Annex TCountry Tables Zdrav to ZdravPlusII TK.pdf

2/3/2008 Response to Tina's Questions -- Turkmenistan Not start work in Turkmenistan until ZdravPlus Most activities done in collaboration with other donors/projects, documented elsewhere, not included due to space constraints Same situation at independence for all countries although level of health financing collapse varied See ZdravPlus II Project Regonal Conceptual/Technical Overview Paper Distributed to USAID Evaluation Team for General Definition of Project Components Tina's Just intended to provide a general picture, not fully specified, activities not always fit precisely across projects, generally allocated to time where most accomplished Scale

ZdravPlus II Remainder +R for Project Component At Independence ZdravPlus ZdravPlus II To Date and Beyond Roll-out

Stewardship

Legal and Policy

No comprehensive policies, patchwork of laws/regulations, governing done by decree

Receive approvals of activities and training participants

Still largely just to receive approvals but due to development of relationships and trust some broader dialogue on some topics

Almost totally dependent on general country environment O

Institutional Structure, Roles, Relationships (ISRR)

MOH monopoly with complete command and control Minimal

Some thinking and discussion about roles, for example, role of Fund for VHI in broader health financing, institutionalizing HIS training in TSMU Health Management Center, relationships service delivery and medical education, etc.

Almost totally dependent on general country environment O

Policy Marketing Command and control, little dialogue

None as environment not allow dialogue

At start none, over time environment becoming slightly more open for dialogue

Almost totally dependent on general country environment O

Monitoring and Evaluation Politically driven initially very difficult as partners not allow access for M&E

Improved significantly due to MCH Center increase in interest and confidence as well as collaboration with WHO to improve IMCI M&E Continue to expand and improve O

Donor/Project Coordination None Generally good although some quirks Generally good although some quirks Expect to remain generally good O

Resource Use

Health Delivery System Structure Inverted pyramid

Minimal. Strong Presidential support for PHC (probably strongest in CAR) resulted in development of PHC sector. Turkmenistan general perspective is right what but the how could use some support, for example, right that need to restructure hospitals but statement that close all hospitals outside of Ashgabat probably not right way to do it (didn't happen...) Largely same as ZdravPlus

Almost totally dependent on general country environment O

Human Resources Planning None None and minimal information None and minimal information Almost totally dependent on general country environment O

Project Component At Independence ZdravPlus ZdravPlus II To Date and Beyond Roll-out

Health Financing

See writing on fragmented financing, no separation of purchaser/provider, wrong incentives in provider payment systems (PPS), etc.

Co-sponsored seminar with WHO went well, strong Turkmen desire to retain universal coverage for all citizens and some understanding of health financing functions. Some dialogue on mandatory health insurance.

Second seminar on provider payment systems also generated interest, agreed to discuss HIS for VHI and distribute manual and discuss case-based hospital payment but no follow-up after death of President and change in MOH leadership.

Turkmenistan showed WB some interest in engaging in health financing, probably connected to financial pressure due to reduction of health budget and allocation of funds for buildings required by the President but this door seemed to close...

Almost totally dependent on general country environment O

Health Information Systems

(HIS)

Excessive but data poor, politicized and not used None

Implemented automated hospital database and HIS first in pilots and then minimal roll-out

Can expand as far as resources will allow O

Health Management

Command and control, politics equated with management None

Institutionalized HIS training in TSMU Health Management Center, other opportunities may arise May be some opportunities… O

Service Delivery General Health System Functions Postgraduate Medical Education Old system collapsed Minimal

Some linkage with Family Medicine Training Center supported by AIHA Potential to develop over time O

Graduate Medical Education Not based on EBM, no outpatient clinical bases Minimal Minimal Potential to develop over time

Undergraduate Medical Education

Not based on EBM, theoretical with little practical clinical training or patient contact Initiated integration of IMCI

Largely completed integration of IMCI and engaging in dialogue on other programs

In contrast to other CAR countries there is movement on improving undergraduate ME early in the reform process O

EBM/CPGs Nature of clinical practice not based on evidence None outside of WHO programs One roundtable demonstrated a lot of interest Potential to develop over time O

Quality Assurance Punishment None None Unclear

Pharmaceuticals

Pharmatsiya (some different names across country) monopoly

Some dialogue on sustainability of IMCI drugs Some dialogue on sustainability of IMCI drugs Unclear O

Infrastructure All owned by state, massive and deteriorating None None Unclear

Service Delivery Priority Programs

General Practice/Hypertension

Problems inherent in system including weak PHC Laboratory training (clinical)

Evolved laboratory training to a broader PHC training linking family doctors and laboratory specialists

Can expand geographically and programmatically (other PHC topics) as resources allow O

Maternal (Safe Motherhood) and family planning

Problems inherent in system including weak PHC and not evidence-based

Healthy Pregnancy training to improve prenatal care and communication with population. Very close collaboration and cost-share with Healthy Family Project

Evolved into broader Safe Motherhood, national program approved, initiated 1 pilot site, great acceptance and enthusiasm, want to expand.

Some collaboration with Healthy Family.

Want to expand slowly to address issues and ensure quality but likely can expand as far as resources allow P, O

Project Component At Independence ZdravPlus ZdravPlus II To Date and Beyond Roll-out

Child Health

Problems inherent in system including weak PHC and not evidence-based

Initiated and rolled-out physician IMCI. Very close collaboration and cost-share with Healthy Family Project

Continued roll-out of physician IMCI. Initiated and rolled-out nurse IMCI. Preliminary activities hospital IMCI. Very close collaboration and cost-share with Healthy Family Project

Can expand geographically as resources allow. Continue to integrate into broader PHC and family medicine P,R,O

TB

Excess capacity in vertical system, not evidence-based treatment, reach of vertical system no longer able to control all TB-related issues

Minimal, largely support for health promotion

Collaborated with Project HOPE on integrating TB DOTS into medical education, IPCS, and health promotion

Continue integrate into medical education, other activiites may be possible over time… O

HIV/AIDS Not yet emerge Minimal, largely support for health promotion

Link to Safe Motherhood and health promotion activities

Continue link to Safe Motherhood and health promotion O

Population and Community Health

Marketing the Reforms Population role not seen as important None None

Almost totally dependent on general country environment

Health Promotion -- Government Not yet emerge

Healthy Lifestyles Center surprisingly active, collaborated on a number of activities

Healthy Lifestyles Center surprisingly active, collaborated on a number of activities

If current perspective continues, is potential for activities O

Health Promotion -- Providers Linked to Service Delivery Not yet emerge

Keeping Children Healthy Campaigns linked to IMCI and healthy lifestyles training for providers

Keeping Children Healthy Campaigns linked to IMCI and healthy lifestyles training for providers

Seems a lot of potential to continue or expand P, R, O

Health Promotion -- Community-Based Entities Not yet emerge None None

Almost totally dependent on general country environment