f (WP)SAP/ICP/HRF/001-E Report series number: RS/RS/2001/GE/36(PHL) English only
REPORT
REGIONAL CONSULTATION ON HEALTH SYSTEM PERFORMANCE ASSESSMENT
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Manila, Philippines 3-5 July 2001
Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines August 2001
NOTE
The views expressed in this report are those of the participants in the Regional Consultation on Health System Performance Assessment and do not necessarily reflect the policies of the Organization.
This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Regional Consultation on Health System Performance which was held in Manila, Philippines from 3 to 5 July 2001.
CONTENTS
BACKGROUND ......................................... .............. ............. ....... .......... ...................... .. ..... .. ....... I SECTION 1. GENERAL OBSERVATIONS REGARDING PERFORMANCE ASSESSMENT ......... ............ .... .......... .. .... ........................ ... ............ ...... ............... . 2 SECTION 2. METHODOLOGICAL ISSUES RELATED TO WHO HSPA .... ....... ........ ........... 2 2. 1 WHO HSPA framework and methodology ................... .... ..................... ..... .... 2 2.2 Country views and experiences .............. .... ......... .. ..... ..... ................................ ) 2.3 Links with policy and management processes .... .................. ........................... 6
SECTION 3. IMPLICATIONS FOR FUTURE WORK ON WHO HSPA AND RELATED AREAS .. .. ..... .... .......... ................... .. ... .. ....... ........................ ... .... 7 CONCLUSION ....... ...... ..... ... ....... ........... ... ........ ........ ....... ........ ... ... .......... ... ... ..... .. .... .... ............. ... 8 ANNEXES: ANNEX 1 - LIST OF PARTICIPANTS .. ... .. .......... ........ ....................... ............. ... .......... .......... II ANNEX 2 - PROGRAMME ......... .......... ..................... ................ ....... ... .................... .... .... ....... _! ANNEX 3 - OPENING REMARKS .... ........ ........ ... ... .... ...... ... ........ ............. ........................ ..... 1S
Key words Process assessment (Health care)- organization and administration, methods. congresses I Western Pacific I Manila
SUMMARY
Representatives from ten countries and twelve technical experts convened to discuss conceptual and methodological issues related to health systems performance assessment (HSPA); to relate various experiences with health systems performance; to identify other critical issues in its application, and to assess the linkage between health systems performance and policy and managerial decision-making processes. It was generally viewed at the Regional Consultation that the HSPA potentially provides an opportunity to review a country's health system and how it improves over time. How a country's health system compares with others requires an understanding of the historical, past development efforts and current conditions of health systems across countries. Some countries in the Region also possess unique features. such as size, isolation, levels of economic and political development, diversity of health systems ctnd human resources capacities. that may affect the results of assessments on their performance and yield inter-country comparisons and ranking meaningless. It was suggested that no ranking of countries be made in the subsequent World Health Report.
It was generally agreed that the current HSPA methodology is complicated. There was agreement that the development of HSPA tools and methods will be more useful to Member States if the objective of the assessment is for in-country use and closel y linked to health systems functions and managerial processes. The concept of responsiveness and its domains are culture-bound and vary with different socio-cultural settings . Fairness of financial contribution (FCC) index was less understood as well, especially in terms of what the index ultimately measures. Suggestions were made to develop a few indicators. particularly at sub-population levels, to illustrate various equity measures within the FFC index. Participants also cited the need to relate the summary indices with the provision and coverage of health services to capture various health care settings in countries, including traditional health systems. The data requirements of HSPA pose problems for data collection. The information needs are not likely to be met by countries on a regular basis, as they involve huge resource trade-offs and capacity overload. There is clearly a need for simpler data sets and streamlined information requests from international partners. Simplification of tools and capacity building support are needed. Participants have voiced the need for the HSPA development processes to be transparent and participatory. Second level HSPA work should not only take account of methodological issues, but also built on Member States health priorities and utilize exi sting works on indicators going on in countries . For countries to make an investment for HSPA . there has to be a buy-in process to foster ownership. Ownership requires an understanding and agreement to the framework and methodologies. The research development process should include open peer review processes, easy and early availability of write-ups. with clear explanations on assumptions made and data limitation acknowledgments. Member States expressed the need to see greater collaboration among development partners, especially with regards to information requests and the over-all direction of health systems development. It is proposed that WHO, in its stewardship role should initiate and facilitate this process. Member States also want better coordination within WHO. especially in areas of programme proposals, development of indicators, tools, methods, guide! ines and consultations and communications on these new developments.
BACKGROUND
Following the memorandum dated 13 March 2001 from the Director-General to "hear and reflect on the widest possible range of views and ideas on health systems performance assessment". the WHO Regional Office for the Western Pacitic organized the Regional Consultation on Health System Performance Assessment (HSPA) in Manila from 3 to 5 July 200 I. Representatives from I 0 countries and 12 technical experts convened with the following objectives: ( 1) to discuss different conceptual and methodological approaches to assessing the performance of health systems; to take stock of different country and regional experiences in the Western Pacific on issues related to health systems performance assessment; to identify critical issues for furthering the conceptual and methodological development of a framework for measuring the performance of health systems that countries could apply on a regular basis, and on which they could inform WHO periodically; to discuss the Iinkage between health systems performance assessment practices and health systems policy and managerial decision-making processes.
(2)
(3)
( 4)
Following the opening remarks by Dr Shigeru Omi, Regional Director, Mr John Goss , country participant from Australia, served as chairman, with Dr Nguyen Dang Vung, country participant from VietNam, as vice-chair, and Dr Rozita Hussein, technical adviser from Malaysia, as rapporteur. Participants were given, as reference material, the WHO background paper for the Regional Consultation on Health System Performance Assessment. The agenda ofthe Regional Consultation was designed to discuss the HSPA framework and methodology issues on the tirst day after the background presentation by Dr C. Murray, Executive Director, Evidence and Information for Policy . The next day saw country representatives and technical experts presenting their views on the HSPA. especially in terms of its applicability to their respective country settings. Open plenary sessions followed to discuss the use of composite and multiple indicators in the HSPA, as well as future research and collaborative issues. On the third day, there was a presentation from Mr 0. Adams. Director, Organization of Health Services Delivery, Evidence and Information tor Policy, on the linkage of HSPA to pol icy and managerial decision-making processes in health systems. Discussions among the participants were followed by the summary presentation of the Regional Consultation. The Regional Consultation was undertaken as an open and frank dialogue. This report provides a summary of the points raised during the Regional Consultation. The paper is divided as follows: the first part covers general observations on HSPA; the second part discusses methodological issues related to WHO HSPA; and the third examines the implications for future work on WHO HSPA and related areas.
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SECTION 1.
GENERAL OBSERVATIONS REGARDING PERFORMANCE ASSESSMENT
1.1 There has been a strategic shift and commitment from WHO to support the Member States in health system performance assessment of their respective health care systems . This was welcomed and supported by Member States in the Western Pacific Region. 1.2 It was agreed that the assessment of health system performance and how it improves over time is important for reviewing a country's health system . This has the potential to provide health policy- and decision-makers with an impetus to consider and institute changes to improve the performance of their health care systems. Health system performance assessments are a useful and necessary part of unravelling and measuring the "black box"- that is, what happens between the inputs to health systems and the final outcomes achieved by countries. The tools developed within HSPA in general may therefore be useful for evidence-based decision-making, provided there is a consensus on the development and use of these tools across countries. 1.3 However, it must also be recognized that comparison between the health systems of different countries requires an understanding ofthe historical , cultural, economic and social contexts, past development efforts, and current conditions of health systems across countries. Some of the countries in the Region are in the midst of refonn initiatives and decentralization activities . Others are contemplating such reforms. The countries in the Western Pacific Region also possess unique features that may affect the results of assessments on their performance. such as size, distance and relative isolation, levels of economic and political development, diversity of health systems and human resource capacities. The various issues raised during the meeting were reflections of relevant health system performance assessment issues in the context of current health sector reform directions among the Member States.
SECTION 2. 2.1
METHODOLOGICAL ISSUES RELATED TO WHO HSPA
WHO HSPA framework and methodology
(General) 2.1.1 There has not been general consensus on the objective of HSPA as ass umed by WHO in its publication, The World Health Report (WHR) 2000. Although there was no dispute on the importance of health system performance assessment for Member States, it was felt that the main objective of HSPA undertaken by WHO with its publication of WHR 2000 seemed to be intercountry comparison. Participants considered that HSPA methods and tools would be more useful to the Member States if the assessment were extended to in-country use . 2.1.2 It was generally agreed that the current WHO HSPA methodology was complicated and difficult to understand by policy-makers and researchers alike. There were strong requests for simpler methods and measures that would illustrate the performance of health systems in a userfriendly fashion. 2.1.3 The current methodology involves measuring attainment indicators for tive goals and combining these into a composite index of health system performance. In this process, there has been an unfortunate mixing of new and recent conceptual and empirical developments in areas such as responsiveness with more advanced empirical and research work on the burden of disease and
-4show up in the measurement of the equity of health outcomes, but equity of provision is such an important process indicator that it should be measured in its own right. 2.1.6 The need to measure the performance of the private, traditional and informal health care sectors was also raised during the discussion. Measurement should be made of resources. in cash or in kind, spent on private providers, and also of services provided by traditional carers such as bitih attendants, healers and informal carers. This provision has an effect on the public provision of health services . (Data issues)
2.1.7 The data requirements ofthe current WHO health system performance assessment pose problems for data collection. Problems with surveys related to the measurement of responsiveness and health state preferences were discussed. The understanding of various concepts measured in the questionnaires by respondents from different cultural backgrounds was one of the major problems raised by participants. Issues regarding the rei iabil ity of responses, response rates to surveys. and gaming were also discussed. The resource requirements of these surveys are extensive. The length of questionnaires was also cited as cause for concern, as well as the use of culture-bound vignettes . It was noted by some patiicipants that the introduction of vignettes had not improved the tool. They may in fact lead to more confusion in understanding the concept, resulting in responses that do not reflect real understanding. WHO is still assessing the validity of this methodology. including the use of vignettes . The choice of data-collection methods wi II have a strong influence on the timing/frequency/ feasibility ofHSPA analysis and repotiing. Household surveys are costly and in many instances can be organized only once every five or ten years. Postal surveys in developing Member States have limited utility. The validity of the key informant survey instrument and method has yet to be established. The burden on countries in collecting data and developing significant analytical capacity in exchange for measuring marginal improvements in health system performance was at the centre of the discussion. The suggestion that annual reporting is required to assist policy- and decision-makers is dependent on the HSPA methodology being demonstrated to be useful for strategic and operational policy- and decision-making at the marginal level. There was a suggestion that the feasibility and appropriateness of biennial repotiing should be investigated . Composite measures. without disaggregation to lower levels, will have less applicability and relevance to the successful management of factors directly within the bounds of control of a minister/ministry of health. 2.1.8 The quality of data used for The WHR 2000 was discussed. It was suggested that there was a need to treat data quality issues in a very transparent manner in future WHO HSPA undertakings. It was also suggested that information should be provided on the quality of data used for such calculations in a tabular format. This should indicate for each country the type and sources of data used, as well as giving a score on the degrees of data quality, including whether the data are actual or an estimate.
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summary indices of population health. The resulting composite index of WHO HSPA reveals the characteristics of research efforts in evolution. with all the problems that may be expected with a newly developing methodology. There were suggestions to concentrate only on the level and distribution of population health status measurement across countries within the WHO HSPA framework, while conceptual and methodological development on the responsiveness and fairness of financial contribution elements were progressed further. (Responsiveness)
2.1.4 There are serious problems with regard to understanding the concepts of responsiveness and its domains, pariicularly given the very different sociocultural settings of various countries. It was felt that the domains being measured for responsiveness were more retlective of areas of concern for developed countries, and less so for developing countries. Similarly, the weighting given to the different domains in developing the index for responsiveness would be different for different countries. particularly if this were to reflect the health system policy priorities ofthe different countries. The instruments developed for measuring these domains, as well as health state preferences, suffer the same lack of understanding. agreement and acceptance by researchers from different countries . The development work being undertaken by WHO may well solve some of these problems. However, because the instruments are still in the developmental phase and the third version is due to come out soon, there were suggestions that WHO should focus on cross-cultural development. acceptance and agreement of these instruments before trying to make comparisons across countries. Public health interventions and spending by governments did not seem to be retlected in the instruments and methodology developed to measure responsiveness. Although the contribution of public health activities would eventually be reflected in the level of health status and distribution. it was mentioned that having a fairly distributed and responsive public health system would go a long way towards improving the well-being of the population. As such, this needs to be measured under responsiveness. (Fairness offinancing)
2.1.5 Participants voiced concern about the complexity of the fairness of financial contribution (FFC) index. They maintained that it was unclear what changes in the index might mean. The index at present includes measures of both horizontal and vertical equity, which make interpretation more difficult. The countries with low scores mainly result from extreme horizontal equity problems (catastrophic expenditures on health). It was also mentioned that the current FFC index relies on household survey data on income and expenditures . Data on government and employer sources of health care financing are imp Iicitly included, but government subsidies, which are substitutes for income support, are not included so as to avoid possible double counting. The need to include non-monetary social support by households was noted . It was stated that there was a need to go beyond the FFC index, measuring the distribution of health financing contributions, to measuring the distribution of provision and coverage of health services. Admittedly, if there is inequitable distribution ofthe provision of health services, this wi II
-5(Rankin g issues) 2.1. 9 In view of the various methodological problems cited, the ranking of countries based on the HSPA indices was discussed extensively. There was a general consensus (withou t dissent) that future reporting should not include rankings for Member States.
There were suggestions that countries should be grouped according to various criteria, such as development status, and that analysis should be provided without ranking . Althoug h it was recognized that the information in any public WHO rep011 of this nature would be used by others to rank countries, some felt strongly that there was a difference between WHO ranking the order of countries as opposed to others using it for that purpose. 2.1.1 0 Another major discussion revolved around translating the global strategy of HSPA into national and local action. If the WHO HSPA framework and methodology cannot be applied to the subnational and subsystem settings of the Member States, it will be difficult for policy- and decision-makers to use the current WHO methodology for health sector develop ment within countries.
2.2
Countr y views and experiences
2.2.1 A number of participants mentioned that the country ranks and scores attracted a lot of attention when The WHR 2000 was released . This distracts attention from the main issues discussed in The WHR 2000 on improving the performance of health care systems. A number of particip ants mentioned that the lack of linkage between health systems performance and outcom es was one of the major limitations of use ofthe current HSPA framework of WHR 2000. This hampered the seeking of guidance on how to improve health systems performance as well as managerial pol icyand decision-making.
The WHR 2000 ranking of countries' health systems performance, without takin g into account the very different resource bases, health conditions, historical influences and current developments in the systems, has been noted to be a major concern. At best, the WHO HSPA ranking s elicited further queries on how to improve performance. At worst, some countries reported that the WHO HSPA rankings caused resentment because of perceived negative and unjustified impressions of some countries' health system performance in Th e WHR 2000. Differences in the culture of policy- and decision-making in different countries affect the use and applicability of a concept such as HSPA . In cases in which politicians appear to be interested merely in the flow of resources to their constituencies, the applicability of the WHO HSPA methodology for intracountry comparison clearly becomes more impmia nt to them than intercountry comparison. It was considered that judgements on health systems perform ance should be linked to the health system priorities of each country . 2.2 .2
True ownership by countries of the HSPA process would be enhanced through clear understanding of and agreement with the framework, methodology and processe s. The participants viewed the lack of prior consultation, before the official release of The WHR 2000, with concern. They suggested that Member States should be consulted in the future development of the WHO HSPA and related works. The future consultation process needs to be transpar ent. 2.2 .3
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2.2.4 Countries have expressed a need to place WHO HSPA within the conte:-.:t of various health system reform effo1ts in health financing and decentralization . Delegation of health authorit: to lower administrative levels such as states/provinces/districts requires adapting the HSPA methodology to such levels in order to ensure that the assessment is meaningful vvithin the context of health sector development in Member States. 2.2.5 The current HSPA framework and methodology appear not to have taken into account previous and ongoing work and efforts within countries on assessing the performance of their own health systems, and the development of health information and survei Ilance systems. It was noted that several countries had developed frameworks to monitor and evaluate health system performance using multiple indicators. Movement towards a multiple indicator-based HSPA system within the composite outcomes framework would be more in keeping with the countries· concerns for monitoring health system performance. 2.2.6 The information requirements ofthe WHO HSPA have been noted to be burdensome to countries. The information needs of WHO HSPA, if they are to be met by countries on a regular basis, are likely to involve resource trade-offs. Resources put into efforts on surveys should be balanced by investment needs in improving vital registration systems and reorienting routine health information systems . The resource constraints are not purely monetary or infrastructure-related. In many developing countries in the Region, there are very limited numbers of trained staff and technical personnel to conduct such assessments. There is a significant problem of overloading the limited human resource capacity . 2.2.7 There is clearly a need for simpler data sets and streamlined information requests. especially from international partners. in addition to requests from WHO Regional Offices and Headquarters. Coordination of information requirements of donors and development partners in the Member States would reduce workloads. 2.2 .8 Country-level capacities for HSPA are not sufficient. Some countries noted the lack of survey skills. and a very limited capacity to carry out in-depth analysis and performance monitoring. Simplification of tools and capacity-building support are needed. The participants highlighted the Pacific island countries' requirements in these areas. 2.3 Links with policy and management processes
2.3.1 Participants in this consultation strongly voiced the need for the HSPA framework to have direct relevance to policy and management decision-making. While research and development of the next level of indicators were recognized as being potentially useful. the consultative process to develop them needs to be put in place. Future developments on indicators of functions and intermediate goals were encouraged, provided that the indicators were relevant as inputs into intracountry assessments and management processes.
2.3.2 It was requested that WHO should review existing in-country indicators in the Member States during the development and drawing-up ofthe next level of assessment tools. Some countries in the Region have institutionalized frameworks for these issues within their health information systems.
-72.3 .3 The use of a parsimonious set of indicators requires prior agreement from countries that these indicators indeed fit into their countries' health system priorities and current diredion . The development of standardized evaluation protocols for critical interventions should look into current indicators used by countries. Deliberate efforts should also be made to link routine data collected by the ministries of health with these protocols. 2.3.4 Current work on the cost effectiveness of critical interventions spans different types of interventions, from preventive to curative, and from public health to personal care services, e.g. from distribution of bednets to seatbelt legislation to insulin treatment. There is a need to identify what can be considered sets of relevant critical interventions from the perspective of differences in health care systems. These sets of critical interventions must be agreed upon by the Member States. and must be flexible to accommodate the priorities and needs of countries with differing health needs and resources. 2.3.5 Given current and future directions in health sector reform. there is a need to examine what goes on in the private sector. Countries in this Region are pluralistic. Focusing only on the public sector as the source of information or as the focus of the assessment will not capture a large and important part of the health system. As part of this, defining stewardship and the development of indicators for stewardship functions is important. This also applies to health care systems with strong and formally recognized traditional health sectors. Linking these providers' behaviour to responsiveness and quality of care was also identified as being potentially useful. WHO's technical expertise in developing mechanisms for governments to interact meaningfully with the private sector and traditional health practitioners, and also in gathering reliable information from them. was discussed. 2.3.6 Policy work in the health sector can be informed by specific measures of affordabi lity and of access to health care services. Participants suggested that issues of cost containment and comparative pricing of health care services and commodities globally would provide practical information to policy-makers. 2.3.7 The second-level WHO HSPA work processes and results must be communicated to regions and countries. Country experts should have the opportunity to conduct a review of the data used and to carry out their own analysis in advance of publication and dissemination of the findings. WHO has begun to send out preliminary data to countries to enable such review. It was also suggested that research using methodologies not yet subjected to peer review should first be published as research reports rather than in The World Health Report (WHR). Only after acceptance ofthe methodologies should the findings be regularly featured in The WHR. SECTION 3. IMPLICATIONS FOR FUTURE WORK ON WHO HSPA AND RELATED AREAS
3.1 It is considered that health systems performance assessment is a valuable tool for health ministries in their efforts to improve the health of their population. The composite measures developed and analyses conducted in the first phase ofthe WHO HSPA should be brought down to subnational and (where appropriate) subpopulation-group levels. In this context, the intracountry application of particular areas of the WHO HSPA methodology for Japan, as was demonstrated during the consultation, can serve as an example of the feasibility of such analysis, where reliable data are available. The presentation from Japan also demonstrated the value oftime-series analysis . The meeting encouraged future work on WHO HSPA to make better use of insights and tools from
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management and policy sciences. At the same time, it clearly highlighted the need t(Jr good, disaggregated data beyond national totals and time-series data. Such data are not currently avai Iable for many countries in the Region; and neither are the skills needed to carry out such analyses. Extensive and intensive training in health economics is also needed. 3.2 Large investments in effort, time and resources are required to undertake WHO HSPA. For countries to make that level of investment, there has to be a buy-in process to ensure ownership. Ownership requires understanding and agreement of the framework and methodologies. Hence. the future research development process of WHO HSPA must be transparent, and should include open peer-review processes with both technical experts and country representatives. It should also include easy and early availability of write-ups, with clear explanations on assumptions made and data limitations. The development of instruments and tools should progress gradually from pilot and small-scale studies in different settings to finalizing and stabilizing the instruments before applying them to more widespread and large-scale studies. An independent evaluation of the WHO HSPA initiative and programme would be helpful. 3.3 There should be greater collaboration among development partners, especially with regard to information requests and the overall direction for health systems development. It is proposed that WHO, in its stewardship role as the main global authoritative body on health issues. should initiate and facilitate this process . At the same time, WHO must have the commitment and capacity to perform the stewardship role of providing technical support to countries that require and request support in improving their health systems. 3.4 At the same time, Member States want better coordination within WHO. between different clusters and programmes at Headquarters and between Headquarters and the regional and country offices. Coordination is required in the areas of programme proposals, data requests, development of indicators, tools, methods and guidelines, and consultations and communications of new developments. They would like to see support for regional and subregional initiatives in capacitybuilding, not just of personnel from Member States, but also of WHO staff. in order to foster close and continuous transfer of technology and skills bui Iding.
CONCLUSION
Member states in the Western Pacific Region fully suppot1 the initiative to measure health system performance. This is reflected in the keenness of countries to participate and learn from the WHO HSPA initiative. At the same time, there is recognition that the framework is only newly developed and pushing forward the frontiers in some areas of research. While it is still in its evolutionary stage, Member States want their concerns and constraints to be considered, and to this end the consultative process with Member States and technical experts that has now been started is supported. It is the expectation of Member States that such a process wi II continue throughout the development and finalization of the WHO HSPA framework, both in the initial phase and for subsequent phases. Through such consultations, it is expected that a manageable and relevant set of indicators and measurement tools will be developed that will not only take into account methodological issues.
-9but will also incorporate countries' priorities, and inter- and intracountry ditTerences. It is expected that these tools will be of use at country level with regard to management and policy. Member States look forward to the greater stewardship role of WHO in coordinating initiatives related to health and health care, at both inter- and intra-agency levels . Member States also look forward to a clear and committed role by WHO in helping countries fultil their potential to develop high-performin g health care systems as envisaged by the WHO HSPA initiative.
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ANNEX I
REGIONAL CONSUL TATION OF HEALTH SYSTEM PERFOR MANCE 3-5 JULY 2001 MANILA, PHILIPPINES
1.
PARTICIPANTS
AUSTRALIA
Mr John GOSS Principal Economist Australian Institute of Health and Welfare GPO Box 570 Canberra City ACT 2601 Australia Tel No: (612)6244 1151 Fax No: (612)6244 1045 Email : john.goss@aihw.gov.au Mr Jun GAO Deputy Director Center for Health Statistics Information Ministry of Health #I, Nanlu, Xizhimenwai Xicheng District Beijing 100044 People's Republic of China Tel No : (86-10) 6879 2297 Fax No: (86-1 0) 6879 2278 Email : jxgO@chsi.moh.gov.cn Dr Pui-Yin CHIU Principal Medical and Health Officer Department of Health 1 21' Floor, Wu Chung House 213 Queen's Road East, Wan Chai Hong Kong Tel No: (852) 296 I 8895 Fax No: (852) 2836-007 I Email : amy m:.. chiu@dh.gQy_,_bk
CHINA, People's Republic of
(Hong Kong)
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Annex I
JAPAN
Dr Masami SAKOI Deputy Director International Affairs Division Minister's Secretariat Ministry of Health, Labour and Welfare 1-2-2 Kasumigaseki, Chiyoda-ku Tokyo l 00-8916 Japan TeiNo : (813) 3595 2403 Fax No: (813) 3501 2532 Email : sakoi-masami(g{mhlw.go.iP. Dr Kalsom MASKOM Principal Assistant Director Planning and Development Division Ministry of Health 14th Floor, Perkim Building lpoh Road 51200 Kuala Lumpur Malaysia TeiNo: (603) 4045 7430 Fax No: (603) 298 5964 Email : kal sommaskom@hotmai I :com Dr Mark BOOTH Senior Analyst Sector Policy Directorate Ministry of Health Level I, Old Bank Chambers Customhouse Quay P.O. Box SO 13 Wellington New Zealand Tel No: (64-4) 495 4444 Fax No: (64 4) 495 4401 Email : mark boo!h@moh.go_yUJZ Dr Gilbert HIA WAL YER Director Monitoring & Research Division Department of Health P.O. Box 807 Waigani NCD Papua New Guinea Tel No : (675) 301 3650 Fax No: (675) 323 0022 Email : ghiawaly(r:!J.health.gov.p!!
MALAYSIA
NEW ZEALAND
PAPUA NEW GUINEA
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Annex I
PHILIPPINES
Dr Mario VILLA VERDE Director IV Department of Health San Lazaro Compound Rizal A venue, Sta Cruz Manila Philippines Tel No: (632) 743 8301 (ext 134) Fax No: (632) 711 6736 Email : marvill@doh.g ov.ph Dr J ae-Goog J0 Director Department of Health Research Korea Institute of Health and Social Affairs San 42-14, Bulgwang-dong , Eunpyung-gu Seoul 122-705 Republic of Korea Tel No : (822) 387 9013 Fax No: (822) 353 0344 Email : jgjo@kihasa.re .kr Ms Pelenatete STOWERS Director of N urs ingl Department of Health Private Bag Apia Samoa TeiNo: (685) 21212 Fax No: (685) 25120 Email : pelenatete({i),health. ws Dr Nguyen Dang VUNG Senior Officer Health Policy Unit Secretary ofthe High Level Committee on Health Policy and Strategy Ministry of Health 138A Giang YoSt HaNoi VietNam Tel No: (84-4) 8 460 464 Fax No: (84-4) 8 463 056 Email : shpa(W,fpt. vn
REPUBLIC OF KOREA
SAMOA
VIETNAM, The Socialist Republic of
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Annex I
2.
TEMPORARY ADVISERS
Dr Manuel DA YRIT Secretary of Health Department of Health San Lazaro Compound Rizal Avenue, Sta Cruz Manila Philippines TelNo: (632) 711 9502 Fax No: (632) 743 1829 Dr Barry BORMAN Manager, Analysis Public Health Operating Group Ministry of Health P.O. Box 5013 Wellington New Zealand Tel No: (64-4) 496 2445 Fax No: (64-4) 496 2340 Email : barrv borman(~moh.govt.nz Dr Maryse DUGUE Health Specialist Office of Pacific Operations Asian Development Bank P.O. Box 789-0980-Manila 6 ADB Avenue 1550 Mandaluyong City Metro Manila Philippines Tel No: (632) 636 2442 Fax No: (632) 632 6179 Email : mdugue@adb.org Dr Toshihiko HASEGAWA Director Department of Health Care Policy National Institute of Health Services Management 1-23-1, Toyama, Shinjuku-ku Tokyo 162-0052 Japan TelNo: (81-3) 3203-4821 Fax No: (81-3) 3202-6853 Email : thasegawa(Ziinih.go.jp
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Dr Rozita Halina bte. Tun HUSSEIN Medical Officer in Research Health Systems Research Division Institute of Public Health Ministry of Health I 9 Changkat Tunku 50480 Kuala Lumpur Malaysia Tel No: (6012) 292 5054 Fax No: (603) 2282 3114 Email : drozita(a).pd.jaring.nw or rozita@iku.gov.my Dr Meng-Kin LIM Associate Professor Department of Community, Occupational & Family Medicine Faculty of Medicine National University of Singapore MD3, 16 Medical Drive Singapore 117597 Tel. No: (65) 874 4981 Fax No: (65) 779 1489 Email : cotlimmk@nus.edu.sg Mr Kitione MULO Acting Director Health Planning and Information Ministry of Health Box 2223 Government Building Suva Fiji Tel. No: (679) 306 177 Fax No: (679) 306 163 Email : kmulo(q)health.gov. {j Ms Dontor ORKHON Head Division for Economics and Technology Ministry of Health and Social Welfare Ulaanbaatar Mongolia Tei.No: (976-11)321014 Fax No: Email : orkl}on(cil.mohsw .miJ,g,net
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Dr Kai-Hong PHUA Associate Professor and Head Health Services Research Department of Community, Occupational and Family Medicine" National University of Singapore Faculty of Medicine MD 3, 16 Medical Drive Singapore 117597 Tel. No: (65) Fax No: (65) 874 4988 Email : cofpkh{a).nus.edu.sg
3.
CONSULTANT
Dr Maria Cristina BAUTISTA Associate Professor Ateneo de Manila University Loyola Heights Quezon City Metro Manila Philippines TelNo: (632) 931 2016 Fax No: (632) 931 2016 Email : mcbautista 2000@yahoo.c om
4.
OBSERVERS
Mr Tony KINGDON Assistant Secretary Policy and International Branch Department of Health and Aged Care Canberra, A.C.T. 2601 Australia Tel No: Fax No: Email : tonv. ki ngdon@health. gov.au
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Mr II Hoon PARK Administrative Officer International Cooperation Division Ministry of Health and Welfare I, Joongang-Dong Kwacheon City Republic of Korea Tel No : (822) 503 7574 Fax No: (822) 504 6418 Email : ihpark58(whanmail.net
5.
SECRETARIAT
Dr Christopher MURRAY Executive Director Evidence and Information for Policy World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland (4 122) 791 21 I I TelNo: Fax No: (4122)7913111 Emai I : murraycrit)who.ch Mr Orville ADAMS Director Organization ofHealth Services Delivery Evidence and Information for Policy World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel No: (4122) 791 21 II (4122)791 3111 Fax No: adamso(tl)who.ch Email : Dr Jie CHEN Special Representative of the Director-General World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland (4122) 791 4711 Tel. No: Fax No: (4122)791 4292 Email : chenj@who.ch
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Annex I
Dr Tessa Tan-Torres EDEJER Coordinator, a.i. Choosing Interventions: Effectiveness, Quality, Costs, Gender and Ethics Evidence for Health Policy World Health Organization 20 A venue Appia CH-1211 Geneva 27 Switzerland TeiNo: (4122) 791 3497 (4122) 791 4328 Fax No: Email : tantorrestai1who.ch Dr Ke XU Evidence and Information for Policy World Health Organization 20, A venue Appia CH-1211 Geneva 27 Switzerland (4122) 791 2111 TeiNo: Fax No: ( 4122) 791 3 Ill Email : xuk@who.ch Dr Alan LOPEZ Coordinator Epidemiology and Burden of Diseases World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland TeiNo: (4122) 791 2855 Fax No: (4122) 791 4328 Email : lopeza@vwho.ch >
Dr A viva RON Director Division of Health Sector Development World Health Organization Western Pacific Regional Office United Nations Avenue 1000 Manila Philippines (632) 528 9802 Tel No: (632) 521 1036 Fax No: Email : rona(Zliwpro. who. int
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Annex 1
Dr Soe NYUNT-U Scientist Situation Analysis for Policy Division of Health Sector Development World Health Organization Western Pacific Regional Office United Nations Avenue 1000 Manila Philippines TeiNo: (632) 528 983 I Fax No: (632) 52 I I 036 Email : nyuntus(W,wpro. w_!:10. i nt Dr Yok-Ching CHONG Regional Adviser in Health Information Division Health Sector Development World Health Organization Western Pacific Regional Office United Nations Avenue 1000 Manila Philippines TelNo: (632) 528 9812 Fax No: (632) 52 I I 036 Email : chongvcl{~wpro. who. int Dr Graham HARRISON Regional Adviser in Health Services Development Division of Health Sector Development World Health Organization Western Pacific Regional Office United Nations Avenue 1000 Manila Philippines Tel No: (632) 528 9806 Fax No: (632) 52 I I 036 Email : harrisongCqlwQrQ, v.ilJiLirn Mr Dorjsuren BAYARSAIKHAN Regional Adviser in Health Care Financing Division of Health Sector Development World Health Organization Western Pacific Regional Office United Nations Avenue 1000 Manila Philippines Tel No: (632) 528 9808 Fax No: (632) 521 1036 Email : !.lliyarsai l<,.band@~Y.I2!"0. v~:J]Q,_Lm
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Dr Michael O'LEARY Epidemiologist c/o The WHO Representative in the South Pacitic P.O. Box 113 Suva Fiji TelNo: (679) 304 600 Fax No: (679) 300 462 Email : olearym@fi j.wpro.who. int Dr Dean SHUEY Programme Managemen t Officer c/o The WHO Representati ve in Lao People's Democratic Republic P.O. Box 343 Vientiane Laos Tel No: (856-21) 413 431 Fax No: (856-21) 413 432 Email : shueyd@lao .wpro.who.i nt
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ANNEX 2
REGIONAL CONSULTATION OF HEALTH SYSTEM PERFORMANCE 3-5 JULY 2001 MANILA, PHILIPPINES
PROGRAMME
1.
OPENING CEREMONY
(09.00- 09.15 AM)
DrS. Omi. Regional Director. WHOIWPRO 2.
INTRODUCTION OF THE REGIONAL CONSULTATION ON HEALTH SYSTEM PERFORMANCE ASSESSMENT
(09.15- 09.30 AM)
Dr A. Ron. Director a,[ Health Sector Development. WHOIWPRO 3. BACKGROUND PAPER ON HEALTH SYSTEM PERFORMANCE ASSESSMENT CONCEPT, FRAMEWORK METHODS AND FUTURE DEVELOPMENT (09.30- 10.15 AM)
Presentation by Dr C. Murray. Executive Director. Evidence and Information for Policy Cluster, WHOIHQ COFFEE BREAK ( 10.15- I 0.30 AM) (10.30- 12.15 PM) (12.15-01.45 PM)
Plenary discussion LUNCH BREAK
4.
HEALTH SYSTEM GOALS AND INDICA TORS Healthy life expectancy, level and distribution (0 1.45- 02.45 PM)
Presentation by Dr M Booth, New Zealand Plenary discussion
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Responsiveness. level and distribution Presentation by Dr K. Maskom. Malaysia and Dr G. Hiawalyer. PNG Plenary discussion
(02.45- 03.45 PM)
COFFEE BREAK Fairness in financial contribution Presentation by Mr D. Bayarsaikhan, HCFIWPRO and Mr J. Goss. Australia Plenary discussion
(03.45- 04.15 PM) (04.15- 05.15 PM)
SUMMARY: 5.
Key points raised in Day I
(09:00-09:10 AM) (09.10- 10.30 AM)
VIEWS AND ISSUES OF WHO HEALTH SYSTEM PERFORMANCE ASSESSMENT IN PACIFIC ISLAND COUNTRIES (CONCEPT, METHODS AND COUNTRY EXPERIENCES) Panel ofpresenters: Professor Stowers. Samoa Dr G. Hiawalyer. Papua New Guinea Mr K. Mulo.F!ji Dr M Dugue. ADB
Plenary discussion COFFEE BREAK (I 0.30- I 0.45 AM)
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Annex 2
6.
VIEWS AND ISSUES OF WHO HEALTH SYSTEM PERFORMANCE ASSESSMENT IN ASIAN COUNTRIES (CONCEPT, METHODS AND COUNTRY EXPERIENCES) Panel ofpresenters: Mr .fun Gao, China Dr Jae-Goog .fa. Republic of Korea Dr Nguyen Dang Vung. VietNam Dr M Dayrit. Philippines Dr Masami Sakai. Japan Plenary discussion
(10.45- 12.15 PM)
LUNCH BREAK 7.
( 12.15- 01.45 PM) (01.45- 03.15 PM)
COMPOSITE INDICES VERSUS MULTIPLE INDICATORS ON HEALTH SYSTEM PERFORMANCE ASSESSMENT Open forum: (I)
Potential Use and Impact of Composite Measurement Indicators on Health Sector Development Policy and Practice Use of Multiple Indicators in Health System Performance Assessment (03. I 5- 03 .30 PM)
(2)
COFFEE BREAK
8.
FUTURE RESEARCH AND DEVELOPMENT ON HEALTH SYSTEM PERFORMANCE ASSESSMENT (RESEARCH ISSUES, AND COLLABORATIVE PROCESS ISSUES) Panel ofpresenters: Dr T Hasegawa. Japan (Research issue.~) Dr R. Hussein. Malaysia (Research issues) Dr D. Shuey, PMOIWPRO (Collaborative process issues) Dr M. O'Lewy. MO/WPRO (Pacific perspective) Plenary discussion
(03.30- 05.15 PM)
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Annex 2
SUMMARY: 9.
Key points raised in Day 2
(09.00- 09.10 AM) (09. 10- I 0.30 AM)
LINKING HEALTH SYSTEM PERFORMANCE ASSESSMENT AND HEALTH SYSTEMS POLICY AND MANAGERIAL DECISION-MAKING PROCESS Presentation by Mr 0. Adams. Director Department ofHealth Systems/HQ Open.forum:
Country reflections on HSPA as a support for health systems policy and managerial decision-making processes (I 0.30- 11.00 AM) (11.30 AM·- 12.00)
COFFEE BREAK 10.
SUMMARY OF THE REGIONAL CONSULTATION Rapporteur and Dr Soe Nyunt-U. SAPIWPRO
II.
CLOSING CEREMONY DrS. Omi. Regional Dir(:'c/or
( 12.00- 12.15 PM
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ANNEX 3
REGIONAL DIRECTOR'S OPENING REMARKS AT THE REGIONAL CONSULTATION ON HEALTH SYSTEM PERFORMANCE ASSESSMENT, MANILA, PHILIPPINES 3-5 JULY 2001
LADIES AND GENTLEMEN, A VERY GOOD MORNING TO YOU ALL Welcome to Manila and the Western Pacific Regional Office. The World Health Report 2000 has brought health system performance assessment to the forefront of international health agenda. It has elicited much interest and debate among various stakeholders, within countries and among international organizations and institutions . The resolution taken during the 10i11 Session ofthe Executive Board of the World Health Organization called for this Regional Consultation to be held to enable WHO to assist countries in conducting health systems performance assessments on a regular basis within the spirit of understanding of the goals and functions of health systems and the need for assessment of their performance. The discussions in the next three days will be very critical in furthering the processes and tools for health sector performance assessment. We will have an opportunity. through various discussion sessions lined up in this Consultation, to voice our concerns about methodologies on one hand , and about linkages between assessment and policy, on the other. This will provide Member States the best opportunity to influence the future framework and methodology of s ubsequent WHO work in this area. You are probably all confronted by the complexity ofthe policy issues in the health sector in your day-to-day work in ministries of health or in other health sector endeavours. We all know that global solutions and prescriptions are likely to be altered when confronted by the realities and constraints of our different country settings. Living with these constraints is one thing. overcoming them and moving on to a better health system and better health status is another matter. To enable WHO to assist countries in the Region in making better policies that meet their health system goals. we invite you to patiicipate fully in the discussions. The collective wisdom and experience in this room represents a good cross-section of the health system performance spectrum. I very much hope that you will provide comments from the perspective of your governments, and in addition . give us your comments as individuals with experience in health systems . In the next two days and a half, we look forward to more inter-country sharing of experiences in health sector review and assessment, and to openness and reasoned debate on the matter. We will particularly appreciate your views on how the assessment can best serve you in policy development. implementation and monitoring to bring about the improvements you seek. With this encouragement to all our participants, I would like to declare this Regional Consultation meeting in session. I wish you all productive and fi-ank discussions on the relevant aspects of the very impotiant task of health system performance assessment. l look forward to hearing your conclusions on Thursday. I also look forward to achieving a report of thi s Regional Consultation, which will provide very important input to the process of consultation outlined in the Executive Board Resolution .