Annex 4:

4PR: Improvement of Regional and Local Health Systems Through the Attraction of Critical Mass of Health Managers to the Policy-Making Process

1. Project description

2.  Project purposes and goals

The project proposal states that along with democratization and the transition to a market economy one of the most significant directions of transformation in the Ukraine is  the decentralization of public administration. Regional public bodies are those who are intended to solve local social and economic problems. However, to the present day, a lot of problems concerning the social and economic development of a region (including public health service) are not solved at regional level. One of the reasons is that regional authorities are not yet ready to accept responsibility for decision-making, Another is due to the imperfection of developed methods of changes planning and resource supply. Besides, managers are not sufficiently trained to form and analyze regional policy and estimate results of its implementation. Because of this, it is important to equip health authorities with relevant knowledge on methods of formation, analysis and estimation of public policy in the health sphere, and to create critical masses of health managers whoare able to influence public policy formation and implement health reform at regional and local levels.

The aim, objectives, outputs and activities of the project were defined as follows:

Aim of the project:

Improvement of regional and local health systems through the greater involvement of citizens and local officials in the policy-making process, the decentralization of decision-making and the strengthening in the capacity of health system managers through the availability of better information and improved policy-making processes.

Objectives of the project

1.  Carry out an analysis of the Ukrainian health system with particular emphasis on potential means to decentralize policy-making authority, and encourage increased citizen involvement in policy-making for that system. This can be done by exploring means of involvement of regional and local government officials, representatives of non-governmental organizations and the citizenry in advising upon and shaping health policy in the Ukraine.  Particular concern will be paid to potential implementation in the Odessa Oblast in light of a general assessment of the expectations of the population for medical service, the epidemiological situation, the potential for resource mobilization (legislative, organizational, international, human and financial) and its potential for implementation in terms of effective management.

2.  Various options will be explored in light of the above.

3.  Specific recommendations with regard to issues of decentralization and citizen participation will be made for transmission to regional and local governments and the health board of the Odessa Oblast.

4.  Suggestions will be made as to the best way to train health managers on the implementation of proposals for encouraging decentralized policy-making and increased citizen participation.

Outputs of the Project

1.  Development of an analytical paper to be used by the health board of the Odessa Oblast state administration for encouraging the implementation of policies involving decentralization and enhanced citizen participation as part of its process of  realization of the program for reform of the health system in the south Ukraine region.

2.  Development of recommendations for improved policy-making through decentralization and increased citizen participation for regional and local governments and health-related institutions.

3.  Development of training materials designed to encourage decentralized policy-making and enhanced citizen participation in the making of health policy with a particular emphasis on the needs of health managers and administrators as well as local governors and public servants.

4.  Provide training to health managers and administrators and local governors and public servants on the assessment and formulation of local and regional health policy in terms of issues of decentralization and citizen participation.

Activities

1.       To examine the base of relevant  materials including:

·          health institutions systems;

·          health policy development systems;

·          effectiveness of the decisions made;

·          current practices of the decisions made for implementation/realization;

·          current practices of public health service reforming;

·          undertaking visits to local and regional health authorities and health care providers;

·          identifying legislative, organizational, informational, human and finance sources;

·          share gathered materials and ideas on possible approaches to carry out state policy reforms at regional and local levels.

2.       Suggest certain approaches using available regional and local  resources in order to improve the policy-making process;

3.       Take expert judgments of the suggested approaches in order to identify those that are the most appropriate for the south region of the Ukraine.

4.       Develop analytical papers on the basis of conducted policy studies results which include recommendations for the improvement of policy formation, assessment and making of regional and local governments and medical institutions.

5.       Develop practical directions on  policy-making improvements for regional and local governments as well as health institutions;

6.       To review both the prepared Analytical Paper and the Directions on the meeting of Health Board, OOAS from the point of view of developing the Programme for Medicine Service System Reforming in the South Ukraine Region.

7.       Develop training materials for improving the making of public policy in the health sphere at regional and local levels on the basis of developed directions and examined materials.

8.       Publication of the materials (Ukrainian).

9.       Three Workshops (one for regional and two for local level health managers and administrators)

3. Project realization

No problems occurred during the project realization. The project team actively cooperated with regional and local government officials. The project implementation went as was planned; the project timeline kept on target; and all team members actively cooperated in the project, fulfilling their roles and responsibilities on time and with quality work. 

4. Project outputs, outcomes and impacts

            The following tangible products resulting from the project can be identified:

1.       “Guidelines for Doing Policy Analysis and Writing Recommendations” on policy analysis for regional and local governments as well as health institutions.

2.       The policy paper, “Health Policy Improvement:  Issues of Decentralization and Citizens Involvement”, written in order to outline a general strategy that could lead to future implementation of reforms at the local and regional levels. This paper was reviewed at the meeting of the Oblast Health Agency from the point of view of developing the Programme for Medicine Service System Reforming in the South Ukraine Region.

3.       Textbook “Health Policy: Formation and Analysis” (authors Z. Balabayeva, A. Korvetskiy) has been developed and approved by the ORIPA Academy Board. The abovementioned policy paper, as well as training materials which were used at the project seminars were included in the textbook as practical material.

4.       Training materials on forming, making and assessing regional/local health policy for health managers and administrators as well as for local governors and public servants, printed in Ukrainian as “The Patients’ Rights: European Experience and Reform of the Health Sector in Ukraine”.

            As other outputs we shall mention:

1.       Trained 60 managers, administrators, governors and public servants on forming, making and assessing regional/local health policy with three workshops.

2.       “Guidelines or Outlining the Agenda of a Two-Day Training Seminar on the Important Issues of Health Care Policy Formulation” and the Questionnaire distributed among participants with the aim of determining to what extent the target group is familiar with the issues of policy formulation, policy analysis and the tools for implementing public policy in the health care system The Questionnaire was collected from the participants and analyzed by the team. 

3.       Protocol of Intent on cooperation between ORIPA and the Institute for Public Management and Community Service, FIU has been signed.

4.       Preliminary discussion between Miami Dade and Odessa Municipality about the possibility of a sister city relationship (including health reform) between the two communities has been started.

The project outcomes, thus far, can be described in following way:

1.       The project has had the important consequence of bringing the senior staff of ORIPA into close working contact with senior Oblast officials with the goal of developing both general ideas about and a consensus about the need to reform the Oblast health system that follows the national program for regional development. The policy paper was considered at the Oblast Health Agency meeting. As a result, the proposal to examine in depth relevant mechanisms of implementation of the two most important goals of the Programme for Medicine Service System Reforming in the South Ukraine Region was approved.

2.       Project realization tends to make the work of ORIPA both more meaningful and more practical. This, in turn, increases our influence in the shaping of public policy and our ability to provide our students with the best possible education. 

3.       Partially as a consequence of the issues raised in discussions of the NASPAA/NISPAcee policy paper and other concerns, the Odessa Oblast government has appointed a Coordinating Council on Implementation of the Program of Reforming Medical Service in the Odessa Oblast which includes, among its membership, virtually all of the key officials concerned with health policy reform in the Oblast including Dr. Alexander Korvetsky, Dean of Public Administration at ORIPA. 

Mentioned outcomes promise that in the near future the project may have important impactsvia the improvement of regional and local health systems. Attracting critical health managers to the policy-making process will help equip health authorities and institutions with relevant knowledge and skills on the mechanisms of formation, analysis and estimation of public policy and the promotion of policy-making processes at regional and local levels. As a result, people in the region will be provided with high quality medical services.