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Recent research and thinking on H ealth P olicy & Systems

Recent research and thinking on H ealth P olicy & Systems. Devaki Nambiar PhD, Kabir Sheikh MBBS MPH PhD Health Governance Hub Public Health Foundation of India 4 th Technical Review Meeting for the HPHFKH 10 th October 2011. PHFI’s health Governance hub. PHFI’s Health Governance Hub.

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Recent research and thinking on H ealth P olicy & Systems

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  1. Recent research and thinking on Health Policy & Systems DevakiNambiarPhD, Kabir Sheikh MBBS MPH PhD Health Governance Hub Public Health Foundation of India 4th Technical Review Meeting for the HPHFKH 10th October 2011

  2. PHFI’s health Governance hub

  3. PHFI’s Health Governance Hub A team of researchers across our family of institutions in five cities Core interest in the relationship between health systems governance and social justice THEME AREAS Regulation and stewardship Community action for health Health workforce governance Pharmaceutical policy Urban health governance Public health philanthropy As India moves towards Universal Health Coverage…

  4. PROJECT: MAPPING THE HEALTH REGULATORY ARCHITECTURE IN lmic mixed systems Sheikh, Saligram, Prasad (2010-2011) Funding: Nossal Institute

  5. Regulatory Framework • Normative position: • Regulation as a means to health equity, health rights, development (Mackintosh 2007) • Approach: • Backward Mapping: ‘bottom up’ understanding of field level phenomena generate policy needs (Elmore 1982) • Process: • Regulatory targets identified from in-depth literature review on LMIC ‘mixed’ health systems • (Oxfam 2009, • Nishtar 2010) Costs of care for users • Development of tool for policy mapping and gap analysis of policy design (relative to target) and implementation (relative to design) • Pilot study in two states in India Quality of care Delhi MP Conduct of providers Accessibility of care

  6. Regulatory Architecture: Design Gaps

  7. Regulatory Architecture: Implementation Gaps

  8. Series: building the field of Health policy & systems research Sheikh, Gilson, Bennett, others (2011) Commissioned by PLoS Medicine

  9. Subjects of enquiry in H(P)SR: the dominant perspective SYSTEMS FUNCTIONS • Systems defined on basis of their utility, problems mainly relate to efficiency • Decisions are concentrated, flow in one direction • Policy content not problematized E.g. WHO ‘building blocks’ Policy Decisions Systems Human Resources, Finance, Medicines & technology, Organizational structure, Service infrastructure, Information systems Outputs Outcomes

  10. Framing the Field: a broad church COMPLEX AND SOCIALLY CONSTRUCTED • Decisions are diffused, relationships are non-linear • ‘Software’ critical to health systems performance • Problems (and solutions) are related to (understanding) complexity • Shaped by particular politics, culture, discourse (and not others) • Solutions within and beyond health systems (e.g. Frenk 1994, de Savigny and Adam 2009, Lambert 2006, Illich 1970) SOCIAL AND POLITICAL CONTEXT ARENA Policy Decisions International National Subnational Local Systems ‘Hardware’ Human Resources, Finance, Medicines & technology, Organizational structure, Service infrastructure, Information systems Systems ‘Software’ Ideas and interests, Relationships and power, Values and norms

  11. Thank you devaki.nambiar@phfi.org

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