Publication: Health Systems Analysis for Better Health System Strengthening
Loading...
Date
2011-05
ISSN
Published
2011-05
Author(s)
Editor(s)
Abstract
Health system strengthening and reform are often necessary actions to achieve better outcomes. The World Bank's 2007 strategy for health, nutrition, and population emphasizes the importance of health system strengthening for results. This paper proposes 'health systems analysis' as a distinct methodology that should be developed and practiced in the design of policies and programs for health system strengthening. It identifies key elements of health systems analysis and situates them in a logical framework supported by a wide range of data and methods and a sizable global literature. Health systems analysis includes evidence on health system inputs, processes, and outputs and the analysis of how these combine to produce the outcomes. It considers politics, history, and institutional arrangements. Health systems analysis proposes causes of poor health system performance and suggests how reform policies and strengthening strategies can improve performance. It contributes to implementation and evaluation. Examples from Mexico, Ethiopia, and Turkey illustrate the positive contributions health systems analysis has made to development of successful health system strengthening policies. Health systems analysis should be an integral part of good practice in health system strengthening efforts, including planning, policy development, monitoring, and evaluation. Health systems analysis can be conceived in a coherent and logical fashion and can be practiced and improved.
Link to Data Set
Citation
“Berman, Peter; Bitran, Ricardo. 2011. Health Systems Analysis for Better Health System Strengthening. Health, Nutrition, and Population (HNP)
discussion paper;. © World Bank. http://hdl.handle.net/10986/13593 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Review of World Bank's Experience with Country-Level Health System Analysis(World Bank, Washington, DC, 2010-12)The World Bank often carries out in-depth analysis of the conditions and challenges facing different sectors in our client countries as a contribution to developing the analytical and information base for lending, policy dialogue, and more in-depth analytical work. In the health sector, we have identified a substantial body of this type of work focusing on analyzing the performance of health systems, its causes, and potential strategies for performance improvement. The Bank's 2007 Health, Nutrition and Population (HNP) strategy emphasizes the importance of our work on health system strengthening. HSA is often the analytical foundation of this work in countries. This paper reviews a sample of HSAs, 12 major studies carried out since 2000 across all Bank regions. Using the health systems framework of the flagship program on health sector reform and sustainable financing, a comparable synopsis of each study has been prepared in a simple two page chart which traces the analysis from measures of health system performance to its causes and then from policy 'control knobs' to proposals for reform which are intended to improve that performance. Several key questions about the conceptual basis, content, process, and results of the Bank's work on HSA are investigated. The review finds that most of our HSAs make use of sound analytical frameworks that link performance to a causal analysis and derive policy recommendations and reform strategies from that analysis.Publication Lessons from 20 Years of Capacity Building for Health Systems Thinking(Taylor and Francis, 2016-08-24)In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.Publication Building Better Policies : The Nuts and Bolts of Monitoring and Evaluation Systems(Washington, DC: World Bank, 2012-04-13)Governments around the world face ongoing pressures from citizens to provide more and better services, and to do this under a tight fiscal environment. This provides the context for government efforts to ensure their policies and programs are as effective, and as efficient, as possible. An emphasis on government performance has led a number of governments to create formal systems for monitoring and evaluating (M&E) their performance on a regular, planned, and systematic basis with the objective of improving it. The focus of this book is on these government M&E systems: what they comprise, how they are built and managed, and how they can be used to improve government performance. M&E systems focus on measuring the results produced by government its outputs, outcomes, and impacts. The M&E system may exist at the level of an individual agency, entire sector, or the government as a whole. M&E can provide unique information about the performance of government policies, programs, and projects at the national, sector, and sub-national levels. It can identify what works, what does not, and the reasons why. M&E also provides information about the performance of a government, of individual ministries and agencies, and of managers and their staff. This book endeavors to expand the frontiers of issues that have been researched and analyzed. However, there are still a number of issues that are still not understood well enough. This book presents case studies on several countries that have succeeded in achieving high levels of utilization of M&E information, including Australia, Canada, Chile, and Mexico.Publication Synopsis of Health Systems Research across the World Bank Group from 2000 to 2010(World Bank, Washington, DC, 2010-11)Policymakers and researchers around the world are working to identify the 'how to' aspect of health systems strengthening. However, there is neither consistency nor clarity on what makes a 'good' health systems study with regard to research design, methodology, etc. This synopsis of health systems research carried out by the World Bank highlights the scale and scope of the Bank's knowledge contributions to this important field over the last 10 years. The authors hope this review will stimulate the Bank and other development partners to strengthen efforts to create knowledge to improve health systems. The purpose of this report is to describe the research on health systems that have taken place across the World Bank Group over the last 10 years. The World Bank is a big contributor to research on health systems. The search identified 664 reports, policy research working papers, discussion papers, books, book chapters, how-to manuals, guides, briefs, policy notes and journal articles on health systems published over the last 10 years. Health systems research is widely distributed across the Bank, and much of it is carried out by region-based staff and their colleagues and clients in countries. The Bank's health systems research covers a wide scope. The authors have considered work which is both problem-specific focused on specific diseases, health problems, or outcomes but with substantial health systems content as well as cross-cutting in terms of specific health system 'control knobs.' The authors lack a very precise definition of health systems. This review highlights the important contributions of the World Bank's partners. The Bank engages researchers in its client countries, partners from academic institutions, development agencies, and knowledge organizations.Publication Shaping Healthier Societies and Building Higher Performing Health Systems in the GCC Countries(Washington, DC, 2015-04)This policy note summarizes the central health sector trends and challenges in the Gulf Cooperation Council (GCC) countries of the Middle East and North Africa region (MENA). These countries are Saudi Arabia, Kuwait, Bahrain, the United Arab Emirates (UAE), Oman, and Qatar. The note also provides an overview of the GCC country context, discussing the commonalities between the six member states, and the major areas of engagement by the health, nutrition, and population (HNP) global practice of the World Bank in support of the health sector reform priorities of these countries. The areas of engagement focus on three main clusters of work: (i) developing multi-layered solutions for improving non-communicable disease and road safety outcomes; (ii) health system strengthening; and (iii) integrating health policy solutions within the wider institutional and policy frameworks in the GCC countries. The note builds on an earlier HNP regional strategy prepared by the World Bank in 2013 focusing on the concepts of fairness and accountability. The strategy highlighted the importance of improvements in health system performance in MENA countries from an equity, accountability, and fiscal sustainability perspective. The framework of the strategy covers equity in health status, financial protection and responsiveness, and the accountability of populations, payers, and health service providers interacting within the health system.
Users also downloaded
Showing related downloaded files
Publication Media and Messages for Nutrition and Health(World Bank, Washington, DC, 2020-06)The Lao People’s Democratic Republic (Lao PDR) has experienced rapid and significant economic growth over the past decade. However, poor nutritional outcomes remain a concern. Rates of childhood undernutrition are particularly high in remote, rural, and upland areas. Media have the potential to play an important role in shaping health and nutrition–related behaviors and practices as well as in promoting sociocultural and economic development that might contribute to improved nutritional outcomes. This report presents the results of a media audit (MA) that was conducted to inform the development and production of mass media advocacy and communication strategies and materials with a focus on maternal and child health and nutrition that would reach the most people from the poorest communities in northern Lao PDR. Making more people aware of useful information, essential services and products and influencing them to use these effectively is the ultimate goal of mass media campaigns, and the MA measures the potential effectiveness of media efforts to reach this goal. The effectiveness of communication channels to deliver health and nutrition messages to target beneficiaries to ensure maximum reach and uptake can be viewed in terms of preferences, satisfaction, and trust. Overall, the four most accessed media channels for receiving information among communities in the study areas were village announcements, mobile phones, television, and out-of-home (OOH) media. Of the accessed media channels, the top three most preferred channels were village announcements (40 percent), television (26 percent), and mobile phones (19 percent). In terms of trust, village announcements were the most trusted source of information (64 percent), followed by mobile phones (14 percent) and television (11 percent). Hence of all the media channels, village announcements are the most preferred, have the most satisfied users, and are the most trusted source of information in study communities from four provinces in Lao PDR with some of the highest burden of childhood undernutrition.Publication Remarks at the United Nations Biodiversity Conference(World Bank, Washington, DC, 2021-10-12)World Bank Group President David Malpass discussed biodiversity and climate change being closely interlinked, with terrestrial and marine ecosystems serving as critically important carbon sinks. At the same time climate change acts as a direct driver of biodiversity and ecosystem services loss. The World Bank has financed biodiversity conservation around the world, including over 116 million hectares of Marine and Coastal Protected Areas, 10 million hectares of Terrestrial Protected Areas, and over 300 protected habitats, biological buffer zones and reserves. The COVID pandemic, biodiversity loss, climate change are all reminders of how connected we are. The recovery from this pandemic is an opportunity to put in place more effective policies, institutions, and resources to address biodiversity loss.Publication South Asia Development Update, April 2024: Jobs for Resilience(Washington, DC: World Bank, 2024-04-02)South Asia is expected to continue to be the fastest-growing emerging market and developing economy (EMDE) region over the next two years. This is largely thanks to robust growth in India, but growth is also expected to pick up in most other South Asian economies. However, growth in the near-term is more reliant on the public sector than elsewhere, whereas private investment, in particular, continues to be weak. Efforts to rein in elevated debt, borrowing costs, and fiscal deficits may eventually weigh on growth and limit governments' ability to respond to increasingly frequent climate shocks. Yet, the provision of public goods is among the most effective strategies for climate adaptation. This is especially the case for households and farms, which tend to rely on shifting their efforts to non-agricultural jobs. These strategies are less effective forms of climate adaptation, in part because opportunities to move out of agriculture are limited by the region’s below-average employment ratios in the non-agricultural sector and for women. Because employment growth is falling short of working-age population growth, the region fails to fully capitalize on its demographic dividend. Vibrant, competitive firms are key to unlocking the demographic dividend, robust private investment, and workers’ ability to move out of agriculture. A range of policies could spur firm growth, including improved business climates and institutions, the removal of financial sector restrictions, and greater openness to trade and capital flows.Publication The Journey Ahead(Washington, DC: World Bank, 2024-10-31)The Journey Ahead: Supporting Successful Migration in Europe and Central Asia provides an in-depth analysis of international migration in Europe and Central Asia (ECA) and the implications for policy making. By identifying challenges and opportunities associated with migration in the region, it aims to inform a more nuanced, evidencebased debate on the costs and benefits of cross-border mobility. Using data-driven insights and new analysis, the report shows that migration has been an engine of prosperity and has helped address some of ECA’s demographic and socioeconomic disparities. Yet, migration’s full economic potential remains untapped. The report identifies multiple barriers keeping migration from achieving its full potential. Crucially, it argues that policies in both origin and destination countries can help maximize the development impacts of migration and effectively manage the economic, social, and political costs. Drawing from a wide range of literature, country experiences, and novel analysis, The Journey Ahead presents actionable policy options to enhance the benefits of migration for destination and origin countries and migrants themselves. Some measures can be taken unilaterally by countries, whereas others require close bilateral or regional coordination. The recommendations are tailored to different types of migration— forced displacement as well as high-skilled and low-skilled economic migration—and from the perspectives of both sending and receiving countries. This report serves as a comprehensive resource for governments, development partners, and other stakeholders throughout Europe and Central Asia, where the richness and diversity of migration experiences provide valuable insights for policy makers in other regions of the world.Publication Economic Recovery(World Bank, Washington, DC, 2021-04-06)World Bank Group President David Malpass spoke about the world facing major challenges, including COVID, climate change, rising poverty and inequality and growing fragility and violence in many countries. He highlighted vaccines, working closely with Gavi, WHO, and UNICEF, the World Bank has conducted over one hundred capacity assessments, many even more before vaccines were available. The World Bank Group worked to achieve a debt service suspension initiative and increased transparency in debt contracts at developing countries. The World Bank Group is finalizing a new climate change action plan, which includes a big step up in financing, building on their record climate financing over the past two years. He noted big challenges to bring all together to achieve GRID: green, resilient, and inclusive development. Janet Yellen, U.S. Secretary of the Treasury, mentioned focusing on vulnerable people during the pandemic. Kristalina Georgieva, Managing Director of the International Monetary Fund, focused on giving everyone a fair shot during a sustainable recovery. All three commented on the importance of tackling climate change.