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Where Do We Go from Here? Entry Points for Action

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Title: Where Do We Go from Here? Entry Points for Action


1
Where Do We Go from Here? Entry Points for Action
  • Tom Merrick, World Bank Institute

2
How 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.

3
Weve seen that there are many actors
  • Politicians
  • Economists and financiers
  • Consumers
  • Civil society institutions
  • Providers, their unions
  • Donors
  • You

4
They 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

5
Why 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?

6
Design 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

7
How 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

8
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9
A 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.)

10
Also 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

11
Pathways 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
12
When 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

13
Evaluation 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?

14
WAYS 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

15
When 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?

16
Community 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
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