1. Essential Characteristics of
Effective National Health Plan
Regional Consultation on
Strengthening NHPs in SEAR
countries 4-6 August 2010
Bali, Indonesia

2. National Health Planning
Group of health planners
in 1960s –confined mostly
internal sector/ mostly led
by Health Ministry
Health
Planning Reform
Health planning become
more multidisciplinary
and multi-sectoral
become a part of
national, social and
economic group
Become a part of overall NHP in
the country
Health Planning today is much different from health
planning yesterday

3. National Health Planning Today

4. Essential characteristics of an effective national health plan
From the perspectives of strengthening National Health plan
there are three important aspects:
1. The context in which NHP are developed and implemented
2. The NHP Process
3. The content of NHP document

5. A set of desirable characteristics of a national health plan
I. The country context
Both the process and content of NHP are bound by the
country’s:
• Development context including socio-economic scenario
•
Institutions and structures-including administrative
&financial structures and legal frameworks
•
Capacity to formulate and implement the health agenda

6. Implication of contextual factors for NHP
Factor
Example of Factor
Typical questions for the
Planning Process
Ideology
National self reliance
Is the role of donors in the
planning process well-defined
and appropriate?
Social and political
events
Political cycles resulting
from elections
Does the planning process
allow for a balance between
political change and planning
continuity?
Economic change
and policy
Liberalization and shift to
a market economy
Has planning adapted to the
changing roles of agencies in
the health field?
International
Relations between
government and
international agencies
Can the planning process
respond appropriately to
changes in the international
financing mechanisms such as
SWAps?

7. II. Key Stages in the Planning Process
Analysis and
Formulation
Monitoring
Evaluation &
Updating
Approval
Consultation
Dissemination
Implementation

8. A set of desirable characteristics of a national health plan
II. National Health Planning Process
(A)Situation Analysis
• A Planning process is based on a complete and relevant
Situation Analysis and that is made dynamic through
consultation and inclusiveness.
• SA are quite complete with respect to the health context in
countries –such as
– SA of health status, SA of demographic & epidemiological trends.
• Broader health systems and contextual issues - political,
economic and social determinants of health - remain less
adequately analysed

9. A set of desirable characteristics of a national health plan
Future NHP- Planning process needs be Inclusive and dynamic
 In most countries planning process is lead by a dedicated
government entity: planning unit, department, ministry or
commission.
To keep in mind of importance of broad based consensus for advocacy
and national ownership of NHP specifically:
– Political support
– Commitment from all health sector stakeholders –public & private
– Multi-sector buy-in from health related sectors
– Overall community confidence in transparent, people-centered
health planning
– A basis for aligning country and international health agenda,
including external assistance
– Plan time frame usually medium term, 5-10 years “Master Health
Plan” linking to overall development planning cycle and with annual

10. A set of desirable characteristics of a national health plan
II. National Health Planning Process
(B) Health information systems have limited capacity to generate
quality and complete information for evidence-based
National Health Planning.
•
This impacted not only the situation analysis but monitoring
and evaluation of the plan as well.
•
Importantly, where evidence-based planning has been
institutionalized, it has added credibility and promoted
ministry of health's leadership in health
Future NHP-
•
– Evidence based research on SDH & HSS, other sector’s papers, NHA, etc

11. A set of desirable characteristics of a national health plan
II. National Health Planning Process
(C) Both consultation and dissemination is most
systematically done within Ministry of Health and at
higher-levels in the first instance.
• Inclusion of other stakeholders especially beyond MoH is
still limited
Future NHP• consider more on consultation and dissemination to
stakeholders within MoH and beyond MoH

12. A set of desirable characteristics of a national health plan
(D). Linkages
• Strong vertical linkages –
• downstream to health systems, sub-national and vertical
programme plans
• upstream to the national health policy as well as national and
international development agendas
• Strong horizontal linkages to health related activities of other
sectors; and, with joint budgeting and expenditure processes
• Linkages beyond health remain persistently weak- with the overall
development agenda especially with respect to using this as a
common platform to link with health-related sectors, including to
initiate joint budgeting; and, with direct horizontal linkages with
health-related sectors and national budget/finance aspects (eg in

13. A set of desirable characteristics of a national health plan
(E). Boundaries
Contextual issues beyond health
• those related to political, economic and social determinants of
health are not adequately accounted for in national health plans
Institution and capacity building
• is not focused upon in national health plans
• planning appears to be more for current structures of ministries of
health rather than responding to for the institution and capacity
needs of population health

14. A set of desirable characteristics of a national health plan
(F) Use of Appropriate Tools
•
Tools available could be used more effectively to inform national
health planning e.g. costing of the plan.
•
Gaps related to weak information systems mentioned above are a
critical constraint but inadequate capacity or use of relevant tools
and techniques to process this data for evidence-based planning
is equally limiting

15. III. Components/Contents in
National Health Planning
• Situation Analysis / Needs Assessment
- including local needs of the people, and
analysis of gaps, socio-economic situation and
trends, availability and sources of finance
• Costing of services

16. Vision, Mission, Goals
•
•
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Equity
Access
Affordability
Efficiency
Quality
Reduce disparities
Aspire towards Universal
Coverage
• Catalytic role in
promoting healthy policy
•Reaching the unreached
•Inter-sectoral collaboration
•Community participation
•Time frame of the plan
•Gender sensitive
•Special needs of the people
•Empowerment of the community,
and strengthening institutions

17. Policy & Strategy
• Focus on Non Communicable Diseases
• Need to involve various levels (District /
Provisional level etc.)
• Multi sectoral endorsement can help avoid
overlapping and strengthen collaboration with
other stakeholders.
• Financing the plan
• Focus on women’s health
• Set targets & goals
• Flexibility in planning

18. Issues & Challenges
• High Out of Pocket expenditure at the point of service in many
SEA countries. Countries need to explore various financing
mechanisms as suitable to their situation to reduce Out of
Pocket Payments.
• Quality of services
• Cover and involve the Private Health Sector
• Public Private partnership to be included in the NHP
• Create good governance in the management of health systems
• Promote healthy behavior
• People’s centered health plan
• Create immunity for diseases and health threats
• Pluralistic approach – balance between different approaches to
medical care should be sought (traditional, modern, alternative).
• Institutionalization of Health systems research

19. Programmes & Services
• Expanded Primary Health Care
• Distribution of Human Resources for
Health
• Emergency preparedness and response
• Document and disseminate best
practices
• Supportive supervision

20. Monitoring and Evaluation
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Monitoring & Evaluation framework
Need to develop indicators
Mid term evaluation
Feedback
Need to be based on outcomes

21. •
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Problems Encountered by Countries
NHP Contents
Alignment of National Health Plan with overall National plan
Various planning units
Integration of NHP with other sectors including private sector
Linkages between strategic and operational/annual plan, how
to link between local and central plan
Planning for Human Resources
How to forecast health problems 3 – 5 yrs ahead
Emerging and reemerging of diseases
Technical knowledge to use evidence for allocating budget to
various levels and institutions
Limited staff capacity in priority setting and planning,
Expanded Primary Health Care
Insufficient technical robustness and evidence base

22. Problems Cont…
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Limited capacity in developing financial plans in NHP
Costing for regional / district budgets and priority areas
Costing of benefit packages
Universal Coverage expenditure has increased
National Health Accounts not used to its potential
Strategy on reducing OUP expenditure limited
Constant financial flow especially from external sources
Statistics and information gaps for measuring targets
Weak Health Information Systems
Disparity among groups, regions, services, situation analysis

23. Primary Health Care principles are stated as the guiding
policy approach in all plans
S

24. Primary Health Care principles are stated as the guiding policy
approach in all plans
Leadership of MoH and Health in Public Policy
• is not clearly established
• Plan documents indicate limited influence on health-related
issues beyond those directly addressed within the health
sector.
Universal coverage
• is an overarching goal in all NHPs.
•
However, further details with respect to the linkages
between a selected benefit package and priority populations
with focus areas/activities of the plan or related budget items
are not clearly evident

25. Primary Health Care principles are stated as the guiding
policy approach in all plans
• Service delivery improvement/scaling-up is a stated priority in
all case studies.
• Other areas of health systems strengthening –
Human resources
Medicines and technology and
Health information systems are also addressed in all plans.
• However, Health Financing and Governance issues are not
similarly covered
• Further, plans do not do explicitly link health systems functions
to highlight their reinforcing contributions to PHC oriented
service delivery strengthening.