Monitoring and Evaluation Practices and Performance of County Maternal Health Programmes

The study sought to establish the relationship between monitoring and evaluation practices and performance of County Maternal Health programmes in Kenya. The combined monitoring and evaluation practices included planning for M&E, stakeholder engagement, capacity building for M&E, and M&E data use. The study adopted a descriptive survey research design. To obtain 282 respondents, stratified random sampling was used. A self-administered structured questionnaire was the study's research instrument. Using descriptive narratives, qualitative data was analyzed within specific themes. Quantitative data was analyzed descriptively using measures of central tendencies and measures of dispersion. Regression was conducted for testing the study hypotheses. Data was presented using frequency tables. The study found that stakeholders’ engagement in M&E and capacity building for M&E influenced the performance of County Maternal Health Programmes in Kenya. The study also found that the respondents agreed that planning for M&E and the data management for M&E. This implied that the combined monitoring and evaluation practices influence performance of County Maternal Health Programmes in Kenya.The study found a strong correlation between the performance of county maternal health programmes and combined monitoring and evaluation practices. The study concluded that combined planning for M&E monitoring and evaluation practices influenced the performance of county maternal health programmes. The study suggests that management develop an effective methodology as well as raise awareness of M&E activities for the success of the project. The study also suggests that human resources issues such as workers charged with monitoring and evaluation ought to have technical capabilities, and roles and duties of monitoring and evaluation personnel should be outlined at the start of projects. To ensure M&E sustainability health sector reforms, investments in strong and vibrant technical harmonization platforms that can sustain the change agenda at all times and every required level.

HISTORICAL AND LEGAL ANALYSIS OF THE HEALTH CARE WORKERS’ LEGAL STATUS DEVELOPMENT

The article is devoted to historical and legal analysis of the health care workers’ legal status development. The paper analyses the beginning of the establishment of the first rules of behavior and professional responsibilities of medical workers in Ukraine, as well as regulations governing the legal status of medical workers in different years in Ukraine. It has been emphasized on the importance of research in the context of the modern health sector reforms for the formation of its directions of implementation. The administrative and legal status of a medical worker makes it possible to determine their place and role in public administration and other public relations. The rights and responsibilities of health care workers are of great scientific and practical importance, especially in view of the ongoing health care reform processes in the country. In view of this, it is important to study the peculiarities of the formation of certain rights and responsibilities of medical workers, which constitute their current legal status, over a significant period of the Ukrainian history.

Rationalizing Mongolia’s Hospital Services: Experiences, Lessons Learned, and Future Directions

Before the 1990s, Mongolia had a health care system that largely depended on hospital-based services. The country’s hospital sector was characterized by the extensive use of an excessive number of acute beds, a large number of medically unjustified admissions, and lengthy hospital stays. In the early 1990s, the Government of Mongolia started socioeconomic reforms as part of the transition to a market economy. It requested the Asian Development Bank (ADB) to support health sector reforms in the country. This paper describes the hospital sector in Mongolia along with the reforms and results achieved, challenges that remain, and ongoing and future directions for ADB support to better respond to the needs of the people.

Supporting Primary Health Care in Mongolia: Experiences, Lessons Learned, and Future Directions

ince the early 1990s, the Asian Development Bank (ADB) has broadly supported health sector reforms in Mongolia. This paper describes primary health care (PHC) in Mongolia and ADB support in its reform. It highlights results achieved and the lessons drawn that could be useful for future programs in Mongolia and other countries. PHC reform in Mongolia aimed at facilitating a shift from hospital-based curative services toward preventive approaches. It included introducing new management models based on public–private partnerships, increasing the range of services, applying more effective financing methods, building human resources, and creating better infrastructure. The paper outlines remaining challenges and future directions for ADB support to PHC reform in the country.

Organizing as negotiation. The making of a pathway in Norwegian psychiatry.

The purpose of this article is to provide a thorough examination on the making of a pathway in Norwegian Psychiatry. During the last decades, much research has examined implementations and outcomes of different public health sector reforms and services in Western societies. However, there has been a lack of research on the process and the making of these reforms and/or services, in particular how they emerge as constructs in context policy, profession and practice. Based on qualitative data and theories on institutional logics, it shows how the two main actor groups are guided by values belonging to a specific logic when understanding the concept of a clinical pathway. The findings show that actors within the political field believe in control and efficiency, in contrast to actors in psychiatry guided by values of discretion and autonomy. This led to a debate of the concept of clinical pathway and psychiatry. The discussion became a polarization between concerns for patients as opposed to efficiency concerns. The making of the pathway was led by the Directorate of health, health professionals operating in the political domain, and with knowledge on both logic`s values. The end result became a logistic pathway were both “logics” got to keep their values, but where the original aims were highly negotiated.

STRENGTHENING DISTRICT HEALTH MANAGEMENT IN LOW-MIDDLE INCOME COUNTRIES: REFLECTIONS AND WAY FORWARD

Introduction: Health systems in low-middle income countries are undergoing considerable changes in a context of ongoing health sector reforms. Districts have, therefore, been increasingly recognised as the level where health policies and health sector reforms are interpreted and implemented. At the same time, decentralisation in its different forms has become a popular reform in many countries, and this increases the importance of ensuring that districts have the organisational capacity to offer a good service.Aim: The article investigates the process, challenges and opportunities of health system development at district level in low-middle income countries.Discussion: While district strengthening is probably necessary in relation to the success of all other health reforms, it is argued that it has not been accorded the importance probably because it is not seen as glamorous. The district health management team must include both strengthening the capacity of individuals, but crucially also, improvement of systems. Many initiatives have been patchy and fail to provide a consistent national approach. The persistence of top-down approaches to health care works directly against districts being able to take charge of their own affairs.Conclusions: A shared vision of district strengthening must be achieved in order to progress with the achievement of Universal Health Coverage and Sustainable Development Goals. Keywords: district health strengthening, capacity building, low-middle income countries, universal health coverage.

16.F. Workshop: Expanding coverage and improving quality: health reforms and policy learning across North America

Health systems globally share challenges with expanding coverage while increasing quality. This workshop organized by the North American Observatory on Health Systems and Policies (NAO) will draw on the results of major health system studies of Canada, the United States (US) and Mexico. The NAO is a partnership of researchers, governments, and health organizations in the three countries, promoting evidence-informed health system policy decision-making. It works with the European Observatory on Health Systems and Policies and other global affiliates. One of the NAO's activities is co-publishing, with the European Observatory and the University of Toronto Press, full-length books about the health care systems in each of the three countries, modeled after the European Observatory's Health System in Transition (HiT) book series that includes full-length treatments of the systems in 70 countries. In 2020 new books will be jointly released in all three countries (Canada's third edition, the US's second, and Mexico's first). This workshop has two overarching Objectives first, to describe the recent health policy developments to provide insights into the successes and challenges of the three North American countries' health systems; second, to explore the potential for policy learning across the three countries with shared challenges but quite different institutional, political and economic contexts. Lead authors of each of these studies will deliver a short presentation describing the major public health and health system challenges faced in their country, and providing an analysis of recent health sector reforms. A panel discussion will follow, facilitated by the chairperson, that will start with a speaker that brings an international perspective to comment on the areas of convergence and divergence in health sector reforms in North America with those taking place across the European region. Each of the lead authors will then respond to the questions and comments raised, and will take questions and comments from the participants. This workshop brings together leading health system and public health scholars from Canada, the US, and Mexico for the first time at this international conference, which will provide participants with an opportunity to learn about these complex and ever-changing health systems and to engage in rich and lively discussion. Key messages In-depth health system studies provide the opportunity to identify lessons that may be transferable across national boundaries. Comparing recent health reforms in the three largest North American countries provide insight into policy learning across high- and middle- income contexts.