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HS2020 Technical Report Template better systems, better health HEALTH SYSTEMS 20/20 FINAL PROJECT REPORT September 2012 This publication was produced for review by the United States Agency for International Development. It was prepared by the Health Systems 20/20 project. Health Systems 20/20 is USAID‘s flagship project for strengthening health systems worldwide. By supporting countries to improve their health financing, governance, operations, and institutional capacities, Health Systems 20/20 helps eliminate barriers to the delivery and use of priority health care, such as HIV/AIDS services, tuberculosis treatment, reproductive health services, and maternal and child health care. September 2012 For additional copies of this report, please email [email protected] or visit our website at www.healthsystems2020.org Cooperative Agreement No.: GHS-A-00-06-00010-00 Submitted to: Scott Stewart, AOTR Health Systems Division Office of Health, Infectious Disease and Nutrition Bureau for Global Health United States Agency for International Development Recommended Citation: Health Systems 20/20 project. September 2012. Health Systems 20/20 Final Project Report. Bethesda, MD: Health Systems 20/20 project, Abt Associates Inc. Cover Photo: David Page Abt Associates Inc. I 4550 Montgomery Avenue I Suite 800 North I Bethesda, Maryland 20814 I P: 301.347.5000 I F: 301.913.9061 I www.healthsystems2020.org I www.abtassociates.com In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University School of Public Health and Tropical Medicine 2 HEALTH SYSTEMS 20/20 FINAL PROJECT REPORT DISCLAIMER The author‘s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government CONTENTS Acronyms ...................................................................................... ix Executive Summary ..................................................................... xi Acknowledgments ...................................................................... xiii Part 1 - Overview of the Health Systems 20/20 Project ........... 1 Purpose .......................................................................................... 3 Introduction ................................................................................... 5 Part 2 – Strategy Chapters ........................................................... 9 1. Financial Risk Protection ........................................................ 11 1.1 Overview ................................................................................................ 11 1.2 The Financial Risk Protection Strategy ............................................ 11 1.3 Illustrative Activities ............................................................................. 14 1.4 Strategy Achievements ........................................................................ 18 1.5 Lessons Learned .................................................................................... 18 1.6 Considerations for Future Work in this Area ............................... 20 2. Resource Tracking ................................................................... 21 2.1 Overview ................................................................................................ 21 2.2 The Resource Tracking Strategy ....................................................... 22 2.3 Illustrative Activities ............................................................................. 25 2.4 Strategy Achievements ........................................................................ 28 2.5 Lessons Learned .................................................................................... 28 2.6 Considerations for Future Work in this Area ............................... 29 3. Performance-based Incentives ............................................... 31 3.1 Overview ................................................................................................ 31 3.2 The PBI Strategy .................................................................................... 32 3.3 Illustrative Activities ............................................................................. 34 3.4 Strategy Achievements ........................................................................ 37 3.5 Lessons Learned .................................................................................... 37 3.6 Considerations for Future Work in this Area ............................... 38 4. Health Governance ................................................................. 39 4.1 Overview ................................................................................................ 39 4.2 The Health Governance Strategy ..................................................... 40 4.3 Illustrative Activities ............................................................................. 41 4.4 Strategy Achievements ........................................................................ 45 4.5 Lessons Learned .................................................................................... 45 4.6 Considerations for Future Work in this Area ............................... 47 V 5. Costing and Sustainability ...................................................... 49 5.1 Overview ................................................................................................ 49 5.2 The Costing and Sustainability Strategy .......................................... 49 5.3 Illustrative Activities ............................................................................. 53 5.4 Strategy Achievements ........................................................................ 55 5.5 Lessons Learned .................................................................................... 55 5.6 Considerations for Future Work in this Area ............................... 56 6. Human Resources for Health ................................................. 57 6.1 Overview ................................................................................................ 57 6.2 The Health Resources for Health Strategy .................................... 58 6.4 Illustrative Activities ............................................................................. 60 6.5 Strategy Achievements ........................................................................ 63 6.6 Lessons Learned .................................................................................... 63 6.7 Considerations for Future Work in this Area ............................... 64 7. Capacity Building ..................................................................... 65 7.1 Overview ................................................................................................ 65 7.2 The Capacity Building Strategy .......................................................... 65 7.3 Illustrative Activities ............................................................................. 67 7.4 Strategy Achievements ........................................................................ 72 7.5 Lessons Learned .................................................................................... 73 7.6 Considerations for Future Work in this Area ............................... 74 8. Measuring and Monitoring Health Systems Performance .. 75 8.1 Overview ................................................................................................ 75 8.2 The Measuring and Monitoring Strategy ......................................... 76 8.3 Illustrative Activities ............................................................................. 79 8.4 Strategy Achievements ........................................................................ 82 8.5 Lessons Learned .................................................................................... 83 8.6 Considerations for Future Work in this Area ............................... 84 Part 3 – New Perspectives on Health Systems Strengthening 85 Lessons Learned .......................................................................... 87 References .................................................................................... 91 Annex A: Health Systems 20/20's Partners .............................. 93 Annex B: Health Systems 20/20's Activity List by Core and Field Support Funding ................................................................ 95 Annex C: Map of Countries Where Health Systems 20/20 Worked ...................................................................................... 105 Annex D: Funding of Health Systems 20/20 Project ............. 107 Annex E: Website and Social Media Outreach ...................... 111 Annex F: Health Systems Strengthening Tools Used by Country ...................................................................................... 113 Annex G: M&E Indicators ......................................................... 115 VI LIST OF TABLES Table 1. Strategies Linked to Intermediate Results ....................................... 6 Table 2. Selected Financial Risk-Protection Activities ................................ 12 Table 3. Selected Resource Tracking Activities ........................................... 22 Table 4. Selected PBI Activities ........................................................................ 33 Table 5. Selected Governance Activities .......................................................
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