Transforming health service delivery: What can policy-makers do to drive change? [Internet]

Excerpt

1. The transformation of health service delivery is about achieving large-scale change to meet population health needs and people’s expectations, despite resource constraints. Innovative ways of delivering health services, such as new models of care and technology-based solutions, can improve the quality and efficiency of care if they are widely and appropriately implemented.

2. Health systems are so complex that change cannot be imposed from the top. Transforming service delivery means engaging with multiple actors, their different interests and interactions. Combining top-down and bottom-up initiatives throughout the process helps.

3. The main role of policymakers in the transformation of health service delivery is

   1. Providing leadership, by setting out a clear vision and strategy for change; aligning governance mechanisms; and cultivating shared commitment; and

   2. Ensuring sufficient resources for transformation, by combining enablers at the system level and support to organizations and people within the system.

4. Developing a clear vision and strategy for change includes

   1. Identifying transformation targets, by leveraging tools such as health system performance assessment, surveys and stakeholder consultation.

   2. Choosing possible solutions that are effective, affordable, equitable and implementable using tools such as

      1. ◦

         Horizon scanning mechanisms and dedicated funding streams (national and international) to identify and/or test potential options.

      2. ◦

         Health Technology Assessment, to make a compelling case for change and help ensure solutions are good for patients and add value.

      3. ◦

         Analysis of the political economy around change to anticipate and address resistance.

5. Governance mechanisms need to be adapted and aligned to facilitate change which means

   1. Deciding what entities are involved in the change process and clarifying their relationships, the processes for making and implementing decisions and accountability.

   2. Adapting relevant regulatory elements (formal legislation, professional standards etc.).

   3. Adjusting payment and accountability mechanisms so they are geared towards transformation and its context.

6. Generating the commitment to implement change is critical, because transformation requires substantial buy-in from stakeholders to succeed. Policy makers need the right skills to achieve this. A system level strategy informed by stakeholder analysis and articulating all the elements of stakeholder engagement, as well as coalition building with civil society, professional associations and others are essential.

7. The resources for transformation at the local level must be aligned with its objectives. This means that policymakers must

   1. Put in place sufficient funding channelled through tailored payment mechanisms.

   2. Use multi-professional and intersectoral workforce planning to put the right staff and skill-mix in the right place.

   3. Nurture organizational and clinical leadership by supporting training opportunities and empower frontline staff by ensuring opportunities for skills development and the space to implement changes on the ground.

   4. Support the necessary technical infrastructures, such as health information systems.

   5. Foster the availability of robust information on good practice and progress on transformation goals, and its communication.

8. Transformation is not a ‘one-off’ or a quick thing.

   1. Transformation takes time so expectations need to be managed to sustain momentum.

   2. Effective change requires ongoing monitoring and adaptation, and good communication of successes and challenges.

   3. Success is very context specific so while international lessons and good practices can be shared, initiatives will always need to be tailored to local circumstances.