International Best Practices- A Review to Inform PSPU Strenghthening

REVIEW OF INTERNATIONAL BEST PRACTICES TO INFORM PUNJAB POLICY AND STRATEGIC PLANNING UNIT STRENGTHENING

DISCLAIMER This project brief was made possible with support from the American people delivered through the U.S. Agency for International Development (USAID). The contents are the responsibility of Nur Center for Research and Policy (NCRP) and do not necessarily reflect the opinion of USAID or the U.S. Government.

REVIEW OF INTERNATIONAL BEST PRACTICES TO INFORM PUNJAB POLICY AND STRATEGIC PLANNING UNIT STRENGTHENING CONTENTS CONTENTS.................................................................................................................................................. 1 INTRODUCTION ........................................................................................................................................ 3 Review Objectives .................................................................................................................................... 4 Review Purpose ........................................................................................................................................ 5 Review Methodology ................................................................................................................................ 5 RESULTS AND DISCUSSION ................................................................................................................... 6 Country Models ........................................................................................................................................ 6 Developed Countries‘ Models .............................................................................................................. 7 1.

United States of America (USA) .............................................................................................. 7 1.1 US Department of Health and Human Services (HHS):, ........................................................ 7 1.2 Presidential Councils on Health Policy ................................................................................... 8 1.3 National Academies of Sciences, Engineering and Medicine................................................. 8 1.4 Council on Health Care Economics and Policy, Heller School for Social Policy and Management, Brandeis University................................................................................................ 9

2.

United Kingdom........................................................................................................................ 9 2.1 The Department of Health....................................................................................................... 9 2.2 Academic Institutions Health Policy and Strategic Planning: .............................................. 11

3.

European Union (EU) AND Other OECD countries .............................................................. 11 3.1 European Health Council, European Health Committee (CDSP): ........................................ 11 3.2 Organization for Economic cooperation and Development (OECD)‘s Health Division of the Directorate for Employment, Labor and Social Affairs: ............................................................. 12

4.

Canada..................................................................................................................................... 12

Middle Income and Developing Countries ......................................................................................... 13 1.

Turkey ..................................................................................................................................... 13

2.

Jordan ...................................................................................................................................... 14

3.

India ........................................................................................................................................ 14 3.1 India‘s Health Policy Project (HPP) ..................................................................................... 14 3.2 A Policy Unit for Health, Nutrition and Population Development ....................................... 14

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3.3 The Strategic Planning and System Design (SPSD) Unit supports Ministry of Health & Family Welfare (MoHFW): ....................................................................................................... 15 4.

Bangladesh .............................................................................................................................. 15 4.1 Health Economics Unit (HEU): ............................................................................................ 15 4.2 The Gender, NGO, Stakeholder Participation Unit (GNSPU) .............................................. 16

5.

Afghanistan ............................................................................................................................. 16 5.1 Public Private Partnership (PPP) unit ................................................................................... 16

6.

Nigeria..................................................................................................................................... 16 6.1 The Nigerian National Council of Health (NCH) ................................................................. 16 6.2 National Primary Health Care Development Agency (NPHCDA) ....................................... 17

7.

Sudan....................................................................................................................................... 17 7.1 Health Policy Unit................................................................................................................. 17

8.

Ethiopia ................................................................................................................................... 18

9.

Indonesia ................................................................................................................................. 18

CONCLUSIONS AND RECOMMENDATIONS ..................................................................................... 19 Conclusion .............................................................................................................................................. 19 Recommendations for PSPU................................................................................................................... 20

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INTRODUCTION The goal of health policy is to protect and promote the health of individuals and the community. According to the World Health Organization (WHO) robust national health policies, strategies, and plans are needed to: 1)respond to growing calls for strengthening health systems through Primary Health Care as a way of achieving the goal of better health for all; 2) guide and steer the entire, pluralist health sector rather than being limited to command-and-control plans for the public sector alone; and 3) go beyond the boundaries of health systems, addressing the social determinants of health and the interaction between the health sector and other sectors in society. Additionally, in countries where external aid plays a significant role, national health policies, strategies, and plans are increasingly seen as the key to improve aid effectiveness. 1 Governments are required to strive to achieve this objective in ways that respect human rights, including the right to self-determination, privacy, and nondiscrimination.2 While some countries have a long tradition of developing health policies and strategic plans to steer their health care systems, in the new millennium there is a renewed interest in institutionalizing these processes and instruments to address the complex challenges and increasing expectations of the people created by globalization and the information communication revolution.3 The increasing recognition that the determinants of health go beyond the health sector and that addressing health issues require an interaction between the health sector and other sectors has resulted in the adoption of the systems approach to health. Stewardship or governance is a key function of a health system and Policy and strategic planning are critical components of the stewardship function. A policy is defined as a statement of intent that defines priorities and parameters for action in response to needs and in context of available resources and other considerations to guide and determine present and future decisions aimed at achieving desired outcomes. 4 Good policies are based on best available evidence and are developed in collaboration with relevant stakeholders. Strategic plans translate the envisioned future into broadly defined medium to long-term goals and objectives, set priorities and targets as well as the means to be used to achieve them.3 Operational plans, also known as implementation plans, are the detailed actions that are identified to achieve the intended results of the strategic plans. The international development leaders and advisors consider it imperative that all countries establish robust mechanisms for policy and strategic planning in order to cost- effectively achieve national and international health goals.

In Pakistan health policy and strategic planning was the mandate of the federal Ministry of Health prior to the 18th Constitutional Amendment. The 18th amendment devolved policy formulation and health planning and all aspects of health care delivery to the provinces. Post devolution the provinces are facing challenges including issues of intra and inter-sectoral coordination, lack of mechanism for release of funds, access to donor funding and donor coordination, sustainability of vertical programs, and above all inadequate capacity and lack of guidance for development of provincial health policies and strategies.5 ,6 To address these governance challenges the Government of Punjab replaced the Project Management Unit of Punjab Health Sectors Reform Program (PMU-PHSRP) with a Policy and Strategic Planning Unit 1 National health policies, strategies and plans. http://www.who.int/nationalpolicies/about/en/ 2 "The Formulation of Health Policy by the Three Branches of Government." Institute of Medicine. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press, 1995. doi:10.17226/4771. http://www.nap.edu/read/4771/chapter/17 3 A framework for national health policies, strategies and plans. World health organization june 2010.

Http://www.who.int/nationalpolicies/frameworknhpsp_final_en.pdf 4 National Guide for the Health Sector Policy and Strategic plan Development. Republic of Rwanda ministry of Health 2014. http://www.moh.gov.rw/fileadmin/templates/Docs/National_guide_for_HSP___Strategic_Plan_dvlpmt_.pdf 5 Health systems governance challenges and opportunities after devolution. Research and development solutions policy briefs series no. 29, march 2012. Usaid.

Http://www.resdev.org/files/policy_brief/29/29.pdf 6 Shaikh BT., Devolution in Health Sector: Challenges and Opportunities for Evidence based Policies. December 14, 2012. Lead, Pakistan. www.lead.org.pk/attachments/updates/293.pdf

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(PSPU) in 2013. PHSRP was designed originally to improve and monitor primary and secondary health care systems by providing missing health facilities and financial incentives to the health facilities‘ staff and also for monitoring absenteeism at health facilities. PSPU was formed in consultation with the international donors to develop a platform for coordination of the Health Department with key stakeholders in the health sector to enhance inputs to policy-making and strategic planning, and to provide strategic guidance and coordination to activities and inputs of donors, partners and Civil Society Organizations.7 PSPU is currently working as PMU for World Bank and DFID sponsored PHSRP and Provincial Health & Nutrition Program (PHNP) for the implementation of health Sector Strategy (HSS). The Unit has 5 functional departments including finance, administration, technical, institutional development and monitoring & evaluation, working under the leadership of Program Directors. The Unit follows a matrix organizational structure with the personnel having varied roles and responsibilities. The Unit does contractual hiring as and when required according to the need identified by relevant departments and project heads. PSPU‘s Knowledge Management Unit is responsible for identification of emerging health systems issues, analysis of primary as well as secondary data, and to provide evidence relevant to policy and strategic decisions. It provides liaison and coordination with Punjab Information Technology Board (PITB) for the implementation of E-Monitoring initiatives like Health Watch, Primary/ Secondary Monitoring and Evaluation Assistance (MEA) dashboard and E-Vaccines. The Unit monitors about 4000 health facilities through Primary and Secondary health care MEAs and provincial monitors across Punjab under CM roadmap Initiative. PSPU is also providing technical support to health road map team and Special Monitoring Unit (SMU) for the implementation of primary/ secondary health reforms/initiatives.

One of the key functions of PSPU is to establish linkages with national and international organizations/ institutions in the country to create a network for advocacy and consensus building on important health policy issues. PSPU plays a key role in analyzing health priorities of multilateral and bilateral agencies with respect to their local relevance and need rather than opting for all-out acceptance.

The project titled, ―Strengthening Policy and Strategic Planning Unit (PSPU) for Coordinated PublicPrivate Health Initiatives in Punjab‖ is being undertaken to assess the functioning of PSPU and its effectiveness in undertaking the responsibilities assigned to it with the purpose of developing recommendations for the strengthening of the Unit and its institutionalization as a regular component of the Punjab Health department. This review of international best practices was undertaken with the following objectives:

REVIEW OBJECTIVES To identify best practice models of international policy and strategic planning institutions and mechanisms with similar mandate to PSPU, Punjab Health Department; more specifically: 1. To review the management models of the identified institutions; 2. To identify the key challenges faced by the identified institutions and the approaches undertaken to address the challenges; 3. To study the interaction mechanisms of the identified institutions with governmental and nongovernmental stakeholders; and 7

Policy and Strategic Planning Unit (PSPU), Directorate General of Health, Government of Punjab. http://dghs.punjab.gov.pk/pspu

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4. To develop recommendations for PSPU strengthening to institutionalize its role as the Punjab Health Department policy and strategic planning and donor-coordination unit.

REVIEW PURPOSE The review will provide inputs for PSPU to: 1. Enhance its technical role as a think tank on health policy and strategic planning development for the Punjab Health Department; 2. Act as a problem solver for the implementation process of reforms and interventions; and 3. Be an effective watch dog to continuously monitor the outcome of the health interventions undertaken in Punjab.

REVIEW METHODOLOGY A Google search was undertaken to access sites including World Health Organization, UD Department of Health and Human Services, UK National Health Services, World Bank, USAID, US disease Control Center (CDC), Harvard Business Review etc. Key words and search string including combination of the terms health, policy, strategic planning, models, councils, mechanisms, processes, projects and structures were used to find structures similar in mandate and functions to PSPU. Civic Engagement in Public Policies Toolkit by UNPAN, United Nations was also used to identify key themes in strengthening policy and strategy making organizations. Some models for coordination and knowledge management of multistakeholder based health sector initiatives were also reviewed. A Similarity to PSPU Score was generated for each model based on the similarity of mandate, functions and management to the PSPU model. The similarity score is calculated out of possible 5 points with 1 being lowest with no similarity and 5 being the highest with substantial similarity in mandate and governance to PSPU.

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RESULTS AND DISCUSSION The World Health Organization (WHO)‘s ‗Framework for National Health Policies, Strategies and Plans‘ 2010 document discusses the wide spectrum of dimensions and hierarchies that are covered by the terms policies, strategies and plans, which reflects a diversity of approaches and levels at which national health policy is undertaken, as well as the different aims countries have. According to the document the terminology used are largely determined by regional and national specificities, by the political culture and history, and by the concrete challenges faced. While recognizing the diverse context of countries in which their policies are made, WHO nevertheless suggests the incorporation of the following generic elements in the development of more robust, effective and credible national health policies, strategies and plans by all countries:2 a. Sound process: Development and negotiation of policies and strategies need to be inclusive of all relevant stakeholders (social, technical, political). The process must include broad consultation and consensus building on situation analysis, goals, values and overall direction, and priorities setting; Active management leading to high level endorsement and mechanisms for feedback on implementation and initiating corrective measures; Alignment with broader frameworks such as national development plans or poverty etc.; and measures to ensure and protect country ownership and institutional capacity in countries where external agencies play an important role. b. Realism: The policies and strategies are more likely to be successfully implemented if they are made by the people who will implement them; are compatible with the sector‘s capacities, resources and constraints; have firm political and legal commitments that ensure long term sustained efforts; the strategic and operational planning have flexibility for adapting to unexpected developments in the economic, political and health environment; and they address the concerns of mid-level implementers and have the commitment of stakeholders with competing interests. c. A comprehensive, balanced and coherent content: National health policies, strategies and plans must articulate: Vision, values, goals, targets and inter-sectoral policy alignment; a robust situation analysis; the policy directions for improving health equity, making services people-centered etc.; a comprehensive strategy to respond to the challenges and implement the policy directions; and the leadership and governance arrangements for implementing the strategy in terms of role of various institutions and stakeholders, monitoring and measuring of outcomes, legal frameworks to ensure sustainability, coordination with other sectors and donors. d. Linking with medium term and sub-national plans: To be effective national strategic plans must be linked to sub-national operational plans, at the regional or district level. e.

Linkage with programs: Health policies, strategies and plans must be linked with the operational plans of the country‘s disease-specific programs and must address their concerns and challenges.

COUNTRY MODELS It was not possible for us to access and describe the innumerable bodies undertaking or influencing health policies and strategic planning across the globe. There is tremendous variation in their scope of work owing to diverse cultures and socioeconomic contexts. Countries of the North and South provide a contrasting view of mandates, roles and responsibilities regarding health research and stakeholder engagement. Our search showed that health policy units or councils in the developed countries were

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formed for specific functions, which were well defined in scope while in developing countries the functions were found to be more generic and wider in scope.

We describe below some of the Policy and Strategic Planning bodies with somewhat similar functions as the Punjab Government‘s PSPU. The Similarity with PSPU Scores of the identified bodies varied from 15. The United States of America (USA) and other developed countries as expected were found to have well established systems and mechanisms for identifying issues and gaps in policies and laws, analyzing evidence and other influences on policy, advocating for policies strengthening and consensus development for the formulation of well-focused policies and strategic plans. Developing countries including middle and low income countries on the other hand have mostly donor-funded project-based institutions tasked with the functions of policy-formulation and strategic planning. Table-1 presents a country wise account of institutions/organizations relevant to the objectives of this review.

DEVELOPED COUNTRIES ‘ MODELS 1. U NITED S TATES OF A MERICA (USA) According to Gostin the US has an expansive range of policymaking bodies and groups seeking to influence policy. However formal development of health policy is considered the primary preserve of the three branches of government-the executive, legislature, and judiciary-at the state and federal levels. The sources of information and influence that help drive policymaking include presidential and congressional commissions, task forces and advisory bodies, professional and trade associations, and public interest, consumer, and community-based groups.1 1.1 US D EPARTMENT OF H EALTH AND H UMAN S ERVICES (HHS):8,9 The Department of Health and Human Services (HHS) is the United States government‘s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. HHS is responsible for almost a quarter of all Federal expenditures and administers more grant dollars than all other Federal agencies combined.

The Department‘s 11 Operating Divisions which contribute to Policy and Strategic Plan Development include: 1) Administration for Children and Families (ACF); 2) Administration for Community Living (ACL); 3) Agency for Healthcare Research and Quality (AHRQ); 4) Agency for Toxic Substances and Disease Registry (ATSDR); 5) Centers for Disease Control and Prevention (CDC); 6) Centers for Medicare and Medical Services (CMS); 7) Food and Drug Administration; 8)Health Resources and Services Administration (HRSA); 9) Indian Health Service (HIS); 10) National Institutes of Health (NIH);11) Substance Abuse and Mental Health Services Administration (SAMHSA).

Policy Development: Office of the Secretary, Staff Divisions: The primary goal of the Department‘s staff divisions is to provide leadership, direction, and policy and management guidance to the Department.

Within the Division Office of Health Reform (OHR) has the mandate to provide leadership in establishing policies, priorities, and objectives for the federal government‘s comprehensive effort to implement the Affordable Care Act and improve access to health coverage and care, the quality of such care, and the sustainability and effectiveness of the health care system

8 http://www.hhs.gov/sites/default/files/secretary/about/priorities/strategicplan2010-2015.pdf 9 http://www.hhs.gov/about/strategic-plan/

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Strategic Plan Development: The HHS, as per the requirement of the Government Performance and Results Act (GPRA) of 1993, and the GPRA Modernization Act of 2010, updates its Strategic Plan every four years. The Plan describes its work to address complex, multifaceted, and evolving health and human services issues. The plan defines HHS mission, goals, and the means by which it will measure its progress in addressing specific national problems over a four-year period.

Each of the Department‘s operating and staff divisions contribute to the development of the Plan. A workgroup of liaisons from the Department‘s operating and staff divisions develop the narrative, strategies, and performance goals for the Plan. The workgroup ensure that the Plan aligns with the Department‘s annual GPRA reporting in Congressional Budget Justifications and the Summary of Performance and Financial Information, which together fulfill HHS‘s annual GPRA performance reporting requirements. This Plan also aligns strategic goals and objectives with priorities of the Administration, the Department, and HHS divisions.

Stakeholder Engagement: Federal Agencies are also required Under the GPRA Modernization Act, to consult with Congress and to solicit and consider the views of external parties. To comply with this mandate, HHS engages the public through the HHS Open Government website), a Notice of Availability in the Federal Register, conference calls with tribal leaders, email notices to external stakeholders and HHS.gov subscribers, and social media postings. The public can review the draft on the HHS Open Government website or can request an electronic or paper copy. The public is able to submit comments via mail, fax, email, and the HHS Open Government website. HHS also seeks input from Congress and the Office of Management and Budget.

1.2 P RESIDENTIAL C OUNCILS ON H EALTH P OLICY Presidential Advisory councils are special panels of experts ordained by the President to provide advice and guidance on combating high priority health issues. For example The Presidential Advisory Council on HIV/AIDS (PACHA) provides advice, information, and recommendations to the Secretary regarding programs, policies, and research to promote effective treatment, prevention and cure of HIV disease and AIDS, including considering common co-morbidities of those infected with HIV as needed to promote effective HIV prevention and treatment and quality services to persons living with HIV disease and AIDS.10 The 2015 Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria provides advice, information, and recommendations to the Secretary regarding programs and policies intended to support and evaluate the implementation of Executive Order 13676 including the National Strategy for combating Antibiotic–Resistant Bacteria.11 1.3 N ATIONAL A CADEMIES OF S CIENCES , E NGINEERING AND M EDICINE They are private, nonprofit institutions that provide expert advice on some of the most pressing challenges facing the nation and the world. The Academies‘ work helps shape sound policies, inform public opinion, and advance the pursuit of science, engineering, and medicine. Founded by Congressional Charter in 1863 to meet the government's urgent need for an independent adviser on scientific matters, the Academies were mandated to "investigate, examine, experiment, and report upon any subject of science." Academy members are among the world's most distinguished scientists, engineers, physicians,

10 https://www.aids.gov/federal-resources/pacha/about-pacha/ 11 http://www.hhs.gov/ash/carb/

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and researchers; more than 300 members are Nobel laureates. Members are elected in recognition of outstanding achievements, and membership is considered a high honor.

National Academy of Medicine, (NAM)12 formerly the Institute of Medicine (IOM), is a non-profit, non-government organization founded in 1970, under the congressional charter of the National academy of Science as the Institute of Medicine (IOM). It was reconstituted and renamed as National Academy of Medicine on July 1, 2015. Alongside with the National Academies of Sciences, and Engineering the Academy serves as adviser to the nation and the international community. Through its domestic and global initiatives, the NAM works to address critical issues in health, medicine, and related policy and to inspire positive action across sectors. The NAM collaborates closely with its peer academies and other divisions within the National Academies of Sciences, Engineering, and Medicine. The Academy provides national advice on issues relating to biomedical science, medicine, and health and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large. The Academy relies on a volunteer workforce of scientists and other experts, operating under a formal peer-review system. New members of the organization are elected annually by current members, based on their distinguished and continuing achievements in a relevant field as well as for their willingness to participate actively. The academy is both an honorific membership organization and a policy research organization. The bylaws specify that no more than 80 new members shall be elected annually, including 10 from outside the United States.

1.4 C OUNCIL ON H EALTH C ARE E CONOMICS AND P OLICY , H ELLER S CHOOL FOR S OCIAL P OLICY 13 AND M ANAGEMENT , B RANDEIS U NIVERSITY This is an independent, body of recognized experts that identifies critical issues generated by health system change; undertakes original research and commissions research; creates discussion forum on health issues; issues back ground papers, journal articles, press releases policy briefs and policy recommendations etc.; and provides analytical leadership by formulating topical research agenda for health services researchers, government agencies, foundations and other organizations. The signature event of the council is the annual Princeton Conference in which health policy experts present and debate issues. Although the principal focus of the Council is on economic issues, the Council also considers the implications of system changes for access to health care services and for quality of care. The Council strives to generate new ideas for improving both the financing and delivery of health care services.

2. U NITED K INGDOM 2.1 T HE D EPARTMENT OF H EALTH 14 The Department of Health sets overall health policy and strategy, as well as deals with legislation and regulation. The Department operates at a regional level through 10 Strategic Health Authorities (SHAs), which are responsible for ensuring the quality and performance of local health services within their geographic area. The Department of Health has three core components: 1) a department of state, run by the Secretary of State for Health and a civil servant, the Permanent Secretary; 2) the national headquarters of the National Health Services (NHS), run by the NHS Chief Executive; and 3) the agency responsible for setting policy on public health, clinical quality, health improvement and protection, and many other 12 National Academy of Medicine. http://nam.edu/about-the-nam/ 13 Council on Health Care Economics and Policy. Brandeis University, USA. https://council.brandeis.edu/ 14Boyle S., Health Systems in Transition-United Kingdom (England) Health System Review 2011. http://www.euro.who.int/__data/assets/pdf_file/0004/135148/e94836.pdf

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related topics, run by the Chief Medical Officer. The Permanent Secretary is responsible for the overall management of the department‘s business. The Permanent Secretary is supported by a Departmental Board comprising the Chief Medical Officer, the NHS Chief Executive, the Director General for Social Care, Local Government & Care Partnerships, the Director General for Department of Health Finance and Operations, and two non-executive members who are intended to provide external input. The Board is primarily concerned with advising on strategic direction as well as ensuring good corporate governance.

The Department of Health‘s Policy Research Programme (PRP) 15 is a national research-funding programme within the department‘s Research and Development Directorate. It commissions high quality research to meet the needs of Ministers and national policymakers in Department of Health‘s and its health and social care system partners and helps to deliver better outcomes for users of health and care services and their carers by providing outputs with strong policy relevance; providing timely evidence for current policy needs; and securing the evidence-base for future policy-making 2.1.1. POLICY RESEARCH UNIT IN COMMISSIONING AND THE HEALTHCARE S YSTEM (PRUCOMM) 16 PRUComm has been established to provide evidence to inform the development of policy on commissioning. The Unit is funded by the Policy Research Programme of the Department of Health as a centre of excellence for research on commissioning. The Unit‘s focus is on maximising outcomes for patients. Evidence generated by the Unit supports understanding of how commissioning operates and how it can improve services and access, increase effectiveness and respond better to patient needs. The Unit develops high quality research programmes that support healthcare commissioners and policy-makers, provides a national resource, holding evidence and research on commissioning and brings together academics who are experts in research of health services, organizations and commissioning.

2.1.2 POLICY INNOVATION RESEARCH UNIT (PIRU)17 PIRU is also funded by the Department of Health Policy Research Programme. The Unit brings together leading health and social care expertise to improve evidence-based policy-making and its implementation across the National Health Service, social care and public health. The Unit strengthens early policy development by exploiting the best routine data and by subjecting initiatives to speedy, thorough evaluation. The Unit‘s work spans the entire Department of Health portfolio of health services, social care and public health policy.

2.1.3 NUMBER 10 DOWNING STREET POLICY UNIT18 This is a body of policymakers in 10 Downing Street with a dedicated section for health policy design.

Originally set up in 1974 to support the then Prime Minister the Unit has gone through a series of changes according to the needs of successive Prime Ministers. It comprises of a body of policymakers and is staffed variously by political advisers, civil servants or a combination of both. .

2.1.4 DEPARTMENT OF HEALTH‘S POLICY RESEARCH UNIT, IN ECONOMIC EVALUATION OF HEALTH 19 AND C ARE INTERVENTIONS (EEPRU): EEPRU is a 5 year programme of work that started in January 2011. It is a collaboration between the School of Health and Related Research, University of Sheffield and the Centre for Health Economics, 15 http://www.nihr.ac.uk/policy-and-standards/policy-research-programme.htm 16 http://www.prucomm.ac.uk/about-us/what-we-do.html 17 http://www.piru.ac.uk/ 18 https://en.wikipedia.org/wiki/Number_10_Policy_Unit 19 http://www.eepru.org.uk/

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University of York. Directed by Professor John Brazier (University of Sheffield) with Professor Mark Sculpher (University of York) as his deputy, the aim of the unit is to assist policy makers in the Department of Health to improve the allocation of resources in health and social care. The Unit has a work programme that covers the applied topics of mental health, cancer, innovative technologies as well as methodological themes relating to, individualized health care, inter-sectoral effects and value based pricing.

2.2 A CADEMIC I NSTITUTIONS H EALTH P OLICY AND S TRATEGIC P LANNING : Several health policy and strategic planning units have been established by academic institutions providing support to the government departments in implementing effective research-based interventions including Health Economics Unit at University of Birmingham20, Global Public Health Unit at University of Edinburgh 21 , Center for Health Policy, Imperial College London 22 , Policy Research Unit in Maternal Health and Care (PRU-MHC), University of Oxford 23 , etc. Department of Health's Policy Research Unit, UK in Economic Evaluation of Health and Care Interventions is a 5 year programme of work that started in January 201124. The aim of the unit is to assist policy makers in the Department of Health to improve the allocation of resources in health and social care. The Unit has a work programme that covers the applied topics of mental health, cancer, innovative technologies as well as methodological themes relating to, individualized health care, inter-sectoral effects and value based pricing.

3. E UROPEAN U NION (EU) AND O THER OECD COUNTRIES Health systems in the European Region are considered generally mature, with well-established healthcare infrastructures and limited need for donor funding. In these countries the ministries‘ of health or the national governments set out their vision, policies and strategies in guiding documents. The guiding documents include the processes whereby national stakeholders consensus on priorities is generated and such documents are integrated with other instruments of governance. However the variety of health systems which exist in Europe preclude the implementation of a uniform model for policy and strategic planning development. Some countries have a federalist structure, with the articulation and implementation of health policies and plans as a regional responsibility while in others policies are defined at federal level and the regions do the budgeting and implementing. The countries in transition in the region are experiencing a number of difficulties owing to staff turnover, inflexibility or resistance from inherited system structures, traditions from the previous health service models or difficult economic situations. 25 3.1 E UROPEAN H EALTH C OUNCIL , E UROPEAN H EALTH C OMMITTEE (CDSP): 26 The EU Committee of Ministers set up the European Health Committee in 1954 to encourage closer European co-operation on the promotion of health.‖ Its idealist aim was to create conditions which would safeguard and improve the health of European citizens.‖ The Committee works with and supports the activities of Council of Europe bodies dealing with health issues, notably the Parliamentary Assembly and the Conference of INGOs of the Council of Europe, in compliance with the terms of reference given by 20http://www.birmingham.ac.uk/schools/haps/departments/healtheconomics/index.aspx 21http://www.sps.ed.ac.uk/__data/assets/pdf_file/0019/127540/MSc_GPHU_Programme_Handbook_2014-15.pdf 22http://www.imperial.ac.uk/centre-for-health-policy/ 23https://www.npeu.ox.ac.uk/prumhc 24http://www.eepru.org.uk/ 25 Framework for national health policies, strategies and plans. Technical briefing WHO Regional Committee for Europe Sixtieth session Moscow, 13–16 September 2010 http://www.euro.who.int/data/assets/pdf_file/0008/120995/RC60_etechdoc2.pdf 26 European Health Committee (CDSP). Health Policy. Council of Europe. http://www.coe.int/t/dg3/health/CDSP_en.asp

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the Committee of Ministers and within the framework of the Strategic Approach to (public) health and related activities. The thematic foci of the committee include good governance, health policy development and promotion, mental health, palliative care, the patients' role and vulnerable groups.

3.2 O RGANIZATION FOR E CONOMIC COOPERATION AND D EVELOPMENT (OECD)‘ S H EALTH D IVISION OF THE D IRECTORATE FOR E MPLOYMENT , L ABOR AND S OCIAL A FFAIRS :27 The 34 member OECD is pursuing an overall mission to promote policies that will improve the economic and social well-being of people around the world and specific to health mission to drive research, innovation and best practice in health policy. The Division helps member countries achieve highperforming health systems by measuring health outcomes and health system resource use and by analyzing policies that improve access, efficiency, and quality of health care. Provides policy analysis and statistical information on health policies and a forum for governments, business, academics and other representatives of civil society to engage in a constructive dialogue on how best to develop policies that ensure utilization of human capital at the highest possible level, improve the quality and flexibility of working life and promote social cohesion.

A Health Committee implements OECD‘s work on health. The Committee, comprised of delegates from capitals, meets twice a year and holds meetings at the ministerial level approximately every five years.

The Committee reports directly to the OECD Council. To assist the Committee in managing this work, a number of expert groups have been set up, both permanent (to cover work on data, health expenditure, quality of care and prevention) and ad hoc (to address time-limited projects). The Committee co-operates with other OECD bodies and Committees, including the Senior Budget Officials Group; the Committee for Agriculture; the Committee on Digital Economy Policy; the Committee for Scientific and Technological Policy; the Committee on Statistics and Statistical Policy; the Economic Policy Committee; the Employment, Labor and Social Affairs Committee. The Committee consults with its social partners, the Business and Industry Advisory Committee (BIAC) and the Trade Union Advisory Committee (TUAC).

Additionally the OECD‘s work on health is carried out in co-operation with international and regional organizations, e.g. the World Health Organization and its regional bodies, the European Commission, Eurostat, the World Bank, the Council of Europe and the International Social Security Association. Key research institutes, think thanks and universities are also important partners.

4. C ANADA Health Care Policy Directorate28 plays a leadership role in health care for the purpose of improving access, quality and integration of health services to better meet the health needs of Canadians. The directorate has four divisions:1) Health Care System Division; 2) Health Human Resource Strategies Division; 3) Chronic and Continuing Care Division; 4) Quality Care, Technology and Pharmaceutical Division. The Health Care System Division (HCSD) provides analytical and policy leadership on issues related to broader health system renewal such as fiscal transfers, governance and accountability, innovation and productivity in health care, and the roles and interface of the public and private sectors. It also coordinates and provides policy leadership in the Health Care Policy Directorate on horizontal issues such as monitoring the implementation of First Ministers' agreements, performance reporting and 27OECD WORK ON Health Brochure. http://www.oecd.org/health/health-systems/Health-Brochure.pdf 28http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/spb-dgps/hcpd-dpmss/index-eng.php

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research. The Division also provides secretariat support to the federal/provincial/territorial Advisory Committee on Governance and Accountability. Finally, the Division develops strategic plans for Health Canada in health care, and coordinates departmental work on the health care issues.

The Health Human Resources Policy Division (HHRPD) is Health Canada's focal point for health human resource (HHR) issues associated with physicians, nurses (in collaboration with the Office of Nursing Policy) and other regulated health professionals. Main activities of the Division include policy development and provision of advice related to identified HHR priorities, and program management for Health Human Resource Strategy initiatives, i.e. Health Human Resource Planning, Recruitment and Retention of health care providers, and Inter-Professional Education for Collaborative Patient-Centered Practice. HHRSD also provides secretariat support to the Federal/Provincial/Territorial Advisory Committee on Health Delivery and Human Resources.

Donor Coordination Mechanisms in Developed Countries Since donor funding is not a significant contributor to health policy and strategic planning in developed countries, no health strategic planning unit or council identified in the developed countries had a broad mandate of ensuring effective strategic design for coordinating with donors and other international partners. The latter is mostly coordinated by the Departments of Finance and Development. According to EU‘s report on Donor Coordination Systems in the EU region, 29 most of the donor funded projects are supervised by the different authorities in member states including Department for Strategy and Donor Coordination, Donor Technical Secretariat, International Aid Coordination Board, Donor Coordination Center, Secretariat for European Integration, etc.

MIDDLE INCOME AND DEVELOPING COUNTRIES Unlike the developed countries in most middle income and developing countries policy and strategic planning institutions/bodies have been established under donor funded projects and programmes or are financially supported by donors. According to McCormick and Schmitz while Aid brings more choices for recipient governments donor proliferation and projects can also put a strain on government systems in a number of ways including increase in transaction costs for government agencies and taking-up of time of key officials; donor‘s particular agendas and schedules disrupt the organizational learning of recipient agencies; and donor‘s hurry to show results and disburse funds, can lead to establishment of parallel organizations weakening the capacity of recipient governments to design and implement policies and programmes. While not much research is available on these issues better co-ordination between donors can address some of these problems.30 1. T URKEY Policy Coordination Unit (PCU) 31 within the Ministry of Health is responsible for carrying out the World Bank projects and reform activities. The Unit was established in the early nineties to oversee and coordinate a comprehensive reforms agenda. With the help of funds from the First Health Project (part of a World Bank loan) several studies and projects have been carried out analyzing the health care financing and expenditure; the healthcare delivery system; the knowledge, skills and attitudes of professionals, etc.

One of the obstacles faced by the unit is poor communication with the autonomous well-established 29http://ec.europa.eu/enlargement/pdf/donor_conference/12_dcf_23_oct_2008_ec_in_country_systems_en.pdf 30McCormick D. and Schmitz H. Donor Proliferation and Co-ordination: Experiences of Kenya and Indonesia. June 2009. Journal of Asian and African Studies. http://www2.ids.ac.uk/futurestate/pdfs/kenyaindonesia_comparisonwebversion.pdf 31http://www.academia.edu/7264044/Health_Sector_Reform_in_Turkey_Old_Policies_New_Politics

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general directorates of the Ministry of Health since it reports to the undersecretary of state and the minister and through them with these Directorates. The Unit functions overlap in many ways those of the general directorates. This creates an awkward situation for them, and sometimes they feel left out from decisions that affect them profoundly.32 2. J ORDAN In Jordan the Higher Population Council (HPC) 33 is the institution whose mandate is very similar to that of the PSPU. The Council is mandated to direct national efforts to achieve sustainable development by striving to create a balance between population growth, economic development requirements and national resources. The HPC established in 2002, was preceded by the National Population Commission (JNPC) which had been formed on the recommendation of the Chairperson of the Board of Trustees of the Jordanian Hashemite Fund for Human Development (JOHUD) in 1988 when a need for a specialized national body concerned with all population development concerns had emerged. The HPC is headed by the Minister of Planning & International Cooperation and members include seven ministers and other relevant stakeholders. Its executive committee is presided over by the Minister of Labor and has five other members. The Council is the reference entity to develop policies, strategies and action plans related to population and development issues, coordinate all concerned national governmental, private and volunteering institutions, monitor and evaluate implementation of plans, initiate advocacy, provide relevant information, raise awareness and strengthens national capacities in the population and development field. The Council works in close collaboration with USAID funded Health Policy Project, of the government.

3. I NDIA 3.1 INDIA ‘ S H EALTH P OLICY P ROJECT (HPP) 34 HPP is being implemented with USAID funding with the primary objective to support the government‘s commitment to expand access to Family Planning and Reproductive Health (FP/RH) by strengthening the capacity of individuals and institutions at the national level and in three high priority states—Uttar Pradesh, Uttarakhand, and Jhakarkand. Along with capacity building for evidence-based decisionsmaking, advocacy for family planning initiative, the HPP is supporting efforts to strengthening the capacity of the National Health Policy Unit.

3.2 A P OLICY U NIT FOR H EALTH , N UTRITION AND P OPULATION D EVELOPMENT 35 This unit was established in the year 2011 under the Health Policy Initiative of the USAID. The Initiative supported the National Institute of Health and Family Welfare (NIHFW) to set up a Policy Unit to undertake systematic and concerted efforts to rejuvenate FP programs through evidence-based advocacy and policy dialogue. The Policy Unit is promoting evidence-based policy analysis, advocacy, and multisectoral coordination. The Policy Unit is also helping create a network of informed champions among senior political and administrative leaders at national and state levels to promote appropriate health, nutrition, and population development strategies. In addition, the unit is strengthening the ability of selected State Institutes of Health and Family Welfare to play a greater role in evidence based policy analysis, advocacy, and coordination across multiple sectors.

32http://www.ncbi.nlm.nih.gov/pubmed/10803100 33http://www.hpc.org.jo/hpc/LinkClick.aspx 34 http://www.healthpolicyproject.com/index.cfm?id=country-India 35 Annual Report for Policy Unit for Health, Nutrition and Population Development 2011-2012, USAID. http://www.nihfw.org/Doc/NIHFW_PU_ANNUAL%20REPORT_Dec_2012.pdf

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3.3 T HE S TRATEGIC P LANNING AND S YSTEM D ESIGN (SPSD) U NIT SUPPORTS M INISTRY OF H EALTH & F AMILY W ELFARE (M O HFW): 36 India‘s Immunization programme has made significant progress in expanding the coverage and quality of routine immunization (RI) service delivery. The SPSD Unit provides support to the Ministry of Health and Family Welfare (MHFW) in developing and implementation plans and provides analysis, research and advice to help ensure efficient delivery of immunization services and equitable access to vaccines for all children irrespective of geographical location, gender and socioeconomic status. The Unit helps improve program quality and reach by supporting monitoring and analysis of immunization coverage and identifies solutions to address constraints in system design and implementation mechanisms at national, state and district levels. It coordinates with key stakeholders on roll out strategies and operational plans for newer vaccine and implementation of GAVI supported Health System Support (HSS). The unit has developed a comprehensive Multi Year Strategic Plan (cMYP 2013–17) in consultation with MoHFW and immunization partners.

4. B ANGLADESH Bangladesh established a Policy Research Unit (PRU) during the implementation of the first health sector programme (HPSP 1998-2003). PRU was formed with three constituent arms:1) Health Economics Unit (HEU); 2) Human Resources Development Unit; and 3) Gender, NGO and Stakeholder Participation Unit (GNSU). It contributed to identifying and including health related issues in Poverty Reduction Strategy Paper (PRSP). In 2002, the PRU was renamed as the Health Economics Unit with a GNSPU. The Unit was transferred to the revenue setup in 2010 and was expanded in 2011.

4.1 H EALTH E CONOMICS U NIT (HEU): 37 The HEU‘s goal is to develop overall capacity in the area of Health Economics, Gender, Equity and Participation towards formulation, implementation and monitoring and evaluation of policies, strategies and interventions. The Unit‘s functions include producing research, conducting capacity building and developing policy advice pertaining to health economics and the health financing of the country. The unit also produces the national health accounts and public expenditure review on a routine basis. The activities of HEU fall into four main areas:1) Policy Advice: In policy advice the health economics unit is playing a central coordinating role and working as focal point of some key activities in the development of health, population and nutrition (HPN) sector. The HEU responds to Ad-hoc policy queries from the MOHFW as well as other related Ministry /Government Department (e.g. the Cabinet Division); 2) Strengthening Capacity: For capacity building in ‗Health Economics‘ HEU organizes foreign as well as local training/workshops. The broad areas of the training include: Basic Health Economics Principles and its uses in Bangladesh, Health Care Financing, Costing and Economic Evaluation of Health Care, Inequity in Health Care and Poverty, Research and Development: The HEU concentrates on providing and commissioning policy relevant research related to Health Economics; 3) Research and Development: The HEU concentrates on providing and commissioning policy relevant research related to Health Economics.

The work encompasses both topics that are traditionally ‗economic‘, such as the annual health Public Expenditure Review (PER), National Health Accounts (NHA), and also topics that have a broader socialscience dimension where the insights of economics can be used together with other disciplines; and 4) Dissemination: Dissemination is one of the main activities of HEU. Through seminars/workshops this activity is done. Specific research findings are disseminated through workshops/seminars.

36https://www.phfi.org/news-and-events/key-projects/immunization-technical-support-unit/strategic-planning-and-system-design-unit 37 Health Economics Unit. http://www.heu.gov.bd/, http://www.heu.gov.bd/index.php/about-heu/organization.html

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4.2 T HE G ENDER , NGO, S TAKEHOLDER P ARTICIPATION U NIT (GNSPU) GNSPU has been established with the aim to mainstream gender in the HPN sector and establish effective coordination among NGOs working on the gender issues. Mandate and Responsibility include Research and Policies development: The GNSPU conducts research and helps the Ministry of health and Family Welfare design gender responsive policies and activities. Workshops: The unit organizes various gender sensitization workshops, training programs and seminars for enhancing the professional capacity of the health care providers and stakeholders in implementing the gender responsive policies and programs.

Strategy development: GNSP unit facilitates the Gender Advisory Committee to guide and identify areas of NGO participation and develop a strategy for NGO participation in the HPN sector. The GNSPU has its own networks with local and international NGOS, working in the area of Gender.

5. A FGHANISTAN 38 The government of the Islamic Republic of Afghanistan (Ministry of Public Health) has made significant progress in providing basic/primary healthcare services to the public but faces many challenges in the provision of secondary and tertiary healthcare owing to inadequate technical, financial and operational capacity to establish and operate hospitals and tertiary care institutions. Afghans spend nearly $90 million seeking medical care in neighboring countries. To address these issues and organize and operate standard secondary and tertiary healthcare services within the country, the Afghanistan Ministry of Public Health (MoPH), has taken the initiative to work in close partnerships with private sector under concession contracts to build hospitals and other healthcare institutions.

The Ministry of Public Health‘s main goals for initiating PPPs are:1) Contract with private sector to ensure risk transfer (financial, technical, and operational) to the private party; 2) Improve quality, quantity and access to secondary and tertiary health care; 3) Ensure Afghan economic growth through creating employment opportunities and development of Afghans skills and expertise.

5.1 P UBLIC P RIVATE P ARTNERSHIP (PPP) UNIT A PPP unit was established within the Office of Private Sector Coordination (OPSC) of the Ministry of Public Health in 2012. Public Private Partnership (PPP) unit is responsible to promote and manages PPPs in the health sector aiming at encouraging interested local and international companies to invest in the health sector undertaking multi-sectoral health initiatives.

6. N IGERIA 6.1 T HE N IGERIAN N ATIONAL C OUNCIL OF H EALTH (NCH) 39 NCH is a decision-making body that establishes health service strategies for all levels of governance including participation from nongovernmental organizations. The Council is headed by the Minister of Health and has four official members. A technical committee advises the Council.

The NCH is responsible for the protection, promotion, improvement and maintenance of health of the citizens of Nigeria, and it formulates policies and prescription of measures necessary for achieving the responsibilities. The Council offers advice to the Government through the Minister of Health, on matters relating to the development of national guidelines on health and the implementation and administration of 38 Islamic Republic of Afghanistan, Ministry of Public Health, General Directorate of Policy and Planning, Public Private Partnership Unit. http://ppphealth.gov.af/MoPH_goals_for_initiating_PPP.html 39 Ministry of Health NCH UYO Meeting 2014. http://www.icebergng.com/nch2014/#services

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the National Health Policy; ensures the delivery of basic health services to the people of Nigeria and prioritize other health services that may be provided within available resources; advises the Government of the Federation on technical matters relating to the organization, delivery and distribution of health services; issues, and promotes adherence to, norms and standards, and provide guidelines on health matters, and any other matter that affects the health status of people; identifies health goals and priorities for the nation as a whole and monitor the progress of their implementation; promotes health and healthy lifestyles; facilitates and promotes the provision of health services for the management, prevention and control of communicable and non- communicable diseases; ensures that children between the ages of zero and five years and pregnant women are immunized with vaccines against infectious diseases; coordinates health services rendered by the Federal Ministry with health services rendered by the States, Local Government, Wards, and private health care providers and provides such additional health services as may be necessary to establish a comprehensive national health system; integrates the health plan of the Federal Ministry of Health and State Ministries of Health annually; performs such other duties as may be assigned to the Council by the Minister of Health.

6.2 N ATIONAL P RIMARY H EALTH C ARE D EVELOPMENT A GENCY (NPHCDA) NPHCDA is a parastatal of Nigeria‘s Federal Ministry of Health with the mandate of providing support to the National Health Policy for the development of Primary Health Care and promoting technical collaboration by stimulating academia, NGOs and International Agencies. The Agency has several departments including Department of Planning, Research and Statistics with similar objectives to PSPU‘s Knowledge Management Unit, Department of Disease Control and Immunization, Department of Community Health Services, Department of Primary Health Care Services in addition to support functions including admin, advocacy and communications.

7. S UDAN Sudan is confronted by political, security, and socio-economic challenges. The country‘s health indicators are comparable to Sub-Saharan Africa averages but the averages mask significant urban-rural and regional disparities, related to conflict, displacement, and chronic poverty. The country has under gone decentralization but continues to face the challenges in coordination between human Resources for Health (HRH) policies and overall health planning, as well as difficulty in translating national level planning to all levels of a decentralized health care system.40 7.1 H EALTH P OLICY U NIT 41 A health policy unit has been established in the Secretariat for Health Policy, Planning and Research. The Unit co-ordinates with relevant stakeholders, especially health policy makers, on periodic basis and assists other departments in policy analysis for key health system issues and designs policy options, including position papers, policy briefs for the policymakers and recommendations for updating legislations. It also ensures the development of a national health system observatory and database to provide information on health system and local and international experience. The Unit works technically with other departments in the Federal Ministry of Health for guiding them in policy analysis and design policy options for health system issues. In addition, the health policy unit works as a secretariat for a health policy forum, which is a think tank constituted in the Federal Ministry of Health.

40 Global Health Workforce Alliance. Sudan.http://www.who.int/workforcealliance/countries/sdn/en/ 41Federal Ministry of Health, Republic of Sudan. Health Policy Unit. http://www.fmoh.gov.sd/En/St_Plan/Health-Policy-Unit-Sudan[1].pdf

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8. E THIOPIA In Ethiopia most development partner‘s coordination and monitoring occur at the federal level through a joint team of the Directorate of Policy and Planning and Resource Mobilization and the NGO Coordination and Project Appraisal Unit 42 of the Federal Ministry of Health (FMoH). The two directorates involved in aid coordination assist the FMoH in mobilizing resources by conducting resource mapping and gap analysis, working with development partners to disburse funding, tracking the level of funding committed by different development partners, monitoring and following the rate of fund utilization and liquidation, and preparing periodic reports on agreed upon formats and disseminating to users. The NGO Coordination and Project Appraisal Unit is responsible for coordinating the health NGOs registered in Ethiopia. The unit performs project appraisal before implementation using a standard format and evaluation criteria to ensure that each project is in line with national government policies and strategies, the health sector development plan and other rules, regulations and proclamations. It is the responsibility of the Directorate of Policy and Planning and Resource Mobilization to follow up on NGO implementation activities at the federal level.

9. I NDONESIA The health sector of Indonesia faces somewhat similar challenges as that of Pakistan. After the 1997-98 Asian Economic crises, with donor support the country has achieved visible progress in macro-economic stability and reducing the economy‘s vulnerability. However the health sector remained low priority with low financial allocation and poor development as compared to regional countries. The 2001 ‗Big Bang‘ decentralization resulted in the abrupt transition of a highly centralized government system to a most decentralized system. However like Pakistan, decentralization brought under focus issues of governance, financing, political will and the health sector capabilities and capacities especially at the provincial and district levels. These challenges are impacting the strategies and priorities of external donor who are reported to be contributing 25-30% of the health sector development budget. 43 Consultative Group on Indonesia was established on the request of the Government of Indonesia (GOI) to facilitate donor coordination. For the Health Sector Partnership for Health was established as the donor coordination mechanism. The Ministry of Health through its directorates for several health areas manages the health interventions and policy decision in the sector. Partners for Health has been absorbed within the Consultative Group of Indonesia. This reflects the low importance being given to the health sector in the broader development of the country.

42http://www.ministerialleadership.org/sites/default/files/resources_and_tools/Improving%20Country%20Capacity%20for%20Aid%20Coordination_Experiences%2 0from%205%20MLI%20Countries.pdf 43http://www.who.int/macrohealth/documents/michaud_annexb.pdf

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CONCLUSIONS AND RECOMMENDATIONS With increasing recognition of the need for adopting the systems approach to health, strengthening the stewardship and governance functions of countries‘ health systems attains priority status. Policy development and strategic planning are key stewardship functions. As evident from the above overview, the developed countries‘ health systems have institutionalized policy-making and strategic planning structures and mechanisms to guide them in achieving national and international health goals and objectives. Most developing countries and even middle income countries have as yet not achieved the maturity of the developed countries systems and are need the persuasion by donors to adopt the systems approach to and put in place policy-making and strategic planning structures and mechanisms. Donor funded initiatives are however project –based and temporary and generally fail to achieve ownership by the respective systems. Multiplicity of donors‘ contribution in developing countries, bring in additional challenges as discussed above. Among these the issue of coordination is pervasive and responsible for implementation of parallel initiative, inefficient utilization of resources and suboptimal achievement of projects and programmes goals and objectives.

CONCLUSION The main conclusions from the review are: 1. Developed countries have institutionalized mechanism and structures for policies and strategic planning with effective stake-holders participation and contribution. Their health departments/directorates/ministries are strengthened, supported and facilitated by necessary laws and regulations in effectively undertaking the stewardship and governance function of their respective health system. Policy-making, planning, coordination, monitoring and evaluation are key stewardship function. Use of systematically acquired evidence has been made an essential component of the policy and planning processes.

2. Mechanisms for stakeholders‘ involvement are well established in the developed countries. All relevant public sector institutions and departments are required to make their contribution and multiple institutions work to provide evidence for the development of well-focused and well-targeted health policies and strategic plans.

3. Private sector councils and think tanks and academic institutions are major contributors to health policies and strategic plans development. Universities are not only sources of evidence and innovation development but also have forums for deliberating on, critiquing and advocating for policies and laws.

4. Developing countries, including middle income countries have generally no regular and institutionalized mechanisms for policy and strategic planning. Their health systems are dependent on donor established and funded project –based mechanisms with functions limited to donor coordination and facilitation. Too often coordination is limited to information-sharing which is perceived to be the primary purpose of coordination.

5. Evidence-base for policy and strategic planning is generally weak or non-existent in developing countries. Health Systems and Policy Research is yet to be understood and established. Research generally remains low priority and demand for systematically acquired evidence by policy-makers is absent.

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universities, both medical and social sciences one or general academic have hardly any contribution to policy and strategic planning development.

RECOMMENDATIONS FOR PSPU 1. PSPU must be strengthened and its role must be institutionalized in order to improve the currently weak governance and stewardship of the health care system of Punjab province. WHO framework me be used to guide the strengthening of the PSPU. 2. The PSPU should have an autonomous/ semi-autonomous status within the Health Department so that it enjoys a reasonable level of independence and has an unbiased view of policy and strategic planning issues. Necessary legislation may be promulgated to define the role and responsibility of the Unit and provided it support in undertaking its responsibilities.

3. The name of the PSPU may be changed to sufficiently reflect its role and functions in the health care delivery system.

4. The scope of work of the PSPU may include but not be restricted to the following:  Health Care Delivery System needs assessment and prioritization of needs. This will be a participatory and consultative process and will include identification of resources and knowledge gaps.  The Unit will develop evidence-based policy and strategic planning documents through consultative and participatory processes.  The Unit will develop and review progress reports of ongoing programs and strategies and submit recommendations for overcoming implementation barriers annually.  The PSPU will develop networks, linkages and partnerships to make available quality technical resources for policies‘ and strategic planning development within the province, nationally and internationally. The Unit/Council will establish and maintain a technical resources data-base. The Unit will develop policy and terms of reference for acquiring services of quality professionals for different policies‘ and strategic planning development purposes and facilitate the hiring of professionals as and when required.  The PSPU will establish a Knowledge Management UNIT (KMU). The KMU will identify evidence needs and organize, promote and facilitate: evidence generation within the province, access to internationally generated knowledge and best practices and the utilization of evidence in policies, planning and decision-making in Punjab‘s health care delivery system. The Unit will encourage and facilitate the institutionalization of the use of information and communication technology in the health care system- more specifically internationally tested systems like computerized information systems, electronic health records, evidence-based medical practice, e-health, telemedicine etc.  The Unit will support and facilitate Health Systems and Policy Research (HS&PR capacity development programs and initiatives in the province and commission HSR as and when required.  The Unit will identify and develop linkages with national and international organizations/ institutions for the purpose of development of collaborative evidence generation initiatives, human resources‘ capacity development for research, policy analysis, communication skills and other needs relevant to policies and strategic planning development.  The Unit will constitute technical panels and organize collaborative forums to prioritize health needs, identify policy gaps and planning and implementation issues in the health care delivery system.

These panels and forums will also identify and prioritize evidence needs and recommend effective

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



solutions and interventions.

The PSPU will specifically identify health care financing resources and organize and facilitate intervention testing and development of different models of health care financing.

The PSPU will identify the legislation needed for strengthening its role and the role of other stakeholders in the health care system of Punjab. Private sector and academic institutions role will be especially defined and PSPU will endeavor to establish linkages and collaboration with them and other relevant stake-holders.

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