Title: Where Do We Go from Here? Entry Points for Action
1Where Do We Go from Here? Entry Points for Action
- Tom Merrick, World Bank Institute
2How Do We Deal With Changes?
- New vision -- reproductive health and rights,
gender, poverty reduction - New challenges -- new and unfinished agendas,
going beyond care - New program environments --
- reforms, sector-wide funding,
- economic crises
- Recognize changes as challenges as
well as opportunities for RH - Tools to address challenges -- policy analysis,
service matrix, costing and priority setting,
benefit incidence, etc.
3Weve seen that there are many actors
- Politicians
- Economists and financiers
- Consumers
- Civil society institutions
- Providers, their unions
- Donors
- You
4They bring many viewpoints
- Politicians want to be re-elected
- Economists follow the money
- Labor unions protect jobs
- Consumers want good services
- Civil society institutions are concerned about
rights and equity - You (I hope) are concerned about the effects of
reform on reproductive health and rights
5Why should you be concerned about reforms? Many
common goals
- More equity in health and health care
- Improved gender equality
- Address key public health needs
- Respond to consumer demands
- Financial and organizational sustainability
- Better coordination of donor roles
- So whats the problem?
6Design implementation of reforms may help or
hurt reproductive health
- Financing schemes should free resources for poor,
but could limit access to poor women insurance
may not cover repro health - Decentralization gives community more say, but
women may not have voice - Private providers may be more interested in
profit than serving the poor - Reorganization may weaken central government
support of reproductive health and rights, reduce
focus on cross-cutting factors
7How to address reproductive health and rights
(RHR) in reform settings?
- Evidence base on how health reform initiatives
affect RHR is weak - Identify key points of intersection between
reform and RHR - Assess impacts through operational
research/monitoring and evaluation - Mitigate adverse effects strengthen positive ones
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9A lot of common ground
- Agree to focus on outcomes
- Agree on need to improve performance
- equity, efficiency, sustainable financing,
quality, accountable to clients - Agree on need for evidence-based policy and
program design (burden of disease, good
indicators, etc.)
10Also differences
- On priorities -- tradeoffs between equity and
efficiency - On how to set priorities -- who decides daly
weights - On how to manage -- donors desire for sectoral
approach - On boundaries -- whats included in health
systems, reproductive health
11Pathways to Improved Health Outcomes
Health sys-tem other sectors
Government policies actions
Households/ Communities
Health outcomes
Health service supply
Household behaviors risk factors
Health reforms
Repro-ductive health out- comes
Other parts of health system
House-hold resources
Actions in other sectors
Supply in related sectors
Community factors
12When we disagree, what to do?
- Say its too complicated and leave it to the
economists, or - Close our minds to viewpoints we dont like and
go about our business, or - Get a place at the table, make sure our allies
are there, understand the opposition and counter
with evidence-based remedies that protect
reproductive health and rights, and - If necessary, hire our own economists
13Evaluation criteria, tools
- Health impact reduced burden of disease
- Equity how do reforms affect access of poor
women and children (DHS tabs, benefit incidence
analysis) do reforms reduce financial risks of
poor families? - Quality how do reforms affect performance of
health providers? - Efficiency is public sector spending its money
on the right things, reducing waste? - Sustainability effect on donor dependency?
14WAYS TO MITIGATE THE RISKS TO REPRO HEALTH
- Involve all stakeholders (including providers) in
setting goals/defining the reform process - Pay close attention to standards, regulation and
accountability mechanisms - Advocacy to ensure that RH gets resources,
quality maintained - Involve the community, womens groups in
monitoring reforms at local level
15When were at the table
- What is our vision for RH and its relation to
health reform? - What will we do differently as a result of the
course that will help us realize this vision? - What difference to we expect our actions to have
on reproductive health and rights? - What actions will we take?
16Community of practice
- Read the rest of the materials
- Communicate with WBI and your colleagues via
email and the website - Use the website or CD-rom for materials
- Read and contribute to the newsletter
- Join WBI distance-learning follow up