Capacity building has become an integral part of health strategies worldwide, helping governments prevent, prepare for, respond to, and recover from health emergencies. There are different ways to approaching capacity building in low- and middle-income countries, however, the success of all hinges on adapting these approaches to local contexts.

The health team at Oxford Policy Management recognises the importance of doing dedicated capacity development, which brings together the needs of policymakers in low- and middle-income countries, and combines those with research and lessons learnt from countries elsewhere, to develop a careful plan of action, adapted to the local context. This approach implies that developing local capacity is as equally valued as the research outputs, and thus should be considered as carefully as research design.

To help support in-country capacity development, OPM launched a financing fellowship in Nigeria. The programme aimed to train selected fellows, 14 in the first intake, from federal and state health institutions to enable them to become results-based financing technical assistants.

In the following video, watch Alexandra Murray-Zmijewski present different types of capacity building, and highlight problems that most often constrain capacity development in low- and middle-income countries.

Ensuring availability, affordability, and quality of commodities (for example medicines) to provide services to the patients is one of the key outcomes which procurement and supply chain management establishes.

This is especially important in low- and middle-income countries, where poor populations often experience out-of-pocket payments and financial hardship for accessing healthcare.

Improving efficiency and effectiveness of procurement and supply chain management systems can help ensure sustainable availability of quality and affordable health commodities for the vulnerable communities.

In December 2018, Vimal Kumar, an expert in health procurement and supply chain management, led a technical seminar around health supply chain management where he talked about his experience in the field.

Developing a sustainable pro-poor health commodity supply is an integral part of developing high-quality and affordable healthcare services for all, which is an important goal for the Health team at Oxford Policy Management.

Helping to strengthen the procurement and supply chain management components, the team’s work in the field included the monitoring, learning, and evaluation of the Bihar Technical Support Programme (BTSP), which focused on improving reproductive, maternal, and child health and nutrition in Bihar, India, in addition to work for HEART.

The event aimed to:

• Educate missions about the critical need for scaling up TB research
• Sensitise missions to the need for commitments to increase TB research funding
• Sensitise missions and key stakeholders on the importance of investing in the full spectrum of TB research, from basic science to R&D to applied health research
• Promote principles to guide research to ensure efficiency in development and equitable access
• Reach a shared vision on priority tools and applied health research needs

Introduction and Keynote Speech

Opening remarks: Mark Harrington, Executive Director, Treatment Action Group

Keynote speaker: Dr. Soumya Swaminathan, Deputy Director General for Programmes, World Health Organization

Panel 1: A Step-Change TB Research: why TB research is critical and how to respond

Opening remarks and moderator: Professor Charlotte Watts, Chief Scientific Advisor, DFID
Panel: 

• Ms. Eloisa Zepeda-Teng, TB survivor, Philippines
• Tereza Kasaeva, Director, WHO Global TB Programme
• Irene Ayakaka, Makere University and Uganda Tuberculosis Implementation Research Consortium

Respondent: Minister Counselor Philip Gough, Permanent Mission of Brazil to the United Nations

Panel 2: Devoting the Resources

Moderator: Dr. Lucica Ditiu, Executive Director of the Stop TB Partnership
Panel:

• Joanne Liu, International President, Doctors Without Borders
• Mike Frick, Senior Project Officer, Treatment Action Group
• Cheri Vincent, Chief, Infectious Diseases Division, US Agency for International Development (USAID)

Respondent: Mrs. Paulomi Tripathi, First Secretary, Permanent Mission of India to the United Nations

Panel 3: Designating Research Outcomes as Global Public Goods

Moderator: Mark Harrington, Executive Director, Treatment Action Group
Panel:

• Paula Fujiwara, Scientific Director, The Union
• Tenu Avafia, Team Leader, Human rights, law, and treatment access, UNDP HIV, Health and Development Group

Closing remarks: Rt. Hon. Nick Herbert, Member of Parliament, U.K.

Event organisation and sponsorship:

The briefing was organised by Médecins Sans Frontières, Stop TB Partnership, Treatment Action Group, and The Union.

Sponsors include Permanent Mission of Brazil to the United Nations, Permanent Mission of India to the United Nations, United Nations Development Programme and World Health Organization.

Related resources:

• Reading pack: Emerging issues in tuberculosis

This collection of videos has been produced in partnership with the K4D programme.

This presentation was delivered as part of a professional development training session for DFID health advisers in March 2018. Subject experts from the Liverpool School of Tropical Medicine (LSTM) presented the latest evidence on the communicable diseases (HIV, malaria, tuberculosis and neglected tropical diseases) that affect the poorest people in DFID partner countries.

Through the K4D programme and in partnership with HEART, a number of reading packs on the topic of communicable diseases have been produced. Related reading packs include:

• Emerging issues in HIV
• Malaria: Key challenges and potential solutions
• Emerging issues in tuberculosis
• The global challenge of NTDs  

Seminar 1: Health service costing and fiscal space analysis
Oxford, 17^th June 2016

Universal health coverage (UHC) has amassed widespread political support from global and national leaders alike, being expected to retain the momentum throughout the SDG agenda. Considerable financial resources are required to pursue UHC and several global benchmarks for government health expenditure have been proposed (e.g. 5% GDP, $86 (2012) per capita), primarily for advocacy purposes. However, for most low- and lower-middle-income countries the gap between current government health expenditure and what would be required for a package of essential interventions in line with UHC is downright prohibitive.

Fiscal space analysis is a useful tool for identifying options for closing the resource gap along four key directions (‘the fiscal space diamond’): health aid, government debt, efficiency savings and domestic spending. Simulation exercises conducted at a global level suggest that closing the resource gap is unlikely without sustained/augmented health aid, particularly in low-income countries.

This seminar brought together thinkers and country decision makers to reflect on the question “How should national policy makers approach the development and deployment of health financing strategies for UHC, with a view to sustainability, efficiency and equity?”

Its specific aims were to:

• Reflect on how the global UHC health financing discourse can be pragmatically translated in country-level health financing decisions and implementation using sector costing and fiscal space as tools
• Summarise lessons from country experiences
• Discuss technical approaches to conducting fiscal space analyses and how to complement them with other analyses.

Resources:

• Technical note: Financing for UHC in low- and middle-income countries
• Technical note: Costing for UHC
• Technical note: Fiscal space for health
• Fiscal space analysis for health: friend or foe? Blog article by Adrian Gheorghe, health economist, OPM.

Seminar 2: Social health protection
London, 27^th June 2017

The essential roles of public financing mechanisms in general and of prepaid contributions in particular for advancing towards universal health coverage (UHC) have been increasingly recognised by governments, donors and researchers alike. Social health insurance (SHI) and taxation are two fundamental mechanisms for raising prepaid contributions and quite a few low- and middle-income countries (LMICs) are currently at various stages of introducing some form or combination of these mechanisms.

There has been less research on the practical implementation details of social health protection (SHP) schemes compared with theoretical foundations of health financing for UHC. Collecting contributions in large pools to avoid fragmentation, focusing on equity from the outset by including the poor, and improving the efficiency of tax collection and health spending are examples of largely undisputed principles – less is known, however, of how such principles can be realistically enacted while accounting for country context. Other relevant considerations relate to ways of reaching the informal sector, the role of private sector provision, shifting from passive to strategic purchasing and ensuring technical capabilities for monitoring SHI. Deploying such complex reforms takes substantial time and resources, and there is no blueprint for preparing, designing and overseeing their implementation.

This seminar brought together leading thinkers and practitioners of SHP in LMICs to reflect on how the latest implementation evidence can systematically translate to the practice of designing and introducing SHP schemes in LMICs. Three broad questions were addressed with a view to past and ongoing country experiences:

• What does it take to prepare for the introduction of nationwide SHP schemes?
• What considerations are pertinent to the policy decision for SHP and for a given design, in combination with tax-based approaches?
• What are the SHP implementation challenges once the policy decision has been made, and what are their potential solutions?

Resources: 

• Social health insurance: the practical challenges. Reflecting on a seminar and opening the discussion, Medium story by Adrian Gheorghe, health economist, OPM.
• Video: how do we finance universal health coverage? Medium story by OPM.

Seminar 3: Technical Efficiency
London, 15^th September 2017

Improving the effectiveness of available health resources in LMICs has increasingly become important as many countries attempt to map out their paths towards achieving UHC. For many of these countries, a combination of increased health coverage targets, increased disease burden from communicable and non-communicable diseases, and sometimes reductions in global support towards the health sector has enhanced the need to improve value for money in the health sector. Indeed, the growing body of literature on measuring health system efficiency shows large variations in efficiency within and across health systems – highlighting the potential for health systems to improve efficiency. Yet, a number of challenges remain in achieving technical efficiency across and within health systems.

First, while there is a growing literature on the sources of inefficiencies in health, it is not yet clear to whom policy interventions to address these should be targeted to achieve the greatest impact. The Ministry of Health (MoH) is the custodian of the health sector but often some of the main causes of inefficiency lie outside the jurisdiction of the MoH – Human Resources for Health being one prime example – which often lies within the Ministry of Public Service (or related). The second relates to methodological challenges in quantifying efficiency in a given sector. Methods to compare health efficiency across health sectors are becoming more standardised (e.g. DEA and Stochastic Frontier Analysis), but the quantification of this remains difficult.

Participants came together to reflect on the question “How can country-specific evidence on the sources and magnitude of health system inefficiency inform policies that enable a better use of available resources?”

The seminar’s specific aims were to:

• Reflect on how the most  pressing sources of inefficiency in a particular health can system be identified
• Identify which stakeholders have decision making power over the major sources of health system inefficiency, and how can they be brought in to the discussion on health system inefficiency
• Discuss ways on how progress on efficiency initiatives can be monitored

Resources:

• Discussion paper: Social Health Protection in low- and middle-income countries: the practical challenges
• UHC Technical Efficiency in Focus, OPM
• Achieving universal health coverage: Can countries learn from each other? And why now is the best time to share knowledge
  Medium story by Alex Jones, consultant, OPM health team.

Seminar 4: Addressing hospital challenges in low- and middle-income countries
7^th November 2017

This seminar, hosted by OPM and supported by DFID, brought together a group of hospital professionals (top academics, hospital managers and international consultants) to discuss challenges in hospital governance, administration, and financial management in LMICs and to reflect on the question: “Why invest in hospital sector improvement?”

Regardless of standpoints and the diversity of expertise, participants spoke unanimously about the need to ‘rethink hospitals in contemporary health systems’. This, in a context of public- private engagement and unavoidable scarcity of resources needed to deliver high-quality services, would streamline the understanding of hospital governance, institutional arrangements, business models and models of care.

Read more about this seminar here.

Resources:

• S