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Assessment of Capacity of the Ministry of Health to Conduct Health Policy Processes in the Republic of Tajikistan

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Assessment of Capacity of the Ministry of Health to Conduct Health Policy Processes in the Republic of Tajikistan Assessment of capacity of the Ministry of Health to conduct health policy processes in the Republic of Tajikistan Tolib Mirzoev Submitted in accordance with the requirements for the degree of PhD The University of Leeds School of Medicine Leeds Institute of Health Sciences Nuffield Centre for International Health and Development July 2010 ‐ i ‐ Intellectual property and publication The candidate confirms that the work submitted is his own, except where work which has formed part of jointly‐authored publications has been included. The contribution of the candidate and the author authors to this work has been explicitly indicated below. The candidate confirms that appropriate credit has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. The right of Tolib Mirzoev, to be identified as Author of this work, has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988. © 2010 The University of Leeds and Tolib Mirzoev Relevant Chapters Jointly‐authored publication, Work directly Contributions of of the thesis authors attributable to other authors to the candidate the work Chapter 2 Leeds HEPVIC team [Bird P., Literature Commenting on “CONCEPTUAL Gerein N., Green A., Mirzoev review in drafts of literature FRAMEWORK FOR T. and Pearson S.] (2009). Chapter 3 review ASSESSING Comparative analysis report “Health policy CAPACITY TO on health policy‐making in processes and CONDUCT HEALTH China, India and Vietnam, their elements: POLICY PROCESSES” their determinants and their current inter‐relationships. Leeds: literature” Nuffield Centre for International Health and Development. Chapter 11 “INTER‐ Mirzoev T., Green A. and Introduction, Commenting on RELATIONSHIPS Kalliecharan R (in progress). Methods, drafts WITHIN THE Conceptual Framework for Findings, CONCEPTUAL assessing MOH capacity to Discussion, FRAMEWORK AND conduct health policy Conclusions IMPLICATIONS ON processes” sections UNDERSTANDING OF MOH CAPACITY” ‐ ii ‐ Acknowledgements First and foremost, my whole‐hearted thanks to my family: my wife Zulaykho and our beloved children Takhmina and Bezhan for their great spirit, courageousness and patience in bearing my regular absences from the family; my parents, Nemat and Rauza, whose regular guidance and support let me reach such a point; and my brothers, Tokhir and Shukhrat, whose encouragement motivated me to accomplish this. My sincere appreciation goes to Professor Andrew Green and Dr. Ricky Kalliecharan for their continued academic guidance and support in the course of this project. The very useful discussions always remained a source of inspiration and encouragement throughout the project and made this an interesting, worthwhile and enjoyable experience. My deepest gratitude to the colleagues at the Ministry of Health of Republic of Tajikistan (RT) and the other health policy actors in the RT for their willingness to participate in this study, endless patience during the lengthy interviews, their support with sourcing of documents and other aspects of this study. Many thanks go to the University of Leeds for allowing me to conduct this study as part of staff development and to the Leeds Institute of Health Sciences for the financial support in conducting the in‐country data collection. Last but not least, I would like also to acknowledge the role of various colleagues in the Nuffield Centre for International Health and Development (Nancy Gerein, Zafar Ullah, Tom Dessoffy and others) for providing other useful contributions or sharing their experiences. ‐ iii ‐ Abstract The widely‐recognised importance of robust health policy processes suggests the need for capacity to ensure these. Whilst research exists on capacity or policy processes, little is known about how these two are related. This study starts to fill this gap by developing a conceptual framework and testing it in the Republic of Tajikistan, where independence reinforced the need for Ministry of Health’s (MOH) capacity to conduct country‐level policy processes. The following overarching research question guided this qualitative study: What are the key elements of, and main effects on, MOH capacity to conduct health policy processes in RT and how has this capacity changed since independence? Data was collected using semi‐ structured interviews, document reviews and observations of policy events. A framework approach was used for analysis, drawing on the conceptual framework. An understanding of what constitutes robust health policy processes is important and six characteristics were identified: holistic, evidence‐informed, efficient, effective, feasible and sustainable. The conceptual framework distinguishes five components: MOH capacity to conduct policy processes (comprising elements of policy cycle, use of evidence, leadership and governance, and resources), actors, context, policy contents and policy results. This study explored the MOH capacity related to its management or response to the first three components. Though positive changes since independence were identified, the study found that MOH capacity is lacking in all following areas: recognising and managing stages of policy cycle, considering wider context, managing involvement of policy actors, ensuring evidence‐ informed policy processes, applying good governance and effective leadership, and establishing and effectively using resources. Each area is dynamic, interrelated with others and involves intra‐relationships, with implications for overall MOH capacity. Two underlying issues are important: the need for both ability and willingness and the inter‐relationships and interdependence between different capacity levels. As a result of the study a revised framework was developed. ‐ iv ‐ Table of contents Intellectual property and publication ....................................................................................... i Acknowledgements ................................................................................................................... ii Abstract .................................................................................................................................... iii Table of contents ..................................................................................................................... iv List of Appendices .................................................................................................................... xi List of Tables ............................................................................................................................ xi List of Figures .......................................................................................................................... xii List of Boxes ........................................................................................................................... xiii Abbreviations ......................................................................................................................... xiv 1 BACKGROUND AND RATIONALE ..................................................................................... 1 1.1 Introduction ............................................................................................................. 1 1.2 Analysis of health policy processes and MOH capacity ........................................... 1 1.3 The policy context of Republic of Tajikistan ............................................................ 2 1.4 Focus of the study .................................................................................................... 5 1.5 Study outputs ........................................................................................................... 6 1.6 Conclusion ................................................................................................................ 7 2 CONCEPTUAL FRAMEWORK FOR ASSESSING CAPACITY TO CONDUCT HEALTH POLICY PROCESSES ............................................................................................................................... 8 2.1 Introduction ............................................................................................................. 8 2.2 Understanding health policy processes ................................................................... 9 2.2.1 Main theories and frameworks for analysis of health policy processes ........ 10 2.2.2 Characteristics for assessment of health policy processes ............................ 14 Holistic nature of health policy processes. ............................................................... 19 Evidence‐informed nature of health policy processes. ............................................ 19 Effectiveness of health policy processes. ................................................................. 20 Efficiency of health policy processes. ....................................................................... 21 Feasibility of health policy processes. ....................................................................... 21 Sustainability of health policy processes. ................................................................. 22 2.3 The concept of capacity ......................................................................................... 22 2.3.1 Key considerations in understanding capacity .............................................. 26 Focus and tasks in understanding of capacity .........................................................
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