2016 Conference on Strengthening Sickle Cell Disease Health Systems in Nigeria HEALTH CARE POLICY. Bola Ibilola Ojo LLB (Hons) LLM, MSc

Transcription

1 2016 Conference on Strengthening Sickle Cell Disease Health Systems in Nigeria HEALTH CARE POLICY Bola Ibilola Ojo LLB (Hons) LLM, MSc

2 Implementation is the process of turning policy into practice

3 Map

4 Policy implementation involves 3 activities (Anderson and Sotir Hussey, 2006): Interpretation: translation of the policy into administrative directives Organization: establishment of administrative units and methods necessary to put a programme into effect Application: routine administering of the service

5 Top-down approach- Policy dev & implementation This approach sees policy formation and policy execution as distinct activities. Policies are set at higher levels in a political process and are then communicated to subordinate levels which are then charged with the technical, managerial, and administrative tasks of putting policy into practice

6 Bottom-up approach individuals at subordinate levels play an active part in implementation, may have some discretion to reshape objectives of the policy and change the way it is implemented. The approach sees policy implementation as an interactive process involving policy makers, implementers from various levels of government, and other actors. Policy may change during implementation

7 Gunn (1978 in Hunter 2003) ten common barriers to effective health policy implementation External circumstances to the implementing agency impose crippling constraints Lack of adequate time and sufficient resources/combination of resources is not available The policy is not based on a valid theory of cause and effect The relationship between cause and effect is indirect and there are multiple intervening links Dependency relationships are multiple poor understanding of, and disagreement on, objectives Tasks are not fully specified in correct sequence There is imperfect communication and coordination. those in authority are unable to demand or obtain perfect compliance

8 Policy Interventions need Political leadership; Effective accountability; Robust data; Vibrant civil society local, state and national; Address the social determinants.

9 Health Care Policy process

10 Effective Policy implementation Lessons learned 1. Be clear about the problem: High-level policy goals need to be matched with analysis of what problem government is trying to tackle and is then used to make good judgement on where to focus attention 2. Work with the wider system: Policies compete for resources/attention with other national policies and local priorities and can draw upon some of the assets that often already exist.

11 Lessons 3. Stay close to implementers: Bring others to policymaking and keep strong links to understand how policies are working on the ground. 4. Stay focused: Continuity is an essential ingredient of effective implementation. 5. Ministers drive progress: politics can add complications. ministers can set milestones and do regular stock takes to keep momentum

12 Factors to take into account when interpreting health policy include (Jenkin et al 2006) Local resources, including human resources and infrastructure Specific characteristics of the population Baseline incidence of the health problem The period before an effect of the intervention will be observed A balance between achieving targets that reflect process change and those that reflect risk factor change Local variations in the likely effectiveness of particular interventions

13 Social determinants of health to consider Income and low rates of literacy indirectly influence health outcomes Power, prestige and access to resources Socio-economic positions, poverty Poor housing weak health systems and limited resources

14 Role of Civil Society & Partnerships partnerships and collaboration - NGOs, academia brings together expertise, resources to build workforce capacity and skills of individuals, families and communities Can help shape policy response Have wide grass root networks for engagement mobilise political awareness and support for addressing SCD Advocate for a higher priority in State health plans Provide services, training and support to families and patient Undertake independent evaluation and monitoring of programs

15 Bridging the implementation gap-key messages Research is essential to bridge the knowledge and practice gap Long term- implementation research and impact evaluation of programs can save resources Early detection is key to improving outcomes for SCD Primary health care approach places equity as a central value Participatory approach by communities in service delivery

16 Specific example- Newborn screening health Policy The Issue

17 The evidence basis for screening Evaluate whether early detection is beneficial persons identified with early-state disease detected through screening have better health outcomes than those who come to clinical attention without screening. Screening, identifying early diseases or conditions at a specific point of disease development. There must also be an effective intervention, which itself must be scientifically assessed Political and legal backing- SCD Bill

18 SCD vision & mission translated to objectives Population-based new born screening for SCD Targeting at risk populations with secondary prevention Improving adherence to pathways of care, therapy, support Ensuring affordable drugs/ access to services e.g. counseling Establish Community-based services, treatment & care Generating the evidence: Research, data collection analysis, M &E, impact & cost-effectiveness

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20 Principles for Quality Management A clear coherent framework of objective, standards, and guidance A culture of learning, not blame A partnership with staff and users Continuous Quality Improvement Clear management structures Performance should be measured effectively and efficiently Adequate systems and resources Bridging the expectation gap - informing the users, public, media, and staff about the benefits and limitations of screening

21 Operational steps to implementing screening Invite target population; Administer screening test; Interpret result of the test Communicate results of the test Follow testing /Treatment (as required) Data management systems Programme coordination, oversight, and quality assurance Ongoing monitoring and evaluation

22 Building blocks of success 1. A unifying vision-brings together all the different motivations 2. The vision allows focus on a common goal, supported by a range of tangible subsidiary objectives 3. Political leadership, cross-party support builds an atmosphere of transparency, trust between government and opposition with regular briefings by civil servants 4. Clear design and governance, clarity on roles and responsibilities within structures that foster problem solving, not blame shifting.

23 Success. 5. Personnel stability and personal relationships allows crucial relationships to make the project work. 6. Getting the right people/skills- in effective teams 7. Budget management. Time discipline crucial 8. Transparency, a hallmark of budget management. quarterly financial updates. 9. Collaborative relationship, combined with speedy decision making. 10. investing upfront in project scoping, management skills and techniques.

24 Key Health Care Policy messages Reduce health inequalities in terms of equitable access to services Networks to share best practice evidence based interventions Improve access to essential medicines Prioritise population wide strategies Control and evaluate resource utilisation Accurate and reliable data collection and analysis Technical capability, use of technologies Competencies of health personnel

25 Thank You!