74921 December 2012 Number 179 www.worldbank.org/enbreve A regular series of notes highlighting recent lessons emerging from the operational and analytical program of the World Bank‘s Latin America and Caribbean Region (LAC). Improving Governance and Management of Health Systems: Partnerships and Observatories in Latin America and the Caribbean by Rafael Cortez and Katharina Ferl Public Health Observatories and National regional level, the European Health Observatory for Health Health Strategies and Policies Systems and Policies engages directly with policy-makers and supports and promotes evidence-based health policy- The goal of a public health observatory, first established in making through comprehensive and rigorous analysis of the France in 1974 and later in England and the rest of Europe, is dynamics of health systems. to support the decision-making process in health and social care by providing policy makers with relevant information. Table 1. Global and European Public Health Public health observatories proactively investigate health Observatories issues to provide robust analytical evidence to policy makers. This type of organization has different characteristics from Global Global Health Observatory other public health institutions, such as information- gathering bodies, academic public health departments, or Europe European Observatory on Health Systems and Policies state employed public health practitioners. Their functions may vary, depending on their mission statements, but, in Great Britain Association of Public Health Observatories general, health observatories produce and disseminate health intelligence in order to provide information and London Health Observatory analysis, inform policy makers and practitioners, improve health, and reduce inequalities1. They provide an arena for France ANTADIR Observatory various actors to discuss health policy trends and reforms and raise awareness of important health challenges. They Spain Public Health Observatory of Cantabria also collaborate with academic institutions, think tanks, government bodies and international organizations to Austria Gesundheit Oesterreich analyze health systems and provide policy advice based on extensive research and analysis. Table 1 lists some health observatories in Europe. Health observatories provide tailored information for planning and supporting better investments in health. This International and regional public health observatories reflect can be achieved by linking data and technical discussions partnerships among national governments, international across relevant units within the government, monitoring institutions, and universities.2 At the international level, health and disease trends, providing strategic areas of the World Health Organization’s Global Health Observatory technical work, holding discussions on health inequalities, provides data and analyses on global health priorities. At the and providing recommendations for future actions. A 1. Lam M, Jacobson B, Fitzpatrick J. 2010. Establishing a Regional Public Health Observatory – Some Questions Answered. London Health Observatory. 2. Hemmings J. and Wilkinson J. 2003. What is a public health observatory? Journal of Epidemiology and Community Health 57: 324–326. 1 key area of work of observatories is the collection of a monitoring mechanism. For example, the Reproductive information from various sources and the production Health Observatory in Guatemala aims to monitor the legal and dissemination of reports and assessments on health framework that was put in place to reduce maternal death, outcomes and health sector performance. Such reports teenage pregnancies, and HIV incidence. It also addresses can help local governments and health services to plan challenges such as equal access to services. The Observatory ahead. To enable decision makers to take advantage of for Hospital Monitoring in Mexico issues an annual report, local knowledge, expertise and insight observatories can which describes and analyzes the performance of the also produce toolkits, which include a large amount of major public institutions of the Mexican hospital system in data covering various topics. Further, they can be used as terms of quality of services, dynamics of emergency room accountability mechanisms by developing tools to monitor services, efficiency, and patient safety. The Observatory and evaluate health programs, enabling local agencies for Medication Prices in Peru provides information on to measure their success against national targets.3 Some price differences by publishing the prices of medicines in observatories also develop “control profiles� to address hospital pharmacies, specialized institutions, and health specific health problems, such as London’s Local Tobacco centers of the Ministry of Health. The Observatory for Control Profiles. These profiles provide data on tobacco Equity in Health in Chile, established because Chile is one users, the impact on their health, and measures to reduce of thirteen countries participating in the Global Alliance these impacts at the local level. for Health, has as its main objective to create a system to monitor health inequities and inform, monitor, and The degree to which public health observatories can fulfill evaluate health policies and their social determinants. their role depends on whether (i) issues such as public health In Brazil, health observatories also focus on a variety of and inequality are priority topics on the health agenda, topics at the national and state levels. For example, the (ii) a public health infrastructure exists at the national, Health Observatory for the Metropolitan Area of São Paolo regional and local levels, (iii) health and demographic data disseminates information on municipal management, are routinely collected and made available, (iv) gaps in institutions that manage the unified health system, and public health information are identified and authorities are health professionals. 4 committed to closing them, and (v) health systems support the standardization of data collection, tools and indicators. Federal Health Observatory in Argentina Public Health Observatories in In Argentina, the Ministry of Health is in the process of establishing a national health observatory, with technical Latin America assistance support from the World Bank, in the context Governments in Latin America have also begun establishing of the goals of the Federal Health Plan for 2010-2016. regional, national, and provincial observatories. Some of the The Strengthening Governance in Argentina’s Health regional observatories provide comparisons of countries in Sector Technical Assistance Project includes several the region in areas such as public health, human resources, activities funded by the Governance Partnership Facility food security, and nutrition. National and provincial Trust Fund. The grant aims to improve governance in the observatories often have a national or a specific agenda. health sector by providing analytical and technical support In addition to providing data, observatories often provide for a multi-stakeholder National Observatory for Heath Policy, in cooperation with the Ministry of Health. Activities supported by the grant were embedded in the Provincial Maternal and Child Health Investment Project, especially in the second component’s strategic goal of strengthening the stewardship capacity of the national and provincial ministries. The activities supported by the project are in line with the government’s strategic priorities. The design and implementation of the observatory is seen as an effective way to improve the stewardship capacity of the Ministry of Health under the Federal Public Health System. Argentina has expressed strong demand for this 3. Ashton J. 2000. Public Health Observatories: the Key to Timely Public Health Intelligence in the New Century. Journal of Epidemiology and Community Health. 54:724–725. 4. A more extensive list of national observatories, with links to their web pages, can be found in Table 2 2 Looking forward: A Regional Partnership to Strengthen Health Systems Following the successful work of the European observatories and the development of observatories in Latin America and the Caribbean, the World Bank is supporting the development of a Regional Partnership Program on Health Systems and Policies (RPPHSP) which will, for the first time, bring together the different regions in the Bank to focus on health systems and policies. Under this initiative, the Bank is supporting regional and national efforts to strengthen governance and health systems. In addition, the partnership aims to foster further collaboration among academic institutions and connect different stakeholders, observatory to provide national and provincial health promote dialogue with key policy-makers, and leverage authorities with solid scientific analyses of relevant practices. additional funding from different agencies. Finally, the In turn, this will help improve planning and management partnership will generate evidence for policy makers processes, standardize health data, and maximize social through activities such as collecting country-specific data equity and efficiency of health programs and policies. Health information, monitoring country performance, conducting authorities also want to improve monitoring of health cross-country comparative analysis, and making research results and health sector performance. The observatory will findings easily available. produce national, regional, and provincial reports every two to three years to analyze challenges and trends in the Summary and conclusions entire health sector, as well as studies and policy briefs, newsletters, a website, articles and databases. It will also Regional and national health observatories have become hold seminars and summer programs to train technical important tools for governments and health ministries to staff. support national strategic partnerships and to empower civil society, health sector stakeholders, and health sector Implementation of the proposed observatory is currently authorities seeking to develop more effective and efficient under review at the Ministry of Health. The proposal health systems. Focused on epidemiological trends, equity recommends locating the Observatory within the Ministry of health service provision, health outcomes, and impact of Health, with its Executive Director reporting directly evaluation of health interventions, these efforts will improve to the Minister. The Scientific Director would lead the planning, management, and monitoring and evaluating of effort to build strong relationships with the scientific and public health actions. academic communities and ensure high quality products, Health observatories are therefore a key instrument services and information systems. The Administrative for health systems to generate information, data, and Director would be responsible for the administration and intelligence on people’s health status and the type and financial management. The proposal’s aim is to link the quality of health care delivery. By making all this information Observatory to an integrated health information system available to health providers and policy makers in a timely that will monitor health policies by collecting independent manner, the health observatories will ensure that their data. Access to such information will help the Ministry set national health systems are results-oriented and engaged investment priorities and obtain consensus among the in a continuous process of improving quality and access. provincial ministries and other stakeholders with respect to the federal health agenda and policies. Table 2. Public Health Observatories in Latin America Through technical assistance supported by the Essential Public Health Functions—Phase 2 Project and the Provincial Regional Public Health Insurance Development Project, the World Health System Observatory of MERCOSUR (in establishment process) Bank will continue supporting the Health Ministry’s Latin America and Caribbean Health Observatory initiatives to enhanced governance in the health sector by Regional Health Observatory introducing participatory approaches and developing and The Andean Observatory of Human Resources in Health testing approaches to greater transparency, accountability, Regional Observatory for Human Resources in Health and financial accountability across levels of government in Observatory for Food Security and Nutrition (Costa Rica, Guatemala, the sector. Mexico, Panama, Honduras) 3 Argentina Ecuador National Health Observatory (in establishment process) National Observatory of Health and Sexual and Reproductive Rights Observatory for Health Systems and Policies Observatory for Health, Gender and Human Rights Guatemala Reproductive Health Observatory Reproductive Health Observatory Observatory for Women in the Province of Tucuman Urban Health Observatory Observatory for Human Resources in Health Public Health Observatory for the Province of Cordoba Mexico Observatory for Road Safety Health Observatory Maternal Mortality Observatory Bolivia Observatory for Monitoring Hospital Performance Observatory for Sexual and Reproductive Rights Nicaragua Brazil Human Rights in Health Observatory Mental Health and Human Rights Observatory Observatory for Human Resources Paraguay Brazilian Observatory for Gender Equality Human Resources Observatory Health Observatory of the Metropolitan Region of Sao Paulo Observatory for Technology of Communication Information in Health Perú Service Systems Health Observatory National Observatory for Human Resources Chile Observatory for Medication Prices Public Health Observatory Gender Equity in Health Observatory Uruguay Regional Observatory for Equity in Health according Gender and Human Resources Observatory Mapuche People National Observatory on Gender and Sexual and Reproductive Health Chilean Observatory for Equity in Health Observatory for Good Health Practice Venezuela Venezuelan Health Observatory Colombia Observatory for Nutrition Santander Public Health Observatory National Observatory for Mental Health National Observatory for Oral Health and Dentistry Practice Observatory for the Quality of Health Care Observatory for Human Resources in Health Observatory for Pediatric Sepsis About the Authors Observatory for Monitoring the Quality of Higher Education in Psychology Rafael Cortez is a Senior Economist and Katharina Ferl is an Observatory for Food and Nutrition Security Economist, both in the Health Sector Unit (LCSHH) Disclaimer: The findings, interpretations, and conclusions expressed herein are those of the author(s) and do not necessarily reflect the views of the Executive Directors of the International Bank for Reconstruction and Development / The World Bank or the governments they represent. 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