On June 27, USAID and CHISU hosted a webinar titled: “Local and Global Health System Performance Monitoring.” The webinar was the second in our series that shares learnings from health system assessments using the High Performing Health Care (HPHC) Tool in low- and middle-income countries (LMICs).
Dr. Anuradha Jain, Senior Advisor Health Systems Strengthening (HSS), USAID India, moderated the discussion with chairperson Dr. Atul Kotwal, Executive Director, National Health Systems Resource Centre, Ministry of Health & Family Welfare, India. Panelists included:
- Professor Rajib Dasgupta, Jawaharlal Nehru University, India
- Professor Alfred A. Yawson, University of Ghana, Ghana
- Mr. Godfrey Nyombi, HSS Team Lead, USAID Tanzania
- Dr. Umme Meena, Family Health Team Lead, USAID Bangladesh
Professor Dasgupta opened the discussion with a question: What can we conclude about the HPHC tool, based on what we’ve learned using it in Ethiopia, Madagascar, Pakistan and Philippines? He concluded that the methodology used to collect data from all system stakeholders allowed for geographical and system-level representation, and for validating data internally as well as triangulating it with external sources of information to ensure high validity and reliability of the data.
He also appreciated the innovative framing of health system performance through accountability, affordability, accessibility, and reliability domains, which are often neglected. Professor Dasgupta acknowledged that the tool is user-friendly and provides real-time data analysis for timely decision making. He suggested that in the next iteration of tool improvement, some flexibility needs to be provided to account for specific country needs while keeping core tool questions for global comparison of health system performance.
Professor Yawson elaborated on how the assumption of “health system is everyone’s responsibility” is operationalized in the tool not only for involving all people, but also for improving accountability. Showing data from the four countries, he emphasized that health system responsiveness, accountability, and trust in the system need improvements.
Dr. Meena described the levels of equity and quality in the health systems of the four countries. She illustrated the financial, system, and cultural barriers accounting for these disparities, and also explained that quality of care is limited in the selected four countries. She explained how a quality health system and its correlates could be modeled using HPHC data. Dr. Meena concluded that without equity and better quality, the health system would not be able to enhance performance and better health outcomes.
Mr. Nyombi stated that the resilience of a health system should not be confined to dealing with emergencies caused by occasional events, but need to account for day-to-day emergencies due to lack of or limited staff, supplies, information, etc. He explained that resilient system performance is facilitated or constrained by interactions among demand, supply, and contextual factors. He demonstrated that health system resilience processes are less than 50 percent functional in the four countries, and that there is a need to pay attention to the interrelationships among health system components affecting the system’s overall performance.
Summarizing the presentation’s findings, Dr. Kotwal said that the HPHC tool is a unique and welcome addition amidst a scarcity of health system measurements. Although it is a perception-based tool, it has accounted for various tests of reliability and validity. Dr. Kotwal also pointed out that there are questions which may not be applicable in all countries’ contexts. He agreed with Professor Dasgupta that there is a need for some flexibility in the tool to account for country-specific situations while keeping a core set of questions for global health system performance comparison.
Dr. Kotwal congratulated all presenters for providing useful information and confirming anecdotal evidence of weak health systems in low- and middle-income countries with empirical data. He concluded that the HPHC tool provides actionable information for strengthening health system processes and performance, which is an important and current need.