Supporting the development of strong national strategic plans for health
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Countries use national strategies as the basis for developing and planning all health programmes, with reference to national policies.
National strategic plans are country-owned and provide the overall strategic direction for a country over a period of time. They should be developed and reviewed with input from all key country stakeholders.
Disease strategic plans (such as those for HIV or TB) should be aligned with the overarching national health strategy. All national health strategies should have the goal of achieving resilient and sustainable systems as part of the national health strategy and any relevant sub-sector strategies.
Programmes should be designed with the aim of achieving national goals and objectives to ensure a coordinated approach and the best use of all available funds—both donor and domestic. To ensure this, the strategy should be accompanied by a national M&E Plan.
WHO has a long track record of supporting countries in developing national health policies, strategies and plans, through country-level technical cooperation, facilitation of national policy dialogue and inter-country exchange.
Stakeholder engagement during the development of national strategic plans is crucial to ensure that the views of communities or key populations on their needs are accounted for to ensure understanding of communities’ opinions on health-related matters, in order to improve policy responses and decision-making, to achieve maximum impact.
Depending on the country context, discussions should include: key and vulnerable populations; implementers; civil society; faith-based organizations; academia; the private sector; the public sector; and bilateral, multilateral and technical partners.
Country dialogue is most successful where it has key population leadership, engagement and support.
Developing resilient and sustainable health systems
Countries should assess what capacity gaps the health system has which will prevent it from achieving the goals of the national strategic plan. This should lead to a plan for developing a more resilient health system. The plan should outline how the investment will help resolve problems and lead to better delivery of services.
The plan should ask:
- what additional capacity is needed in the health system to scale up and improve quality and sustainability of services?
- what additional capacity is needed to reach and implement services targeting key affected and underserved populations?
- what current capacity-development activities are being funded and implemented in the country?
This should identify what is required for strengthening key focus areas vital to a strong health system.
The Global Fund prioritizes strengthening health systems in the following areas:
- strengthening community responses and systems
- support RMNCAH i and platforms for integrated service delivery
- strengthen global and in-country procurement and supply chain systems
- leverage critical investments in human resources for health (HRH)
- strengthen data systems for health and countries’ capacities for analysis and use
- strengthen and align to robust national health strategies and national disease-specific strategic plans
- strengthen financial management and oversight
Monitoring and evaluating national strategic plans
Evaluations of both service delivery and plans to strengthen the health system should feed back to the stakeholders involved in the programme design and implementation and to the national strategic plan to assess the programme’s contribution to national goals.
UHC2030 supports the Joint Assessment of National Health Strategies (JANS) tools, which provide a shared approach to assessing the strengths and weaknesses of a national health strategy. It examines the soundness and feasibility of a strategy in five areas:
- situation analysis and programming: clarity and relevance of priorities and strategies selected based on a sound situation analysis.
- process: soundness and inclusiveness of development and endorsement processes for the national strategy.
- costs and budgetary framework for the strategy: soundness and feasibility of the financial framework.
- implementation and management: soundness of arrangements and systems for implementing and managing the programmes contained in the national strategy.
- monitoring, evaluation and review: soundness of review and evaluation mechanisms and how their results are used
JANS can support the assessment of what is required to develop resilient and sustainable health systems.
UNDP & The Global Fund in Zimbabwe
In 2013 the Global Fund was launching its New Funding Model (NFM) and decided to pilot the process and tools in six countries. UNDP is a key partner of the Global Fund, and in the wake of Zimbabwe’s economic crisis in 2009, was appointed as Principal Recipient (PR) for all Global Fund grants in the country.
As PR, UNDP supports national partners in the implementation of the grants and the development of national capacity and strengthening of national systems.
UNDP supported the Zimbabwe Ministry of Health and Child Care and the Global Fund Country Coordinating Mechanism in being part of the NFM pilot. In only a month, this involved reviewing the Zimbabwe HIV/AIDS National Strategic Plan, organizing consultative country dialogues with multiple country stakeholders about what should be in the application, and developing a strong national concept note which led to the country being awarded US$555 million in funding.
The Global Fund will invest in interventions that support national strategic plans and promote alignment with disease-specific plans. Interventions eligible for Global Fund support include:
- activities that contribute to planning, developing and reviewing national health sector strategies, health systems-related strategies and sub-strategies (e.g., HRH or procurement and supply chain systems)
- developing and supporting mechanisms to supervise, monitor and report on the implementation of health sector and disease-specific laws and policies
- activities that contribute to financing of these plans
- activities at the local, district, regional and national levels aimed at integrated planning, programming, budgeting and financings
- HRH-related costs, such as capacity-building for policymakers
Suggested capacity development indicators
- existence of an up-to-date national health strategy, linked to national needs and priorities
- evidence of mid-term strategy review and updates, and final evaluation
- strategy has a supporting operational plan and is fully costed