A framework for national health policies, strategies and plans
Just as constructing a building or a machine depends on the design and plans, so too the operation of the health system depends on the policies and plans that guide it. This seems obvious, but we often find that there are problems with health sector plans, and this can then lead to problems with health system operation.
Can you think of some problems that might occur with health planning, or problems that you have experienced? Jot down your thoughts before we move on.
Here are some of the problems that World Health Organization identified as needing attention in their review in 2010.
The first is that there are many types and levels of the health system where planning takes place, and planning documents are produced. You can look back at the diagram in the previous step to see some of the different types of plans. They range from national level policies, to strategic plans, specific program plans and operational plans at subnational or district levels.
A frequent problem is that these different plans do not link up or connect with each other and may go in different directions. Or they may not link with other sectoral or high-level national plans. There is a lack of coherence between different levels and types of plans.
A second problem is that key stakeholders involved in providing resources for the plans, or in implementing the plans, do not know about the plans, do not understand them, or do not support them. We need to recognise that planning is not just a technical process, it is also a political process, and that it needs to involve and engage key stakeholders and those involved in implementation. This increasingly means we need also to include those affected by the plan, including the communities that receive services, and those who have special needs or are currently facing barriers in accessing services. Planning needs to be inclusive.
A third problem is that the plans may assume capacities and the availability of resources for implementation that are not actually available. We particularly see this when the timelines for implementation cannot be met with available resources. Plans need to be realistic and appropriate to the context.
These are three key elements of good plans: they are coherent, inclusive, and realistic.
Think about your own situation and reflect on the practice of planning in the health sector in your own country. To what extent are your plans coherent, inclusive and realistic? Where do you think the main weaknesses lie?
How then can we improve the planning process?
Here are some ideas from the WHO national planning framework referred to above. You can read this in more detail by clicking on the link in the ‘see also’ section below.
(1) Undertake a thorough situation analysis prior to planning, which includes examination of the national policy and planning context, available resources and capacities.
(2) Provide a clear description of the policy and plan directions, and set out a vision that can inspire implementation. Seek to anchor the policy directions in political and legal commitments to ensure long term sustained efforts.
(3) Link high level plans with strategic and operational level plans while retaining flexibility to adapt to unexpected developments in the economic, political or health environment.
(4) Provide a comprehensive and feasible strategy to enable achievement of the policy directions, within the available resources, or, if necessary, with additional resources and capacity building.
(5) Describe the leadership and governance arrangements for implementation.
(6) Include a performance monitoring and feedback process to allow for learning, continuous improvement, and timely corrective measures.
Within your own context and experience, identify one element in the planning process from the WHO recommendations, or from your own ideas, that you think could address the main weaknesses in planning that you identified.
Share your answers with your peers by posting to the comments section below.
World Health Organization 2010, A framework for national health policies, strategies and plans, viewed 26 June 2019, <https://www.who.int/nationalpolicies/FrameworkNHPSP_final_en.pdf>.
© Nossal Institute for Global Health at the University of Melbourne