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Health systems strengthening: a common classification and framework for investment analysis.

Shakarishvili G, Lansang MA, Mitta V, Bornemisza O, Blakley M, Kley N, Burgess C, Atun R - Health Policy Plan (2010)

Bottom Line: Such a framework would make it possible to comparatively analyse donors' contributions to strengthening specific aspects of countries' health systems in multi-donor-supported HSS environments.Four pre-requisite factors are required for developing such a framework: (i) harmonization of conceptual and operational understanding of what constitutes HSS; (ii) development of a common set of criteria to define health expenditures as contributors to HSS; (iii) development of a common HSS classification system; and (iv) harmonization of HSS programmatic and financial data to allow for inter-agency comparative analyses.Building on the analysis of these aspects, the paper proposes a framework for tracking donors' investments in HSS, as a departure point for further discussions aimed at developing a commonly agreed approach.

View Article: PubMed Central - PubMed

Affiliation: The Global Fund to Fight AIDS, Tuberculosis and Malaria (TGF), Geneva, Switzerland. george.shakarishvili@theglobalfund.org

ABSTRACT
Significant scale-up of donors' investments in health systems strengthening (HSS), and the increased application of harmonization mechanisms for jointly channelling donor resources in countries, necessitate the development of a common framework for tracking donors' HSS expenditures. Such a framework would make it possible to comparatively analyse donors' contributions to strengthening specific aspects of countries' health systems in multi-donor-supported HSS environments. Four pre-requisite factors are required for developing such a framework: (i) harmonization of conceptual and operational understanding of what constitutes HSS; (ii) development of a common set of criteria to define health expenditures as contributors to HSS; (iii) development of a common HSS classification system; and (iv) harmonization of HSS programmatic and financial data to allow for inter-agency comparative analyses. Building on the analysis of these aspects, the paper proposes a framework for tracking donors' investments in HSS, as a departure point for further discussions aimed at developing a commonly agreed approach. Comparative analysis of financial allocations by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance for HSS, as an illustrative example of applying the proposed framework in practice, is also presented.

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Structure of the proposed health system strengthening (HSS) classification
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Figure 1: Structure of the proposed health system strengthening (HSS) classification

Mentions: Each of the above four components of the HSS classification is a composite entity. For example, ‘health services’ encompasses staff, infrastructure, organizational management systems, referral systems, demand generation and other expenditures. Therefore, for more detailed analysis of HSS expenditures, the structure of the classification system has been disaggregated by applying consistent rules. The first rule is to disaggregate each of the four health system components into several health system elements, so that each element represents either an action necessary for producing the corresponding component (these are processes, for example policy dialogue, undertaking a survey etc.), or a material, technical, institutional or structural constituent of the corresponding component (these are inputs, for example money, equipment, facility etc.). The second rule is to further disaggregate each health system element into HSS interventions. In the classification system this third layer represents a transitional level from health systems to health systems strengthening. Thus, by knowing the amount of expenditures spent for the activities which compose relevant HSS interventions, it is possible to contextually allocate these expenditures to the relevant health system element, and consequently aggregate them to the level of health system components. Such aggregation would easily allow for comparative cross-donor analysis as by applying the same analytical approaches, it will be possible to attribute each specific donor’s financial contributions to strengthening each element and component of the health system in a given country (Figure 1).Figure 1


Health systems strengthening: a common classification and framework for investment analysis.

Shakarishvili G, Lansang MA, Mitta V, Bornemisza O, Blakley M, Kley N, Burgess C, Atun R - Health Policy Plan (2010)

Structure of the proposed health system strengthening (HSS) classification
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3118911&req=5

Figure 1: Structure of the proposed health system strengthening (HSS) classification
Mentions: Each of the above four components of the HSS classification is a composite entity. For example, ‘health services’ encompasses staff, infrastructure, organizational management systems, referral systems, demand generation and other expenditures. Therefore, for more detailed analysis of HSS expenditures, the structure of the classification system has been disaggregated by applying consistent rules. The first rule is to disaggregate each of the four health system components into several health system elements, so that each element represents either an action necessary for producing the corresponding component (these are processes, for example policy dialogue, undertaking a survey etc.), or a material, technical, institutional or structural constituent of the corresponding component (these are inputs, for example money, equipment, facility etc.). The second rule is to further disaggregate each health system element into HSS interventions. In the classification system this third layer represents a transitional level from health systems to health systems strengthening. Thus, by knowing the amount of expenditures spent for the activities which compose relevant HSS interventions, it is possible to contextually allocate these expenditures to the relevant health system element, and consequently aggregate them to the level of health system components. Such aggregation would easily allow for comparative cross-donor analysis as by applying the same analytical approaches, it will be possible to attribute each specific donor’s financial contributions to strengthening each element and component of the health system in a given country (Figure 1).Figure 1

Bottom Line: Such a framework would make it possible to comparatively analyse donors' contributions to strengthening specific aspects of countries' health systems in multi-donor-supported HSS environments.Four pre-requisite factors are required for developing such a framework: (i) harmonization of conceptual and operational understanding of what constitutes HSS; (ii) development of a common set of criteria to define health expenditures as contributors to HSS; (iii) development of a common HSS classification system; and (iv) harmonization of HSS programmatic and financial data to allow for inter-agency comparative analyses.Building on the analysis of these aspects, the paper proposes a framework for tracking donors' investments in HSS, as a departure point for further discussions aimed at developing a commonly agreed approach.

View Article: PubMed Central - PubMed

Affiliation: The Global Fund to Fight AIDS, Tuberculosis and Malaria (TGF), Geneva, Switzerland. george.shakarishvili@theglobalfund.org

ABSTRACT
Significant scale-up of donors' investments in health systems strengthening (HSS), and the increased application of harmonization mechanisms for jointly channelling donor resources in countries, necessitate the development of a common framework for tracking donors' HSS expenditures. Such a framework would make it possible to comparatively analyse donors' contributions to strengthening specific aspects of countries' health systems in multi-donor-supported HSS environments. Four pre-requisite factors are required for developing such a framework: (i) harmonization of conceptual and operational understanding of what constitutes HSS; (ii) development of a common set of criteria to define health expenditures as contributors to HSS; (iii) development of a common HSS classification system; and (iv) harmonization of HSS programmatic and financial data to allow for inter-agency comparative analyses. Building on the analysis of these aspects, the paper proposes a framework for tracking donors' investments in HSS, as a departure point for further discussions aimed at developing a commonly agreed approach. Comparative analysis of financial allocations by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance for HSS, as an illustrative example of applying the proposed framework in practice, is also presented.

Show MeSH
Related in: MedlinePlus