Strengthening Evidence and Governance in Health
Governments have limited resources for healthcare, and the needs of the people they serve are significant and complex. Allocating health resources equitably and efficiently, establishing national health priorities that take diverse population needs into account, and ensuring those priorities are reflected in plans and budgets are critical to enhance health outcomes across the globe.
Global Evidence to Inform Local Change
The Abt-led USAID Local Health System Sustainability Project (LHSS) collaborates with governments and other stakeholders in low- and middle-income countries to achieve sustainable improvements in affordability, access to, and quality of health care. We also generate knowledge and promising practices on health systems strengthening issues many countries share.
Although health sectors have limited resources, their challenges are not just about resource scarcity. Countries often struggle to establish national health priorities in a way that consistently uses evidence-based, transparent, fair, and inclusive decision-making processes. We recently generated important insights on how to institutionalize such processes for setting national health priorities. Establishing an evidence-based, fair, and accountable approach to priority setting helps ensure that a country's health investments are aligned with national health goals, such as universal health coverage, and that the needs of underserved groups are fully considered.
Health financing and governance go hand-in-hand, as sector resources need to be spent in the best way possible. This requires strong public financial management, among other things. Last year, LHSS advanced global learning on health budget execution by compiling lessons learned from eight countries that have made good progress. Experts met as part of the LHSS-Joint Learning Network for Universal Health Coverage Health Budget Execution Learning Exchange. They reached five key conclusions on how to improve budget execution:
- Health and finance ministries must collaborate for better budget execution
- Government-wide health budget reforms must account for health emergencies, uncertain utilization, and varied financing arrangements
- The Ministry of Health must engage with stakeholders to gain acceptance of health budget reforms
- Reforms require capacity development at all health-system levels
- Governments must commit and invest over the long term to improve budget execution.
Strengthened Governance: Foundational for Resilience
Effective governance is especially important when a country faces an unexpected system shock that disrupts health care services or increases the number of people needing access to health care, or both. Such shocks can include conflict, natural disasters, health emergencies like the COVID-19 pandemic, or economic crises.
Countries in Latin America and the Caribbean have faced such a shock amidst recent widespread migration flows, including the influx of migrants leaving Venezuela due to the country’s economic, political, and social crisis. An estimated 5 million people and counting have left Venezuela since 2015, many of whom transit through or stay in communities in nearby countries like Colombia and Peru. Helping health systems respond to this challenge is part of the LHSS Project’s work in the region.
In Colombia, our work with national and subnational governments has increased access to health care for migrants and host communities and has helped include migrants’ needs in health planning. The LHSS “Comunidades Saludables” (Healthy Communities) activity supports government partners in addressing the needs of migrants and other people who are underserved by the health system, especially in areas with high concentrations of migrants and/or low capacity to respond to their arrival.
With LHSS support, migrants participated in the development of Colombia’s Ten-Year Public Health Plan for the first time. This was significant in ensuring their voices were heard and considered as part of health system planning for 2022–2031. Our support led to the inclusion of migrants in national and regional health priorities.
LHSS also identified key community-based organizations in strategic cities like Cali and worked with them to improve people’s awareness of how to access integrated health care services. Our technical support and grants helped expand the healthcare system’s inclusion of Venezuelan migrants, Colombians who have returned after migrating abroad, and others in host communities. Since 2021, we have helped Colombian health authorities enroll more than 90,000 Venezuelan migrants in Colombia’s national health insurance system.
Peru has also received an overwhelming number of migrants: By the end of 2022, Peru had received approximately 1.4 million Venezuelan migrants, including about 490,000 asylum seekers, the highest number of asylum claims from Venezuelans in any country. More than 320,000 Venezuelans in Peru are expected to need some form of assistance, including health care, and the influx of migrants is expected to continue.
In response, LHSS helped establish a new mechanism to improve access to the data required to prepare and respond to the growing need. The Peruvian Observatory of Migration and Health was launched in 2022, through a grant awarded to the Universidad Peruana Cayetano Heredia. This rich database gives Peru and other countries on the migration path timely data that helps them plan and coordinate efforts to deliver health services to people who need them and strengthen cross-border continuity of care.
Since its launch, over 2,360 people have accessed the observatory data and over 300 people or organizations have received newsletters with migration and health insights. And this has led to action. For example, in May 2023, the Observatory hosted an online forum in partnership with the Chile migration observatory to discuss the migrant crisis at the Peru-Chile border, and called for action.
In other important work, LHSS collaborated with UNAIDS and the ministries of health in Peru, Ecuador, Colombia, and Chile to assess cross-border HIV-related information and develop a road map to facilitate continuity of HIV care for Venezuelan migrants along the migration route. The road map was validated by the HIV program directors of Chile, Ecuador, and Peru, and USAID and UNAIDS representatives.
LEARN MORE: Local Health System Sustainability Project Overview | Institutionalizing Explicit Processes for Setting National Health Priorities: Learning from Country Experience
PROJECT: Local Health System Sustainability Project (LHSS)
CLIENT: U.S. Agency for International Development (USAID)
Adapting to Emergency Conditions in Ukraine
It has long been said that in war, no plan survives the first contact with the enemy. It is also true for plans to improve governance. When war broke out in Ukraine and the environment changed radically, Abt’s Good Governance Fund Technical Assistance Facility Eastern Partnership (GGF TAF EP) project responded to accomplish our mission in a variety of critical areas, including economic recovery, energy policy, and war damage assessment.
It was not the first pivot for GGF in the region. Funded by the Foreign, Commonwealth and Development Office (FCDO), GGF TAF EP was supposed to provide technical assistance and capacity building in four countries: Ukraine, Georgia, Moldova, and Armenia. In 2021, FCDO budget cuts eliminated the work in every country except Ukraine.
Then in 2022, Russia invaded. That posed a major challenge to the program. Our team of a dozen people adapted to address Ukraine’s new needs. In-country clients that the British Embassy Kyiv had identified and Ukrainian ministries set the priorities. It was an achievement to do any work at all in the conflict-affected country, much less complete projects. We were able to do so thanks to our adaptive management approach.