CRITICAL REVIEW ON HEALTH SECTOR

Theme: Management and Strategic Planning
Overview of Organization and Structure of the Health System
• Historic background and development
• Organizational Overview
- Public Sector (MoPHP, other Ministries providing health services)
- Non-Profit Sector/Non-Governmental Organizations
- Private Sector
• Consumer and Patient Roles

Sectoral Priorities
• Health Sector Objectives and Priorities
• Health and Poverty
• Equity and Health Care
• Gender and Health

Stewardship Functions
• Good Governance
• Strengthen leadership
• Voice of MoPHP in wider Government
• Health Sector Reform and Civil Service Modernisation

Institutional Set-up
• Redefining the role of the government
• Functions of the health system (regulation, financing, purchasing, provision)
• Policy roles of government, local government, professional associations
• Roles of public vs. private sector
• Organigram of the MoPHP
• MoPHP decentralization – performance and roles of the GHOs and the DHS

Planning
• Strategic Planning (5-.year plan)
- Capital investments / health facility plans
- Capacity and training
• Operational Planning
- Capacity of MoPHP departments and programmes

Monitoring and Evaluation
• Health Management Information Systems
- Appropriate indicators
- Appropriate systems
- Appropriate technology
- Use of data for decision making
• Monitoring systems
- Indicators / dashboard systems
- Reporting and supervision systems
- Enforcement
• Quality Assurance
- Licensing and Accreditation
- Evidence-Based Medicine

Partnership
• Donor harmonization
• Standardization of procurement procedures

Theme: Human Resource Development
Definition of roles in HR policy making, HR planning and training
• MoPHP
• GHOs, DHOs
• Vertical programmes
• Other Ministries (MoSC, MoL)
• Universities
• HIHS
• Private training institutions

Planning of health care personnel
• Assessment of present health workforce
- Public sector
- Private sector
• Standardization of job descriptions
• HR needs assessment/projection (e.g. based on ESP)
- Public sector
- Private sector
• Broken down by
- Physicians, by Specialty
- Nurses
- Ancillary personnel

Training of health care personnel
• Standardization of programmes
• Training needs assessment
• Broken down by
- Physicians, by Specialty
- Nurses
- Ancillary Personnel

Continuous Medical Education programs
• Standardization of programmes
• Roles of MoPHP, GHOs, health facilities, vertical programmes, training institutions, etc

Registration, licensing, accreditation
• Recruitment procedures
• Accreditation of medical doctors

Redeployment of staff
Promotion of staff
Accountability system
• Incentives
• Disciplinary measures

Capacity building programmes for HRD institutions
Human Resource Information System

Theme: Health Financing
Overview of health financing system
• Roles and responsibilities of stakeholders (MoF, MoPHP, private sector, etc)

Overview of Health Expenditures
• Public Expenditure Review
• National Health Accounts
- per capita health expenditure
- by type of expenditure (ambulatory/hospital/drugs)
- differences by region / sex / income groups
• Cost studies for specific services / providers

Sources of Revenues
• Budgets (actual vs. planned)
• Compulsory premiums or dedicated taxes
• Voluntary health insurance
• Out-of-Pocket Payments
• Other Sources of Financing

Pooling of Funds
• Pooling Agencies
• Mechanisms for Allocation and Re-distribution

Purchasing
• Benefits Package(s)
• Contracting
• Provider Payment Methods

Policy issues of special interest
• Cost-sharing and equity
• Drug revolving funds
• Health insurance
• Performance based payment of providers

Long-term health financing projections
• Public, insurance and household budgets
• Additional sources of funding

Financial management and accountability

Theme: Service Delivery
Overview of structure of the health care delivery system
• Present roles and responsibilities of providers
- Public, private for-profit, private non-profit
- Relationships between each other, and towards Government
• Distribution of providers (geographical and by services they provide)
• Public / private partnerships

Regulation of health care providers
• Overview of main legislation and policies governing health care delivery
- 5-year plan, ESP, sub-sector and programme specific policies
- Private sector legislation
• Enforcement capacity of Government for this legislation / policies within public and private sector
• Trends in development of the health care delivery structure (e.g. redefinition of role of public sector away from service delivery)

Public health programmes
• National public health priorities
• Population health
- Responsibilities
- Available strategies and programmes
- Intersectoral linkages
- Performance of programme implementation
- Future directions
• Primary Health Care
- Responsibilities
- Available strategies and programmes
- Intersectoral linkages
- Performance of programme implementation
- Future directions
• Health Promotion (health education) and Disease Prevention
- Responsibilities
- Available strategies and programmes
- Intersectoral linkages
- Performance of programme implementation
- Future directions
• Water and Food Safety
• Disaster preparedness programmes
• Trends in burden of diseases / health care needs (e.g. increase of non-communicable diseases) and appropriate system response

Curative services
• Coverage, utilization and quality of the following services:
- Patient outreach services (mobile clinics, home deliveries, etc.)
- Informal Care (TBAs, etc.)
- Primary Care
- Secondary Care
- Tertiary Care
- Emergency Care
- Rehabilitation
- Mental Health
- Dental Health
- Special areas of interest like (blood safety, HIV/AIDS services, road accidents, etc)
• Referral systems
• Integration of services at district / provider level

Physical Resources (public and private)
• Infrastructure
• Medical equipment, devices, aids
• Capital investment trends and projections

Pharmaceuticals
• Essential drug policies
• Drug licensing and quality control
• Future of revolving funds
• Cost-sharing for drugs
• Private sector involvement

Standards and Guidelines
Management
• Hospital management and hospital autonomy
• Community participation in management of public health services

Surveillance, information and monitoring systems (programme specific)
• Disease surveillance systems
• Health Information system
- Appropriate indicators
- Appropriate technology
- Reporting systems
- Use of data for decision making
• Service monitoring and supervision systems
• Integration with sector wide information systems

Theme: Assessment of Health Situation
Geography and socio-demographics
• Demographic Trends
• Human Development indicators

Macro-Economic and Political Context
Health Status
• Current epidemiologic profile (health indicators)
- Communicable diseases
- Non-communicable diseases
- Child health
- Reproductive health
- Nutrition
- Injuries
- Disabilities
- Mental health
- Substance abuse (Qat)
• Trend Analysis
• Burden of Disease

Achievement of MDGs
General Health System Statistics
• Facilities
• Human resources
• Services
• Coverage

Health Systems Performance
• Strengths of the System
• Weaknesses of the System
• Overall Quality and Clinical Effectiveness
• Overall Efficiency
- Technical
- Allocative
• Access and Equity
- Benefit-incidence
- Equity and benefit-incidence
• Accountability
• Linking Inputs and Outcomes

International Comparisons
• Demographic indicators
• Health status indicators
• Delivery system and capacity
• Health expenditures

Health Development Partners’ Database
• Mapping of activities by subject and geography