Advancing universal health coverage in a federalized governance structure

Situation assessment

 

The Federal form of governance introduced by the new Constitution implies a significant restructuring of health services. Many details of the practical implementation of federal governance and its implications for the health sector have still to be worked out. This provides an opportunity to pursue and advocate for universal health coverage, but also carries considerable risks for a potential setback to primary health care until the full implementation and the capacity of the local government are established. Of special concern would be the potential negative impact on vulnerable groups such as women, children and poor people’s access to quality health services. The transition period, therefore requires major inputs and focus from WHO assisting the Government both in the design and implementation phase of all aspects of health system strengthening. Federalization will also require a new set of public health policies and legislation.

 

Focus area 1.1: Strengthen health systems to deliver basic health services at local government level

WHO will:


  1. Assist the Ministry of Health and Population in defining the basic health package and minimum standards in health facilities, and its implications for provider payment mechanisms and health financing.
  2. Facilitate that the local governments and health workers understand the basic health package, standards and treatment guidelines and ensure they are easily available (e.g. webportal).
  3. Build capacity in public health and health administration to strengthen health systems to deliver the basic health package at provincial and local government level.
  4. Monitor, document and analyse the implementation of the basic health package and the quality of care under 753 local governments.
  5. Assist the Ministry of Health and Population in providing opportunities for professional development of health workers at the primary health care level, in particular online access to international best practices.

 

Focus area 1.2: National oversight and policy development

WHO will:

  1. Support evolution of the federal restructuring proposing delineation of roles and responsibilities, setting standards and public health legislation.
  2. Support HR planning and development, including required HRH management capacity at the federal, provincial and local government level.
  3. Support the review of minimum requirements for curriculums of courses in medicine, nursing, pharmacy and paramedics in collaboration with training and academic institutions, Ministry of Health and Population, Ministry of Education and other line ministries, councils and professional societies.
  4. Provide technical support to the health resource tracking (National Health Accounts) to ensure the regular monitoring of the health expenditure for policy-making and financial protection tracking as part of UHC monitoring.
  5. Facilitate health-financing policy-making, ensuring a robust and consistent legal framework and a strategic and operational plan that strengthens the strategic purchasing function.
  6. Build national capacity of regulatory authority for ensuring quality, safety and efficacy of regulated medicines, vaccines and health products and improve pharmacovigilance.
  7. Provide technical support to the Ministry of Health and Population for regulation of private health care and facilitate that private health service providers follow national protocols and standards.
  8. Provide technical support to strengthen quality of care mechanisms, particularly to strengthen Accreditation and Quality Authority and establishment of clinical audit systems.
  9. Provide technical support to strengthen Health Management Information System (HMIS) in the federated context for reporting, in particular on UHC and the health-related SDGs.
  10. Expand quality and coverage of birth and mortality statistics and use of ICD-10 in hospitals in line with the mortality statistics improvement plan.
  11. Provide technical support to develop national eHealth architecture, interoperability framework and standards. Leverage use of information and communications technology (ICT) to advance implementation of eHealth strategy.
  12. Stimulate health system research related to federalization and public health by setting of research priorities that meet needs of the country.
  13. Engage with professional societies and academic institutions for institutionalizing continual professional development promoting public health, evidence -based best practices and quality of care in health service delivery.
  14. Promote collaboration between academic and national training institutes and WHO collaborating centres to enhance their capacity to run specific courses in priority areas of public health and health service delivery.
  15. Provide basic technical support to newly established provincial Ministries of Health.
  16. Ensure effective coordination of partner support to avoid fragmentation and identify gaps as federalization is evolving.