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Report of the Seminar on Programme Sustainability through Cost Recovery, Kuala Lumpur, Malaysia, 21-25 October, 1991.
London, England, IPPF, 1991. 15,  p.In the face of widespread user acceptance, rapidly growing demand, and developing country financial constraints, family planning associations must learn how to operate more efficiently and mobilize new resources with a view to ensuring greater long-term sustainability. Cost recovery was therefore identified as a means of maximizing the use of limited resources, improving program quality, strengthening management, and making service providers more accountable to clients. This document reports results from seminar participants organized to share the benefits of cost recovery with the international community, and to review policy and management issues. Reviewed in the seminar were country experiences with cost recovery, working group discussions on the definition of sustainability, the cost framework of family planning, determining user fees and clients' willingness to pay, preconditions for setting user fees, prerequisites for social marketing, models for cost sharing with the government and private sector, and country case studies from the Gambia, India, and Kenya. Those programs attaining highest self-sufficiency were aided by strong government commitment to either support family planning or to not impede program progress. Also helpful were a businesslike approach to service provision, a strong promotional campaign, organizational structure conductive to effective resource management, and resolve to try diverse approaches. In concluding, the importance of placing the customer first, cost-effectiveness, cost analysis, strategic planning, inter-FPA cooperation, and business plans are mentioned.
HEALTH POLICY AND PLANNING. 1991 Dec; 6(4):327-35.Many non-governmental organizations (NGO) remained in the Wollo region of Ethiopia following famine relief and emergency medical service efforts of 1984-85. Since then, these organizations have helped identify strategies and processes needed to implement Ministry of Health (MOH) policies, especially in the area of integrated maternal-child/curative health services. This paper discusses the strengths and weaknesses of 4 broad approaches to health development adopted by the NGOs over the post-famine relief period of 1986-88, and considers further strategic adaptation in later years. Under the themes of direct management, clinic adoption, impact area, and air-drop resources, earlier NGO approaches largely suffered poor sustainability, non-replicability, and inefficient use of resources. Moreover, these approaches distracted the MOH from pursuing its own viable approaches, effectively stymieing the development of district and regional health systems. Later NGO approaches support improvements in the MOH's priority health programs through the provision of technical and material assistance for analyzing, developing, and implementing improved systems of district health management and care. NGOs wishing to adapt their existing programs into a comparable health systems approach should build upon existing relationships with the MOH in support of district and regional health services, foster skill development among indigenous health personnel, seek avenues to improve efficiency, and promote activity-based training and regional and district health team management.
Management information systems in maternal and child health / family planning programs: a multi-country analysis.
STUDIES IN FAMILY PLANNING. 1991 Jan-Feb; 22(1):19-30.Management and information systems (MIS) in maternal and child health were surveyed in 40 developing countries by trained consultants using a diagnostic instrument developed by UNFPA and the Pan American Health Organization (PAHO). The instrument covered indicators of input (physical infrastructure, personnel, training, finances, equipment, logistics), output (recipients of services, coverage, efficiency), quality, and impact, as well as frequency, timeliness and reliability of information. The consultants visited national and 2 provincial level administrative and service points of public and private agencies. Information on input was often lacking on numbers and locations of populations with access to services. In 15 countries data were lacking on personnel posts filled and training status. Logistics systems for equipment and supplies were inadequate in most areas except Asia, resulting in shortfalls of all types of materials and vehicles coinciding with idle supplies in warehouses. Financial reporting systems were present in only 13 countries. Service outputs were reported in terms of current users in 13 countries, but the proportion of couples covered was unknown in 25 countries. 2 countries had cost-effectiveness figures. Redundant forms duplicated efforts in half of the countries, while data were not broken down at the usable level of analysis for decision-making in most. Few African countries had either manual or computer capacity to handle all needed data. Family planning data especially was not available to draw the total picture. Often information was available too late to be useful, except in Portuguese speaking countries. Even when quality data existed, managers were frequently unaware of it. It is recommended that training and consultancies be provided for managers and that these types of surveys be repeated periodically.
Washington, D.C., PAHO, Pan American Sanitary Bureau/Regional Office of the World Health Organization, 1985. xix, 265 p. (Official Document No. 201)Efforts to meet the goal of health for all by the year 2000 have been hampered by the internal and external problems faced by many countries of the Americas. The pressures of external debt have been accompanied by a reduction in the resources allocated to social sector programs, including health programs. In addition, the conflict in Central America has constrained solutions to subregional problems. The health sector suffers from uncoordinated services, lack of trained personnel, and waste. Thus 30-40% of the population do not have access to basic health services. In 1984, the governments in the region, together with the Pan American Health Organization (PAHO), undertook projects in 5 action areas: new approaches and technology, development, intra- and intersectoral linkages, joint activities by groups of countries, mobilization of national resources and external financing, and preparation of PAHO to meet the needs of these processes. New approaches include the expansion of epidemiological capabilities and practices, the use of low-cost infant survival strategies, the improvement of rural water supplies, and the development of domestic technology. Interorganizational linkages are aimed at eliminating duplication and filling in gaps. Ministers of health and directors of social security programs are working together to rationalize the health sector and extend coverage of services. Similarly, countries have grouped to deal with common problems and offer coordinated solutions. The mobilization of national resources involves shifting resources into the health field and increasing their efficiency and effectiveness by setting priorities. External resources are recommended if they supplement national efforts and are short-term in nature. In order to enhance these strategies, PAHO has increased the managerial and operating capacity of its central and field offices. This has required consolidating programs, retraining staff, and instituting information systems to monitor activities and budgets. The report summarizes health indicators and activities by country, for all nations under PAHO.