Systems Thinking: Getting Research into Policy and Practice through Embedded TA
- 1. 10/16/2018 1 GRIPP through Embedded TA Cindy Carlson October 2018
- 2. 2 The programme Strengthening performance monitoring culture & management taking hold Strengthened stewardship, coordination and action in the health sector Enhanced financial management and democratic accountability of the health sector Strengthened health service planning and monitoring Increasingly open and influential civil society accountability efforts Continued alignment of elite interests with programme supported changes Technical and Management capacity increased through an effective technical assistance programme at national and district levels Improved utilization of quality, effective essential health services especially for the poor
- 3. 3 The intervention Aid Coordination It embedded 4 advisors in the MOHP DPPD to work on: Planning and Budgeting Decentralisation reforms Health Financing reforms Strengthening culture of performance monitoring and management taking hold Strengthened stewardship, coordination and action in the health sector Enhanced financial management and democratic accountability of the health sector Strengthened health service planning and monitoring Increasingly open and influential civil society accountability efforts Continued alignment of elite interests with programme supported changes Technical and Management capacity increased through an effective technical assistance programme at national and district levels Improved utilisation of quality, effective essential health services especially for the poor
- 4. 4 Methods Social process undertaken with colleagues ‒ MHSP-TA worked hand in hand with govt staff to review and validate evidence Provided insights worthy of interest to a wider audience - Wide stakeholder consultations on all reforms proposed, ensuring political and social acceptability Focused on aspects the TA had control over and could initiate change - TA funded further studies on MOH-CHAM service level agreements and initiated further analyses
- 5. 5 Application and result MOH request: whether to continue supporting the SLAs btw districts and CHAM facilities Embedded TA does feasibility study, with qual. and quant. analyses TA presents strong evidence of health equity benefits of SLAs New request for support: Embedded TA is tasked with operationalising new SLAs MoU and set up the new Unit MOH and MoF want to expand SLAs and prepare revised MoU
- 6. 6 Reflections • Embedding skilled TA to assist with already defined policy priorities was a plus – not always the case when agendas are defined externally • Using MOH defined priorities as the starting point, TA can build on and influence thinking on what policy research is needed and moving it into practice. • Relationships developed through work of embedded TA allowed for more controversial reform areas to be addressed or researched – e.g. medicine theft and new community accountability mechanisms
- 7. 7 ZIKOMO!
- 8. 8 Additional slide on decentralisation • Decentralisation Act dates back to 1998 but progress severely stalled in intervening years. • At MOH request, MHSP-TA funded two short term consultants to assess the state of decentralisation in 2014/5 and provide detailed findings and recommendations to the Decentralisation Expert Group. • Followed by MHSP-TA funding of two government staff to develop a ‘decentralisation concept note’ for discussion in MOH and at Cabinet – needed further work. • Then recruited a long term embedded TA to work within MOH to drive forward further assessments and strengthen links with MOLGRD. MOH/MOLGRD now have sufficient evidence to develop decentralisation guidelines – next step…
Editor's Notes
- #3: - The Malawi Health Sector Programme – TA component provides technical assistance to enhance implementation of the Malawi’s Health Sector Strategic Plan (HSSP) - It aimed at supporting sustained health system performance improvements for more efficient, effective, equitable and accountable delivery of high quality health care services. - TAs were considered ‘jointly appointed staff’ as well as ‘funded research staff placed within the system’ when considering the the HPSR embedded researcher matrix
- #4: - This presentation will use the stewardship workstream as an example of the role embedded TA can play with regards to strengthening the use of health systems research for policy and practice - 4 advisors were …. DPPD = Department of Planning and Policy Development
- #5: Idealised’ criteria realized - Reference Box 2.1 in De Savigny et al 2017 – especially Social process undertaken with colleagues - MHSP-TA worked hand in hand with government staff to review available evidence to inform each reform area and agree where further evidence was needed Focused on aspects of practice in which the researcher has some control and can initiate change – MHSP-TA funded further studies/assessments regarding MOH-CHAM service level agreements, as well as other reform areas. Likely to yield insights that can be conveyed in a form that make them worthy of interest to a wider audience – all reforms we supported have been widely consulted on to ensure political and social acceptability
- #6: Add notes on: process and how embedded TA was able to influence the decision (thinking about the counterfactual: if they were not embedded what would have gone differently?) Challenges faced
- #7: Add notes on: process and how embedded TA was able to influence the decision (thinking about the counterfactual: if they were not embedded what would have gone differently?) Challenges faced