Terms of reference for the analysis of the implementation of health policies in Cameroon, Ivory Coast, Mauritania and Togo
Context and rationale
PROPEL Health’s predecessors, including Health Policy Project (HPP) and Health Policy Plus (HP+), supported the development of multiple budgeted national action plans (NBAPs) and task-shifting policies, new health laws of reproduction, throughout the West African region.
This investment in the implementation of policies and strategies has certainly driven change, but much remains to be done for a greater impact on populations and communities. Very often policies and strategies are not effectively and completely implemented. Despite progress in improving the health and well-being of the population in recent years, inequalities in access to health care persist. This is why analyzing public policies, particularly public health policies , is becoming more and more necessary, even imperative, for the Governments of the West African sub-region. It is a question of understanding the functioning of these policies, because they generally lead to changes in the organization of the different functions of the system (Walt, 1994, Janovsky and Cossells, 1996) such as general administration, financing, service delivery and resource generation (WHO, 2000). Also, these policies are neither monolithic nor linear (Grindle and Thomas, 1991): the choice of solutions to be implemented is not always rational and their implementation does not always correspond to what was initially planned.
To better understand their relative effectiveness, it is urgent to study in depth the interactive role played by the main actors in the implementation of health policies in the PROPEL Santé focus countries.
Efforts under PROPEL Health will aim to help countries address policy and systemic issues related to:
- the weak implementation of Budgeted National Action Plans for Family Planning (PANB)
- limited access to primary health care, hampering universal health coverage (UHC)
- a significant financial burden on families due to weak implementation of universal health insurance policies
- the weak mobilization of national resources for health
- insufficient public/private coordination in the health sector.
Objectives of the analysis:
The object of this work is
- Take stock of the implementation of RMNCAH/FP and HIV health policies in the four (4) Focus countries (Cameroon, Ivory Coast, Mauritania and Togo) of PROPEL Health West Africa and identify the strengths and weaknesses;
- to contribute to the establishment of a common analytical framework of reference which makes it possible to carry out a holistic diagnosis of the implementation of the programs and strategies defined in the national RMNCAH/FP and HIV health policies;
- Identify the major challenges in the implementation of RMNCAH/FP and HIV health policies;
- Highlight the main lessons and perspectives;
- Formulate relevant and operational recommendations;
- Design a dynamic monitoring dashboard with captions on their policy implementation status.
- The expected results of this mission are as follows:
- The state of implementation of policies related to Health, particularly family planning, in the 4 focus countries (Cameroon, Ivory Coast, Mauritania and Togo) is made
- a holistic diagnosis of the implementation of programs and strategies defined in national policies carried out; eDn9CGw BIpnb
- the implementation status is achieved and strengths and weaknesses are identified and documented;
- key challenges are listed;
- lessons learned and perspectives are listed
- relevant and operational recommendations for the successful implementation of public health policies in the countries are formulated;
- A dynamic monitoring Dashboard with captions on the status of policy implementation is available.
The policy analysis will be carried out in PROPEL Health’s three West Africa focus countries (Cote d’Ivoire, Mauritania and Togo) and in Cameroon.
The consultant will have to develop a relatively standardized, integrated and modular diagnostic methodological approach which allows both: 1. to monitor the implementation of policies in the four countries concerned;
2. identify the strengths and weaknesses of policy implementation in the four;
3. to provide useful operational information to technical and financial partners, making it possible to provide better support for the implementation of public health policies.
4. to facilitate cross-analyses, sharing of experiences and to strengthen dialogue between the different stakeholders (Governments, CSOs, Donors, Implementation Actors, etc.) engaged at the national and regional level on the challenges and issues public health policies;
5. Formulate relevant and operational recommendations for the successful implementation of public health policies in the countries.
Overview of targeted national health policies
The policy analysis will be carried out following a methodological approach which will take into account the information on the various indicators linked to the key policies (non-exhaustive) below:
- Population Policies,
- National health policies,
- the Reproductive Health Law (SR Law),
- Community health policies;
- National health financing strategies;
- Task delegation policies;
- Policies, standards and procedures document;
- PANB (Budgeted National Action Plan for Family Planning);
- UHC (Universal Health Coverage) policies;
- PHC (Primary Health Care) policies;
- Implementation of FP2030 commitments,
Some theoretical orientations
Several theories and perspectives exist on the key elements of policy implementation and the means by which successful implementation can be judged. The consultant must draw inspiration from the following seven dimensions of policy implementation: 1. The policy, its formulation, and dissemination 2. The social, political and economic context 3. Leadership for the implementation implementation 4. Stakeholder engagement 5. Implementation planning and resource mobilization 6. Operations and services 7. Feedback on progress and results
By presenting the evaluation process as seven distinct dimensions of implementation, the Policy Implementation Analysis Tool will capture information about a dynamic, multi-faceted process in a systematic manner. The dynamic dashboard that will be provided will also be inspired by these seven dimensions.
For illustrative purposes, the table below provides some guidance for designing and implementing a dynamic dashboard with colors showing the level of implementation and changes on the evolution of each indicator
Gaps in health policies and state of their implementation in African countries Focus of PROPEL Health West Africa
Policy Issues/Advocacy Needs
Pays Focus de PROPEL Health WA
1. Development of a Budgeted National Action Plan for Family Planning (PANB)
Weak implementation of National Budgeted Family Planning Action Plans (PANB)
2. Universal health coverage (UHC) strategy
Limited access to primary health care, hampering universal health coverage (UHC)
3. Reduction of out-of-pocket health expenses
A significant financial burden for families due to unreimbursed health expenses
4. Mobilization of national resources for health
Low mobilization of national resources for health
5. Public/private coordination in health sectors.
Insufficient public/private coordination in the health sectors
6. Demographic dividend
7. Task delegation policy
8. Free Family Planning
9. Reproductive Health Law (RH Law)
The situation in each country can be assessed for each policy document based on a number of qualitative and quantitative indicators. The indicators measure the degree to which conditions in the country are favorable or unfavorable with respect to policy implementation. For each document, these indicators can help identify the needs and potential levers of action in the area of the policy put in place to provide responses to population health problems. The evaluation framework will be accompanied by a data collection tool which can be structured as follows: Expected deliverables
1. A detailed Implementation Analysis Report is available for all four focus countries. This report will take into account comments from stakeholders. The latter will be sent to PROPEL Health West Africa in accordance with the terms of the contract;
2. A dynamic Dashboard which allows you to visualize the status of policy implementation will also be available.
The study will be entrusted to an independent consultant who will work jointly with the PROPEL Sante team. The consultant considered for this mission must meet the criteria mentioned below: – Be a Senior consultant and hold a postgraduate diploma in Statistics, Planning, Law, Strategy Development (or in project management/monitoring);
– have strong leadership capacity and be able to mobilize high-level national actors to host discussion panels;
– have a good knowledge of public health policies or be familiar with the policies or policy issues in the 4 focus countries;
– essential knowledge of the Excel tool for setting up a dynamic Dashboard.
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