Map Map


How big is the the problem?

Providing a description of how big a problem is requires a consideration of which indicators would describe the size of the problem best, of the consequences of the problem, of what comparisons should be used to clarify the size and consequences of the problem, and where to find relevant data. Box 3.2 below illustrates an example of these considerations:

Box 3.2 Recruitment and retention of health professionals in rural areas: which indicators and comparisons can be used to describe the size of a problem

The problem (indicators and comparisons)

(Compared to goals or other problems over time, within the country, and within other countries)


Numbers of doctors, nurses and medical technicians in remote areas

  • Compared to targets in the National Plan

  • Compared to international (WHO) standards

  • Compared to other countries  

  • Changes over time/turnover/length of stay  

  • Remote areas compared to non-remote areas

Numbers of doctors, nurses and medical technicians registered in remote areas but not located there



Consequences of the problem (indicators and comparisons)

(Compared to goals or other problems, over time, within the country, and within other countries)


Utilisation of services, health status, quality of service, attitudes towards health services in remote areas

  • Compared to non-remote areas


Implicit or explicit comparisons are needed to establish the size of a problem. The following types of explicit comparisons may be helpful:

Different indicators may be relevant when estimating the size of a problem. This may depend on whether the problem is described in terms of:


Sources of data for risk factors and the burden of disease include epidemiological surveys and routinely collected data2. Sources of health services utilisation data also include routinely collected data, as well as studies of access to care, of the utilisation of care, of the quality of care, of health care expenditures and of health inequities. The availability of data describing health system arrangements and the implementation of policies and programmes is highly variable and such data may be difficult to find. Sources include government documents (often unpublished), data collected by the government or other agencies on their behalf (e.g. regarding expenditures or health workers), and studies that describe or analyse health system arrangements or policy implementation.  A SUPPORT Tool providing guidance on how to find and use evidence about local conditions together with a worksheet, workshop materials and a presentation are provided in the ‘Additional resources’ of this guide. Strategies for finding unpublished studies and grey literature are also described in the ‘Additional resources’ section.


Table 3.2 Health system arrangements

Health system organisation can be categorised in different ways. The taxonomy illustrated below was developed by Lavis and colleagues and divides health system arrangements into three main types. Strategies for realising change do not form part of this taxonomy, but include those for changing health behaviours, professional practice, and organisational change.

Delivery
arrangements

Financial
arrangements

Governance arrangements

Including problems with:

Including problems with:

Including problems with:

To whom care is provided and the efforts made to reach them (such as culturally inappropriate care)  

Financing – e.g. how revenue is raised for programmes and services 

Policy authority – who makes policy decisions (such as specific types of decisions being centralised rather than decentralised)

By whom care is provided (such as providers working autonomously rather than as part of multidisciplinary teams)  

Funding – e.g. how clinics are paid for the programmes and services they provide  

Organisational authority – e.g. who owns and manages clinics (such as private for-profit clinics)

Where care is provided – e.g. care delivered at inaccessible health facilities  

Remuneration – e.g. how providers are remunerated 

Commercial authority – e.g. who can sell and dispense drugs and how they are regulated

What information and communication technology is used to provide care – e.g. record systems may not be conducive to providing continuity of care 

Financial incentives – e.g. financial disincentives for patients or a lack of incentives for health workers 

Professional authority – e.g. who is licensed to deliver services; how their scope of practice is determined; and how they are accredited

How the quality and safety of care is monitored – e.g. not having quality-monitoring systems in place  

Resource allocation – e.g. providing insurance coverage for inefficient or ineffective services

Consumer and stakeholder involvement – who from outside government is invited to participate in policymaking processes and how their views are taken into consideration




This page was last updated November 2011.