations, the lack of contextualised and relevant evidence, the diverse interests of the actors involved, and the lack of conceptual clarity on what policy dialogue entails impact the outcomes of a policy dialogue process. The critical factors for a successful policy dialogue have been identified as adequate preparation; secured time and resources to facilitate an open, inclusive and informed discussion among the stakeholders; and stakeholders’ monitoring and assessment of the dialogue’s activities for continued learning. Peculiarities of low income countries pose a challenge to their policy dialogue processes, including the chaotic-policy making processes, the varied capacity of the actors and donor dependence. Conclusion Policy dialogue needs to be appreciated as a complex and iterative process that spans the whole process of policy-making, implementation, review and monitoring, and subsequent policy revisions. The existence of the critical factors for a successful policy dialogue process needs to be ensured whilst paying special attention to the peculiarities of low income countries and potential power relations, and mitigating the possible negative consequences. There is need to be cognisant of the varied capacities and interests of stakeholders and the need for capacity building, and to put in place mechanisms to manage conflict of interest. The likelihood of a favourable outcome from a policy dialogue process will depend on the characteristics of the issue under consideration and whether it is contested or not, and the policy dialogue process needs to be tailored accordingly.

Policy dialogues - The "bolts and joints" of policy-making: Experiences from Cabo Verde, Chad and Mali

Article

Full-text available

Jul 2016
BMC HEALTH SERV RES

Background Policy processes that yield good outcomes are inherently complex, requiring interactions of stakeholders in problem identification, generation of political will and selection of practical solutions. To make policy processes rational, policy dialogues are increasingly being used as a policy-making tool. Despite their increasing use for policy-making in Africa, evidence is limited on how they have evolved and are being used on the continent or in low and middle income countries elsewhere. Methods This was an exploratory study using qualitative methods. It utilised data related to policy dialogues for three specific policies and strategies to understand the interplay between policy dialogue and policy-making in Cabo Verde, Chad and Mali. The specific methods used to gather data were key informant interviews and document review. Data were analysed inductively and deductively using thematic content analysis. Results Participation in the policy dialogues was inclusive, and in some instances bottom-up participatory approaches were used. The respondents felt that the execution of the policy dialogues had been seamless, and the few divergent views expressed often were resolved in a unanimous manner. The policies and strategies developed were seen by all stakeholders as relating to priority issues. Other specific process factors that contributed to the success of the dialogues included the use of innovative approaches, good facilitation, availability of resources for the dialogues, good communication, and consideration of the different opinions. Among the barriers were contextual issues, delays in decision-making and conflicting coordination roles and mandates. Conclusions Policy dialogues have proved to be an effective tool in health sector management and could be a crucial component of the governance dynamics of the sector. The policy dialogue process needs to be institutionalised for continuity and maintenance of institutional intelligence. Other essential influencing factors include building capacity for coordination and facilitation of policy dialogues, provision of sustainable financing for execution of the dialogues, use of inclusive and bottom-up approaches, and timely provision of reliable evidence. Ensuring continued participation of all the actors necessitates innovation to allow dialogue outside the formal frameworks and spaces that should feed into the formal dialogue processes.

Briefing Note -- Policy Dialogue: What it is and how it can contribute to evidence-informed decision-making

Technical Report

Full-text available

Feb 2015

In: Health systems (website) Geneva: WHO

Oct 2016

Health Systems Strengthening Glossary

7 Health Systems Strengthening Glossary G-H. In: Health systems (website). Geneva: WHO; 2016 (http://www.who.int/healthsystems/hss_glossary/ en/index5.html, accessed 11 September 2016).

Public financing for health in Africa: from Abuja to the SDGs. Geneva: World Health Organization

Oct 2016

Public financing for health in Africa: from Abuja to the SDGs. Geneva: World Health Organization; 2016 (Health Financing toward UHC; http://www.who.int/ health_financing/documents/public-financing-africa/ en/, accessed 11 October 2016).

Making services work for poor people World Bank Governance: concepts, experience and program options

Jan 2004

D Brinkerhoff
T Bossert

14 Original design, adapted from World Development Report 2004: Making services work for poor people. World Bank; 2004. and Brinkerhoff D, Bossert T. Governance: concepts, experience and program options. Bethesda: Health Systems 20/20 Project; 2008

19 WHO Framework Convention on Tobacco Control

Nov 2005

19 WHO Framework Convention on Tobacco Control. Geneva: WHO; 2005 (http://www.who.int/fctc/en/, accessed 11 October 2016).

Policy dialogues: the "bolts and joints" of policy-making: experiences from Cabo Verde, Chad and Mali

Oct 2016
BMC HEALTH SERV RES
11

D Dovlo
J Nabyonga-Orem
Y Estrella
A Mwisongo

Dovlo D, Nabyonga-Orem J, Estrella Y, Mwisongo A. Policy dialogues: the "bolts and joints" of policy-making: experiences from Cabo Verde, Chad and Mali. BMC Health Serv Res. 2016;16(4):216 (https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC4959380/, accessed 11 October 2016).

Global health expenditure database (GHED)

Oct 2016
11

Global health expenditure database (GHED). [online database] Geneva: WHO; 2016 (http://apps.who.int/ nha/database, accessed 11 October 2016).

Briefing Note: Policy dialogue: What it is and how it can contribute to evidence-informed decision-making

D Rajan
T Adam
El Husseiny
D Porignon
D Ghaffar
A Schmets

Rajan D, Adam T, El Husseiny D, Porignon D, Ghaffar A, Schmets G. Briefing Note: Policy dialogue: What it is and how it can contribute to evidence-informed decision-making. Geneva: World Health Organization;

Chapter 1 Introduction: Strategizing national health in the 21st century

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