9 October 2015

Mikael Ostergren is Program Manager for the Department of Maternal, Newborn, Child and Adolescent Health, at the World Health Organization. Mikael recently attended the Joint Assessment of National Strategy (JANS) in both Ethiopia and Uganda, and has spoken to IHP+ about his observations about how the process can benefit sub-sectors.

JANS: a process with sub-sector benefits

Mikael Ostergen, World Health Organization 

“When I took part in the JANS in Ethiopia and Uganda this year, some of the team were from the Global Fund, GAVI and the World Bank, so there were lots of sub-sector specialists. We looked at sub-sector plans within the broader health plan. Having different specialists, including health financing experts, look at particular areas but still have the broader health sector plan in mind, was a very useful part of the JANS process." 

"In countries, a challenge for sub-sector planning in general is that if you only focus on the sub-sector you miss the link to the broader national health plan. For example, in the case of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH), if you want to expand care services to include Community Health Workers, it has human resource implications. So you can have a good idea for your sub-sector plan, but implementing it depends on the broader health plan. It also depends on the health financing strategy. You might identify a sub-sector plan that should have a Universal Health Coverage element, but if it is not reflected in a minimum benefit package as part of the financing strategy, it will not go very far." 

"Right now we are working in the area of maternal health in RMNCAH and we are also working with the new Global Financing Facility (GFF) and the GFF Trust Fund hosted at the World Bank. As part of the GFF, the core investment case (basically a sound, prioritized plan for RMNCAH) is also linked to the broader health financing strategy and linked to the broader health plan."

"We’ve had a lot of discussions about how we ensure that the quality of the investment case is at a level that will attract investors, which is firstly the Ministry of Finance and then external investors such as the World Bank. There is not yet agreement on this. In my view when we talk about how to assess quality, it should not be about global experts reviewing a country’s health plan and saying ‘Yes’ or ‘No’, as this is too top down." 

"It is better to find a way for a country-led process. It should be a joint exercise that can lead to improvement. In my view, the JANS process is the best option of producing a quality assessment. This could be of sub-sector plans, and using the same elements of a JANS, or it could be a full JANS of the national plan with a more specific focus on RMNCAH. If a JANS process includes RMNCAH then it is a way of quality assessing RMNCAH. I would like to see that being part of the GFF process."

"Ethiopia is a good example of integration. They said that the case for investment for maternal and child health actually is the national plan. There is good alignment between the sub-sector plans for maternal, reproductive and child health and the national plan. The delivery mechanisms for interventions proposed in the sub-sector plans for RMNCH are very well reflected in the overall national plan. So here you can see the alignment between the sub-sector plans and the national plan."

"Overall, there are two main benefits for a country to conduct a JANS. Firstly, it is an opportunity to improve the national health plan because there is a chance to have the plan reviewed, by peers. In Uganda, it was very encouraging to see the government’s ability to respond to suggestions for changes to the national health plan, and in a very short space of time. The plan, about to be adopted officially, was improved considerably due to their readiness to take on the recommendations that were developed in a collaborative manner. A second benefit is that by involving key partners in the JANS, it ensures a buy-in and commitment to the plan. A Ministry of Health might not be willing to take on all the recommendations, but the process is one of progress and learning. It is reasonable to expect that sometimes a government will not take on the recommendations, and this is very fair. Elements of the national plan and targets for health can sometimes be politically driven; this is the environment in which we all work. We have to be realistic."

"In my opinion, JANS could be improved if some members of the JANS team are from other countries and have already done their own JANS. For example, people from the Ethiopian Ministry of Health could participate in a JANS in another country. It is like a peer review, as they have an understanding of the process and share valuable insights." 

"The link between JANS and donor approval of the national health plan, followed by pooling of funding by different donors is not straight forward. But it is far less likely to happen without a JANS process having taken place. We have to ask ourselves, what is the alternative to doing JANS? It may be an external technical review, which is a top down process. I would like to see all the main donors using JANS processes, instead of their own external review processes. I think this is where we should move towards.” 

IHP+ would like to thank Mikael Ostergren for his time and inputs. 

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