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									The Ouagadougou Declaration
on HSS and PHC, where are we
         in Ghana?
               By
       Dr. Frank Nyonator
                 What is a health system
         • Health System is all the organizations, institutions
           and resources that are devoted to producing
           health actions ……
         • Health actions include all the activities, (whether
           in personal health care, public health services or
           through intersectoral collaboration initiatives,)
           whose primary purpose is to promote, restore or
           maintain health
                           • World Health Report 2000: Health Systems:
                             Improving Performance


Aug-06                                CHPS - a Health System Backbone
Boundaries of Health System

 Primary Boundaries of Health            Secondary Boundaries of Health
 Systems                                 Systems
 •Formal Health Services – including     •All those activities whose primary
 professional delivery of personal       purpose is something other than
 medical attention                       Health – education for example, even
 •Traditional Public Health Activities   if these activities have a secondary,
 – health promotion, disease             health enhancing effect
 prevention and other health                    • note that general education
 enhancing interventions like road              might be secondary, but health
 and environmental safety                       related education is primary
 improvements                            •Some actions are intended chiefly to
 •Traditional Healers and all use of     improve health indirectly by
 medications – prescribed or non-        influencing how non-health systems
 prescribed                              function – eg actions to increase girls
 • Home care of the sick including       school enrolment or change the
 Self Medications                        curriculum to make student better
                                         future caregivers and consumers of
                                         health care
  Who are really the producers of ‘Health’?....
• The primary producers of health -
  the individual households
  especially with mothers often
  taking the first key decision to
  seek health care for her sick child
• This decision to seek health care     Local &
  and which health care is sought        Global       Households
  depends on information
  available to the household            Driving
• Communities provide the social         Forces
  cohesions for families to function
  in
• And to facilitate the uptake of
  health services by households, it
  is necessary to provide health
  information and education to the            Government       Communities
  households in a way and manner
  that is acceptable and convenient
  to them.
                 The Declaration
• I believe it is in this direction that the Ouagadougou
  Declaration on Primary Health Care and Health Systems in
  Africa - Achieving Better Health for Africa in the New
  Millennium - urges the international community to support
  Member States to translate the recommendations of the PHC
  Conference (28th – 30 April 2008) into concrete actions
• …… Ghana was at the forefront in calling for a framework that
  will help member countries to operationalize the
  Declaration….. And then signed it off……
Framework….
• This generic implementation framework proposes concrete
  actions that Member States can implement to improve the
  nine major priority areas contained in the Declaration:
   –   leadership and governance for health;
   –   health service delivery;
   –   human resources for health;
   –   health financing;
   –   health management information systems;
   –   Health technologies
   –   community ownership and participation;
   –    partnerships for health development;
   –   and research for health.
• For each of these priority areas, the implementation
  framework proposes a goal followed by objectives,
  interventions, potential actions and stakeholders.
                           Context
Six Building Blocks of WHO        9 Priority areas of
                                  Ouagadougou


• Service Delivery                •   Service delivery
• Human Resources for Health      •   Human resources for health
• Health management information   •   Health financing
   systems                        •   Health management information
• Health Commodities & Tech           systems
• Health Financing                •   Health Technologies
• Leadership/Governance           •   Community ownership and
                                      participation
                                  •   Partnerships for health development
                                  •   Research for health
                                  •   Leadership and governance for
                                      health
Priorities of the Ouagadougou
           Declaration
       Leadership and governance
• The interventions proposed for strengthening leadership and
  governance for health, include
   – institutionalizing intersectoral action for improving health
     determinants;
   – updating national health policy in line with the PHC approach and
     regional strategies;
   – updating national health policy and aligning the MOH organizational
     structure with the PHC approach and regional strategies;
   – updating national health strategic plans to ensure integrated
     management and provision of comprehensive essential health
     services;
   – updating or enforcing public health acts and laws in line with the PHC
     approach; and
   – creating or strengthening mechanisms for transparency and
     accountability in the health sector.
        Health Service Delivery
• proposed interventions for improving
  effectiveness of health service delivery include
  – consultation and consensus building on the
    elements of essential health services, mode of
    delivery and costs; and
  – service organization and stakeholder incentives to
    ensure integration and strengthened efficiency
    and equity.
     Human Resources for Health
• The interventions recommended for improving
  management of human resources for health (HRH)
  include
  – comprehensive evidence-based health workforce
    planning;
  – building health training institution capacity for scaling up
    training of relevant cadres;
  – building HRH management and leadership capacity for
    better HRH management;
  – developing and implementing retention strategies,
    including better management of migration; generating and
    using HRH evidence for informed decisions at all levels;
  – and increasing fiscal space for HRH development.
        Health Systems Financing
• In order to improve health system financing, it is
  proposed that countries should
   – strengthen or develop a comprehensive health financing
     policy and a strategic plan;
   – institutionalize national health accounts (NHA) and
     efficiency monitoring within health management
     information systems (HMIS);
   – strengthen financial management skills at district/local
     levels and financial decentralization;
   – respect the pledge to allocate at least 15% of the national
     budget to health development and allocate enough of that
     for implementation of the PHC approach at local level; and
   – implement the Paris Declaration on aid effectiveness.
     Health information systems
• To ensure availability of timely and reliable
  information at all levels of the health system,
  countries should
  – develop and implement a comprehensive national
    health information system policy and strategic
    plan, taking into account the International Health
    Regulations; and
  – establish a functional national HMIS in line with
    the PHC approach….
          Health technologies….
• In relation to health technologies, countries should
   – increase access to quality and safe health
     technologies; develop national policies and plans on
     health technologies;
   – develop norms and standards for the selection, use
     and management of appropriate health technologies;
   – and institute a transparent and reliable system for the
     procurement of health technologies.
       Community participation
• For effective community participation in
  health development, it is proposed that
  countries should
  – create an enabling policy and implementation
    framework for community participation;
  – build community capacity;
  – reorient the health service delivery system; and
  – develop and implement health promotion policies
    and strategies.
Partnerships for health development

• To improve harmonization and alignment
  towards government-led policy and strategic
  orientations, it is proposed that countries
  should institutionalize a framework for
  harmonization and alignment of partner
  support.
                       Research
• In order to improve generation and utilization of
  research for health in health development, the
  proposed interventions include
   – review of structures and mechanisms for implementing
     research for health and knowledge systems;
   – institutionalize a framework for research for health agenda
     and priority setting;
   – improve South-South and North-South cooperation and
     collaboration;
   – create a critical mass of national researchers for health;
   – allocate adequate funding to research for health; and
   – create a framework for sharing new knowledge and its
     applications.
            Enabling
          sub-system
                               …generate                            A Health Systems
          inputs and
          priorities…            system
 Integrated service            outcomes…          …that alter the      Development
    components                                      climate of
  Health workforce                                 demand for                Framework
  size, composition                                 services ,
      & training           Extend
                        availability of                                    …impact on
  Information for
                        services and                                         health
  decision-making
                        technologies                                        behavior,
                                           Improved
                                             equity                          and ….
Essential drug supply      Increase
     & logistics        access to care
                                                             Enhanced
                             and
                                                               Health
Health financing &      technologies
                                                              Service
resource allocation
                                                              Delivery
   Leadership &           Improve                               and
    governance            quality of                         Utilization
                           services         Reduced
    Community                              social costs                            Improve
  Ownership and                                                                    survival
   Participation;
                           Improve
  Partnerships for        efficiency
Health Development
Emphasis on District Health Systems….

  • The Ouagadougou Declaration on PHC and HS in Africa, the
    Addis Ababa Declaration on Community Health, the WHR
    2008 on PHC and other related documents outline the
    principles and approaches for strengthening (district) health
    systems and also re-emphasizing the role of communities and
    partners in health development.
  • For Ghana,
     – in implementing CHPS we recognize the pivotal role of communities
       and effectively involve them in health development.
     – we need to ensure existing coordination mechanisms are reinforced
       including strengthening national intersectoral committee (with Local
       Govt and other Stakeholders) to take into account the current context
       of PHC renewal
                                                                                            This Declaration…… gives a
      Implications for Ghana…..boost for                                                    lifeline to the District health
                                                                                            systems development with
            District Health System                                                          Community-based Health
                                                                                            Planning and Services (CHPS)
                                                                                            at the base


D is t ric t le v e l
 D istr ict H ealth
 Managem ent
                                                                Di stri ct
     Team s                                                    h o sp i tal
     (D H MT)


                                       patient r efer r al       super vision           patient r efer r al

Sub-dis t ric t
   le v e l
 S ub-distr ict                    H e a lt h c e nt re s in                    H e a lt hc e nt re sin
    Health
 Managem ent
   Team s               ...           Sub-dis t ric t                              Sub-dis t ric t
                                                                                                                     ...
    (S D H MT)
                                       patient r efer r al        patient r efer r al                  patient r efer r al

                        super vision                         super vision               super vision

C ommunit y                      C H PS               C H PS                   C H PS                C H PS
   le v e l                   z one s with         z one s with             z one s with          z one s with
  Com m unity                 c ommunity           c ommunity               c ommunity            c ommunity
     H ealth                    s upport             s upport                 s upport              s upport
  C om m ittees
                        ...    s y s t e ms         s y s t e ms             s y s t e ms          s y s t e ms
                                                                                                                     ...
                                                                                                                     20
    To deliver on the Framework…
• As stated in the JANS review (and other reviews) we need
  to strengthen our existing structures (in the SMTDP) to
  support our health systems
   – Strengthen the leadership of district health management
     teams
   – Implement a comprehensive package of essential health
     services
   – Improve organization and management of health service
     delivery
   – Strengthen CHPS as the hub of coordination of phc
   – Improve the adequacy of HRH and introduce a team
     approach in performance assessment
To deliver on the Framework… (ctd)
  – Strengthen our national social health insurance and tax-
    based financing of health care
  – Strengthen our procurement, supply and distribution
    processes and minimize commodity wastage
  – Clarify district responsibility in achieving national,
    international and millennium development goals
  – Empower communities (including women, the elderly,
    children and other disadvantaged groups) to take
    appropriate actions for the promotion of their own health
  – Create an enabling environment for devolution of health
    sector responsibilities to the districts (especially working
    closely with the local Govt structures)
 The HSMTDP….
• The HSMTDP 2010 – 2013, reflects the government’s
  development agenda for the medium term (GSGDA 2010-2013)
  and aligns previous policies with the national objective of
  attaining middle income status by 2020.
• The HSMTDP builds on the general principles of providing
  affordable phc to all people living in Ghana, developing cost-
  effective general health systems, bridging of current equity gaps
  in access to health care services, and reinforcing the continuum
  of care.
   – …… the plan is to align the HSMTDP to the framework that we have
     signed on to and fill in the gaps that exist therein
   – …. and be ready for the proposed country peer review of health systems
     in Africa, share best practices whilst learning from others
                Conclusion
• At the African Regional level, It is expected
  that the implementation of this Framework by
  countries will contribute to accelerating the
  achievement of MDGs and better health in the
  new millennium.
• At the country level, we need to have the
  framework to guide our national strategic plan
  (NSMTDP) (the Ghanaian specific context) in
  order to accelerate towards the MDG’s and
  the better Ghana Agenda…..
• Thank You

								
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