MIDTERM EVALUATION
OF THE
LATIN AMERICA AND THE CARIBBEAN
REGIONAL HEALTH SECTOR REFORM INITIATIVE
VOLUME II
By:
Gary Robinson
Maria Helena Jaen
Sergio Jellinek
Submitted by:
LTG Associates, Inc.
and
TvT Associates, Inc.
Submitted to:
The United States Agency for International Development
Under Contract No. HRN-I-00-99-00002-00
March 2000
Midterm Evaluation of the Latin America and the Caribbean Regional Health Sector Reform Initiative was
prepared under the auspices of the U.S. Agency for International Development (USAID) under the terms of
the Monitoring, Evaluation and Design Support (MEDS) project, Contract No. HRN-I-00-99-00002-00.
The opinions expressed herein are those of the authors and do not necessarily reflect the views of LTG
Associates, TvT Associates, or USAID.
Information about this and other MEDS publications may be obtained from:
Monitoring, Evaluation and Design Support (MEDS) Project
1101 Vermont Avenue, N.W., Suite 900
Washington, DC 20005
Phone: (202) 898-0980
Fax: (202) 898-9397
scallier@ltgassociates.com
ACRONYMS AND FOREIGN TERMS
C-NGOS Contracting NGO Services
CORE Cost revenue analysis tool
DAR Decentralization Applied Research
DDM Data for Decision-Making
DR Dominican Republic
DTF Dissemination task force
FPMD Family Planning Management Development
FY Fiscal year
G/PHN Bureau for Global Programs, Field Support and Research
Center for Population, Health and Nutrition
GPP Guidelines for policy process
HSR Health sector reform
IADB Inter-American Development Bank
Initiative Latin America and the Caribbean Regional Health Sector Reform Initiative
IR Intermediate Result
KPAB Knowledge, patterns, attitudes and behavior
LAC Latin America and the Caribbean
MHR Framework for Monitoring Health Reform
MOF Ministry of Finance
MOH Ministry of Health
MOST Management and Organizational Sustainability Tool
MPI Master plans of investment
MSH Management Sciences for Health
NGO Nongovernmental organization
NHA National health accounts
PAHO Pan American Health Organization
PHR Partnerships for Health Reform
PYS Performance incentive system
RSD Office of Regional Sustainable Development
SO Strategic Objective
TAG Technical advisory group
TPI Tool for plan investment
USAID United States Agency for International Development
WHO World Health Organization

CONTENTS
ACRONYMS AND FOREIGN TERMS
APPENDICES
C: Methodology for Collecting and Analyzing Data on Effectiveness
(Intermediate Results 3.4.1, 3.4.3 and 3.4.4)...................................................................
D: Interview Formats Model.................................................................................................
E: Conceptual and Methodological Framework...................................................................
F: Results Framework Analysis: IRs, Indicators and Expected Results
of Tools, Methodologies, Instruments, Experiences, Forum and
Study Tours (March 2000)...............................................................................................
G: Criteria for Assessing Communications Components in Development Programs
H: Database IRs 1, 3 and 4 (Raw Data)................................................................................
I: Tools, Methodologies, Experiences, Exchanges, Forum,
and Study Tour Evaluation Results: Effectiveness by Tool or
Experience and Country Evaluation Results IRs 1, 3 and 4 ............................................
J: Results on Dissemination Strategy ..................................................................................
K: HSR LAC Newsletter Concept Paper..............................................................................
L: Hits Recorded–LAC/RSD Web Site................................................................................
M: Official Documentation of the Strategy (Messages Defined by the Strategy).................
N: Traditional Communications Approaches .......................................................................
O: Partners’ Opinions on Audiences and Media
(Opinion de Socios Sobre Audiencias y Medios)............................................................
P: The Development Communications Strategic Cycle.......................................................

APPENDIX C
METHODOLOGY FOR COLLECTING AND ANALYZING DATA ON
EFFECTIVENESS
(INTERMEDIATE RESULTS 3.4.1, 3.4.3, AND 3.4.4)
APPENDICES
2
Methodology for Collecting and Analyzing Data on Effectiveness (Intermediate
Results 3.4.1, 3.4.3 and 3.4.41
)
Evaluation Procedure
1. To answer the question on effectiveness, a case study was conducted and three
countries were studied (Peru, Honduras and Dominican Republic). The countries
selected exhibit different stages of advance and degree of progress with respect to
Initiative implementation. The steps of the evaluation process were:
2. Review secondary information on Initiative’s results:
ß Annual reports
ß Specific reports of each partner
ß Documents, working papers, and others of LAC Regional Health Reform
Initiative
Identification of tools, methodologies and experiences under Intermediate Result (IR)
3.4.1, 3.4.3. and 3.4.4 and their expected results up to this moment (know, test, used,
applying learning experiences or institutionalized).
1. Selection of institutions and key stakeholders or key actors to be interviewed in each
country (definition of the denominators for each instrument, tool, methodology or
experience).
2. Preparation of a draft of the conceptual framework to design the interview formats
(what do we want to measure or estimate?), identifying the variables and factors that
affect the progress and achievement of the Initiative’s intermediate results and
indicators. The factors that can influence the institutionalization and sustainability of
the Initiative’s tools, methodologies and experiences were also identified and
incorporated in the interview formats.
3. Preparation of the format for interviews at country level by country, institutions and
key stakeholders, IR, indicator, instrument, methodology and experience.
4. Performing of the interviews in 3 study-cases: Peru, Honduras and DR.
5. Final definition of the conceptual framework for data analysis.
6. Preparation of tables and definition of variables and categories for data analysis.
7. Preparation of the database in “excel”.
8. Analysis of the data, results and conclusions.
Instruments, tools, methodologies, experiences and exchanges by country
The objective is to identify the tools, methodologies and experiences designed, tested,
developed and disseminated by the Initiative that are part of this midterm evaluation. The
tools and experiences were classified in:
1. Instruments, tools, methodologies and experiences under IR 3.4.1 with up to date
results
2. Methodologies under IR 3.4.3 with up to date results
 
1 To simplify the presentation in the main report, we use Intermediate Results 1, 2, 3 and 4 instead of IR
3.4.1, 3.4.2, 3.4.3 and 3.4.4 and Indicators 1, 2a, 2b, 3a, 3b and 4 instead of 3.4.1, 3.4.2.a, 3.4.2.b, 3.4.a,
3.4.b and 3.4.4.
APPENDICES
3
3. Experiences associated with forum and study tour under IR 3.4.4 with up to date
results
4. Expected results for each activity of the Initiative (know, test, used, applying learning
experiences or institutionalized)
Institutions and key stakeholders identification: the denominators selection
The objective of this step was to identify and to select the institutions and key
stakeholders to be interviewed in each country in order to choose the proper denominator
to the evaluation process. To choose the institutions and key stakeholders the following
process was followed:
1. Identification of each one of the Initiative’s activity developed in each country
regarding IR 3.4.1, 3.4.3 and 3.4.4
2. Identification of all the participants in Initiative’s activities or programs based on:
ß The list that each partner gave to the evaluator team and MEDS (PAHO List,
PHR list, FPMD list).
ß The reports of each event that each partner produces.
ß The discussion and analysis of the selection of the key actors with each partner
(USAID, PAHO, PHR and FPMD).
3. Preparation by MEDS and partners at country level of the first list of institutions and
key stakeholders to be interviewed in each country and the draft schedules for
meetings and interviews. In the case of Peru by PAHO and in Honduras and DR by
PAHO and PHR.
4. When the evaluators arrived in each country they worked with partners, analyzing the
draft list and matched key stakeholders in health reform in the country with
participants on Initiative’s events. The criteria were to choose key actors participating
in health reform that at the same time have participated or have knowledge of
Initiative’s activities. The exception was the case of the FPMD activities, since the
key stakeholders are NGOs and no public official institutions, it was necessary to
interview the people identified by the partner, whom in the majority of cases were not
considered as key actors in health reform.
5. For the final selection of the interviewees, the evaluators had a session with the
PAHO/PHR representative in each country in order to assure reliable denominators
for each Initiative activity.
6. Final preparation of the list:
ß Tables A, B, C and D: Index for interviewees by country and tool
ß Tables E, F and G: List of interviewees by country: Peru, Honduras and
Dominican Republic
ß Table H: Interviewees by Institutions and posts
7. Definition of the denominators for each instrument, methodology, activity, tools and
forum and study tour in each country (Table I: Denominators definition). There is a
difference in the participation of NGOs in health reform process between the
Dominican Republic on one hand and Peru and Honduras on the other. In the first
case, since the NGOs interviewed participate actively in the process different from
the other two, it is the only case where it is included in the denominator of the ratios
to analyze the results. In the other two cases, the two NGOs are only taken into
APPENDICES
4
account with regard to the specific Initiative’s activities in which they participated
(i.e. MOST, CORE or NGOs in Health Reform).
Instruments for collecting the data at in country level
1. Preparation of format for interviews at country level by country, institutions and key
stakeholders, IR, indicator, instrument, methodology and experience Interviews
format testing in Peru.
2. Redesign of interview formats in Honduras and Dominican Republic based on:
ß The Peru’s experience (a new format was prepared using not only open
questions but also close questions)
ß The final match between key stakeholders on health reform and participants
on Initiative’s activities. Based on this information the evaluator team was
able to identify the specific activities that were applicable to each country (For
example: The tool for Investment Plans is only applicable to Honduras).
3. Please, see: Interview formats for Peru, Honduras and Dominican Republic
APPENDICES
5
Table A
Affiliations of the key stakeholders interviewed by country
Country INSTITUTION* Number
of cases
Peru MOH (MINSA) 8**
REFORM UNITS AT MINSA 2
UNIVERSITY CAYETANO HEREDIA (FACULTAD DE SALUD PUBLICA) 1*
NGOs 2
PAHO 1
AID 2
MSH 1
PROYECTO 2000 1
TOTAL 18
Honduras MOH (MINSA) 8
MINISTRY OF FINANCE 1
SOCIAL SECURITY (IHSS) 1
PAHO 3
AID 1
PHR 1
NGOs 2
TOTAL 17
Dominican Republic*** MOH (SESPAS) 6*
REFORM UNITS AT SESPAS 4
CENTRAL BANK 1*
SOCIAL SECURITY (IDSS) 1
STATE REFORM 1
CONGRESS 1*
TECHNICAL ADVISOR OF PRESIDENT’S SECRETARY 1
MEDICAL ASSOCIATION 1*
PAHO 1
AID 1*
PHR 1
NGOs 1
TOTAL 20
*See tables B to I for interviewees by country and tool, for specific Institutional and post identification and for
denominator definition to each activity
**More than one person answered the same interview. For database’s purpose, only one case is counted.
**There are two extra cases (2 Hospital Director) for the analysis of Study Tours in DR.
Table B
Index of Interviewees by Tools, Instruments or Study Tours Peru (Final Edition: MARCH 29, 2000)
Tool
Interviewee
Institu.tion
Response:I
:
Interview
Q:
Question
1.Nat.
Hlth. Invst
2.NHA
3.Monit
Hlth. Ref
4.NGOs in
Health
Reform
PHR
5.C’trac
NGO Ser.
PHR
6.Decentr
Dec. Spce
DDM
7.G/L
Policy
Process
DDM
8.Prov
Pay. Mech
9.St. Tour
Panama
10.St. Tour
Colombia
11.St.
Tour
Canada
12.Perf.
Inc.
System
13. CORE
14. MOST
15. Decent.
NGOs
16. QQA
NGOs
17.
Andean
Region
Forum
C.Adamczyk AID NO
D.Aspilcueta NGO I Q Ecuador
Juan Arroyo Univ. Q
N.Baiocchi MoH Nutricn I Q X
J. Chaing AID I Q
L. Coca Silva MoH I Q (by fax) M/E/D
M.-A.Diouf OPS NO
T.Espejo MSH I Q
B.Feringa AID Q
D.Fernandez MoH I Q X
A.Fernandini MoH I Q
D. Gonzalez MoH I Q = Torres
M. Habich Proy.2000 I Q X X
D.Haustien NGO I Q X
Doris Lituma MoH I Q X
O. Lazo Univ. I Q= Llanos
A.Llanos Univ. I Q
L.Manrique MoH I Q X X
R.Martin AID I Q
A.Meloni RU-MoH I X
M. Merino MoH I Q (by fax) El Sal
V.Montañez RU MHO I Q X
M.Petrera OPS I Q DR/ES X X
R.Torres MoH I Q M/E/D
E. Velasquez OPS Q X
L.Seminario AID I Q X
Table C
Index of Interviewees by Tools, Instruments or Study Tours Honduras
(Final Edition: March 29, 2000)
Tool
Interviewee
Institution
Response:
I:
Interview
Q:
Questionna
rie
1.Nat. Hlth.
Invst
2.NHA
3.Monit
Hlth. Ref
4.NGOs in
Health
Reform
PHR
Bol.
5.C’trac
NGO Ser.
PHR
DR
6.Decentr
Dec. Spce
DDM
7.G/L
Policy
Process
DDM
8.Prov
Pay. Mech
9.St. Tour
Panama
10.St. Tour
Colombia
11.St.
Tour
Canada
12.Perf.
Inc.
Systems
13.CORE
14.MOST
15.Decent.
NGOs
16.QA
NGOs
17. Andean
Region
Forum
John Rogosch AID No answer
Meri Sinnitt AID I Q
F. Vallejo PHR I Q El Sal X X
P.Castellanos MoH I
J. M.Matheu MoH I Q DR
M.Gamero MoH I Q X X X
G.Flores MoH I Q X
C.Samayoa OPS I Q X X
H.Jaime A. OPS I Q X
E.Ramirez P. OPS I Q X X
Glenda Ruiz MoH I Q El Sal X X
H.A. Castillo. MoF I Q El Sal
R.O.Alcántara MoH I Q X
F.Cerrato MoH I Q X X
V.Meléndez MoH I Q
Elena Bosch NGO I Q X
G.Cerrato NGO I Q X X
S. A. Carías MoH I Q X El Sal X X
H. L Madrid IHSS I Q
Table D
Index of Interviewees by Tools, Instruments, or Study Tours: Dominican Republic
(Final Edition: March 29, 2000)
Tool
Interviewee
Institution
Response:
I: Interview
Q:
Questionna
rie
1. Nat.
Hlth. Invst
2. NHA
3. Monit
Hlth. Ref
4.NGOs in
Health
Reform
BOLIVIA
5.C’trac
NGO Ser.
DOMINIC
A REP
6.Decentr
Dec. Spce
7.G/L
Policy
Process
8.Prov
Pay. Mech
9.St. Tour
Panama
10.St. Tour
Colombia
11.St. Tour
Canada
12.Perf.
Inc.
Systems
13. CORE
14. MOST
15.Decent.
NGOs
16.QA
NGOs
17. Andean
Region
Forum
S. Gross OPS NO
R. Centeno OPS I Q
G. d/laRosa NGO I Q DR X X X EDG X X
S. Majerowicz AID I Q
P. Schenkel AID I with Sara M
 A.Diaz S. CONG. I Q DR
I. Rondon CONG. NO I
O. Rojas STATER
EFORM
I Q
P. Guerrero Central
Bank
I Q DR/
EL
M. Carrasco Central
Bank
I = with
Guerrero Q
R. Peguero SESPAS I Q DR
S. Felix SESPAS I: with
Peguero X
Juan Esteban
Peguero
SESPAS I: only study
tour Panama
(by fax)
X
R.Schiffino SESPAS I Q
A. Fiallo SESPAS
CERS
I Q
F.Severino AMD I Q with 3
AMD X
P. Murgueytio PHR I Q X
 J.Ceballos SESPAS I
T.Quezada ASESOR I Q
H. Natera SESPAS I Q x
F. Fernandez AMD I with
Severino
Q
M.Rathe REFUNI I Q DR/
EL
F. Rojas /F REFUNI I (fax)
C. Gil SESPAS I Q X
 H.Bido / F SESPAS I: only study
tour Panama
(fax)
Q
X
D. Espinal /F SESPAS NO answer X
S. .Sarita SESPAS I Q DR
C. del Villar REFUN I Q X
Guzman A ASESOR NO (It was
not possible
to find her)
DR
R Aquino/ MoF I Q
X
W. Ron AMD With AMD
R. Velez/ NA SEC.
TEC.
PRESID
NO out of DR
X
J.Ferreras AMD I = with
Severino Q
B. Sarubbi SESPAS I (by fax)
X
Table E
Interviewees by Institution—Peru
(Final edition: March, 29 2000)
Institution Player Ministry of health Ministry of finance Social Security NGO Partners Academic USAID
Christine Adamczyk X
Daniel Aspilcueta INPARRES
Juan Arroyo UPCH
Nelly Baiocchi
Jaime Chaing X
Luis Coca Silva X
Marie-Andre Diouf PAHO
Teobaldo Espejo MSH
Barbara Feringa X
Danilo Fernández X
Alejandro Fernandini X
Diego Gonzalez X
Midori de Habicht Proyecto 2000
Delia Haustein PRISMA
Doris Lituma X
Oswaldo Lazo UPCH
Alejandro Llanos UPCH
Luis A. Manrique Morales Retired
Richard Martin X
Augusto Meloni X
Miguel Merino X
Vilma Montañez X
Margarita Petrera PAHO
Lucho Seminario X
Raul Torres X
Luis Eliseo Velásquez PAHO
Table F
Interviewees by Institution—Honduras
Final edition: March 29, 2000
Institution Player Ministry of Health Ministry of Finance Social Security NGO Partners Academic USAID
John Rogosch X
Meri Sinnitt X
Francisco Vallejo PHR
Plutarco Castellanos X
Jose Manuel Matheus X
Manuel Gamero X
Gustavo Flores X
Carlos Samayoa PAHO
Humberto Jaime A. PAHO
Emilio Ramirez Pinto PAHO
Glenda Ruiz X (World Bank contract)
Hugo Alejandro Castillo A. X
Ricardo Ochoa Alcántara X
Franklin Cerrato X
Victor Meléndez X
Elena Bosch ASHONPLAFA
German Cerrato ASHONPLAFA
Sergio Alberto Carías X
Hena Ligia Madrid X
Table G
Interviewees by Institution—Dominican Republic
(Final edition: March 29, 2000)
Institution Player Ministry of Health Reform Commissions Social Security Central Bank NGO Partners Medical Association Other
Government USAID
Socorro Gross PAHO
Guillermo de la Rosa INSALUD
Sarah George X
Paul Schenkel X
Arismendi Díaz S. X
Onofre Rojas CRMS (State reform) CRMS
Olga Diaz X
Reynaldo Peguero x
Rafael Schiffino x
Alberto Fiallo CERSS (Health R U)
Fulgencio Severino CERSS (Health R U) and
Patricio Murgueytio PHR
Juan Octavio Ceballos X
Tirsis Quezada President’s Secretary
Advisor
Hilda Natera x
Fernando Fernandez Com/Ref/ and AMD
Magdalena Rathe Com/Ref. (retired)
Fernando Rojas (Fax)
Cándida Gil X (Munc)
Héctor Bidó García (Fax) X (Prov.)
Daniel Espinal (Fax) X (Prov.)
Sergio Sarita x
Claudio del Villar CERSS (Health R U)
Altagracia Guzmán Marcelin Of. De la Presidencia de la
República.
APPENDICES
13
Table H
List of Interviewees by Institutional Post
PERU
MHO–OFICINA GENERAL DE PLANIFICACION
MHO–ASESOR MINISTRO - VICEMINISTRO
MH0–EX SUPERINTENDENTE
MH0–COORDINADOR REFORMA y COORDINADOR REFORMA FONDOS CONTRIBUTIVOS
MHO–ACUERDOS DE GESTION
MH0–DIRECCION DE ALIMENTACION Y NUTRICION
MHO–TECNICO OFICINA GENERAL PLANIFICACION
MHO–TECNICO OFICINA GENERAL DE PLANIFICACION
REFORM UNIT–OFFICE MINSAL
REFORM UNIT–PAR SALUD
UNIVERSITY
NGO–INNPARES
NG0–PRISMA
SPECIAL PROJECT 1: PROYECTO 2000
USAID–OFFICIAL
USAID–OFFICIAL
PAHO–CONSULTANT
MSH–CONSULTANT
18 PEOPLE INTERVIEWED
REPUBLICA DOMINICANA
MHO–MINISTRY OF HEALTH
MHO–DIRECTOR GENERAL DE SALUD.
MHO–DIRECTOR DE PLANIFICACIÓN
MHO–DIRECTOR DESCENTRALIZACIÓN.
MHO–DIRECTORA MUNICIPAL SANTO DOMINGO CENTRO
MHO–COORDINADORA DE HOSPITALES (SERPASS)
REFORM UNIT–CONSULTANT
REFORM UNIT–CONSULTANT
REFORM UNIT–EX CONSULTANT (VISION HISTORICA REFORMA)
REFORM UNIT–EX CONSULTANT NHA (VISION HISTÓRICA CUENTAS NACIONALES)
IDSS: REPRESENTANTE DEL IDSS QUE PARTICIPÓ EN EVENTO DE LA INICIATIVA (MEC. PAGO)
STATE REFORM: SECRETARIO EJECUTIVO DE LA COMISION NACIONAL DE REFORMA Y MODERNIZACIÓN
CENTRAL BANK
CONGRESS: SENADO DE LA REPUBLICA: COMISION PERMANENTE PARA LA REFORMA DE LA SEGURIDAD SOCIAL.
ASESORA TÉCNICA SECRETARÍA DE LA PRESIDENCIA
NGOs–INSALUD.
AMD–ASOCIACIÓN MÉDICA DOMINICANA
OPS–CONSULTANT
PHR–CONSULTANT
USAID–OFFICIAL
HOSP.DIRECTOR–STUDY TOUR PANAMA
HOSP.DIRECTOR–STUDY TOUR COLOMBIA
20 PEOPLE INTERVIEWED
HONDURAS
MHO–MINISTRO DE SALUD
MHO–VICEMINISTRO POLÍTICA SECTORIAL.
MHO–DIRECTOR GENERAL SALUD REDES DE SERVICIOS
MHO–JEFE DE UNIDAD REGIONAL.
MHO–DIRECCIÓN DE HOSPITALES.
MHO–UNIDAD DE PLANEAMIENTO Y EVALUACIÓN DE GESTIÓN.
MHO–DIRECTOR SERVICIO HOSPITAL PÚBLICO.
MHO–CONSULTORA DEL BANCO MUNDIAL EN EL MINSA
MF–VICEMINISTRO DE FINANZAS.
IHSS–DIRECTORA EJECUTIVA DEL SEGURO SOCIAL.
OPS–PWR HONDURAS.
OPS–CONSULTOR SERVICIOS DE SALUD.
OPS–CONSULTOR NACIONAL SERVICIOS DE SALUD.
USAID–CHIEF HEALTH, POPULATION AND NUTRITION.
PHR–CONSULTOR PHR
GNO–ASHONPLAFA. JEFE DIVISION DE ADMINISTRACIÓN Y FINANZAS.
NGO–ASHONPLAFA. JEFE DE OPERACIONES Y COSTOS.
17 PEOPLE INTERVIEWED
APPENDICES
14
Table I
Denominators (key informants) by tool, methodology, forum and study tour
Tool, Methodology, Forum and Study Tour Denominator by country (number of cases): key informants
Tools and methodologies Honduras DR Peru
Tool for Plan Investment
1. Findings: Outcomes or results (knowledge, use) Total - 2 NGOs
(n= 15) NA NA
2. Factors affecting the findings Interviewees
knowing the tool
(n=8)
NA NA
Assumption: All public institutions (MOH, MOF and IHSS) and all partners must know/use this tool. The NGOs interviewed don’t have to know/use
about this tool.
National Health Accounts Honduras DR Peru
1. Findings: Outcomes or results (knowledge, use) Total – 2 NGOs
(n= 15) Total (n=20) Total – 2 NGOs
(n=16)
2. Factors affecting the findings Interviewees
knowing the tool
(n=14)
Interviewees
knowing the tool
(n=16)
Interviewees knowing
the tool (n=12)
Assumption: All public institutions (MOH, Reform Units, MoF or equivalent, Social Security, University) and all partners must know/use this tool. NGOs
interviewed in Peru and Honduras don’t have to know/use about this tool.
Methodology for Monitoring HSR Honduras DR Peru
1. Findings: Outcomes or results (knowledge, use) Total – 2 NGOs
(n=15) Total (n=20) Total – 2 NGOs
(n=16)
2. Factors affecting the findings Interviewees
knowing the tool
(n=8)
Interviewees
knowing the tool
(n=18)
Interviewees knowing
the tool (n=7)
Assumption: All public institutions (MOH, Reform Units, MoF or equivalent, Social Security and University) and all partners must know this framework.
Peru and Honduras NGOs don’t have to know about this framework
Tools and methodologies (knowledge and use) Honduras DR Peru
Performance Incentive Systems Total cases: 2 NA NA
Cost Revenue Analysis (CORE) Total cases: 2 NA NA
Mgt. And Org. Sustainability Tool (MOST) NA Total cases:1 Total cases:1
Assumption: Based on the Initiative’s institutional strategy for the dissemination and training of these tools, only NGOs must know/use them.
Experiences Honduras DR Peru
Guidelines for Policy Process
1. Findings: Outcomes or results (knowledge of technical assistance) Total - 2 NGOs
(n= 15) NA NA
2. Factors affecting the findings Interviewees
knowing the tool
(n=5)
NA NA
Assumption: All public institutions (MOH, MOF and IHSS) and all partners must know about this experience (technical assistance). Based on the practice
used to choose the key stakeholders to participate in this activity, the NGOs interviewed don’t have to know about it.
Decentralization Using Decision Space Honduras DR Peru
1. Findings: Outcomes or results (knowledge of research) Total - 2 NGOs
(n=13) NA NA
2. Factors affecting the findings Interviewees
knowing the tool
(n=6)
NA NA
Assumption: MOH’s official (8) and all partners (5) must know this research. Based on the practice used to choose the key stakeholders to participate in
this activity, the MoF, IHSS and NGOs interviewed don’t have to know about it.
Contracting NGO services (DR) Honduras DR Peru
1. Findings: Outcomes or results (knowledge and sharing) NA Total: (n=16) Total: (n=16)
2. Factors affecting the findings
NA
Interviewees
participating in
workshop (n=3)
Interviewees
participating in
workshop (n=1)
Assumption: DR: MOH’s official (6), Reform Unit at SESPAS (3/4), State Reform, Congress and President’s Advisor and all partners (3) and NGO (1)
must know about this experience.
Peru: MOH (8), Reform Unit at MINSA (2), NGO (1) and Partners and consultants (5) must know about this experience
APPENDICES
15
NGO in the Health Reform (Policy Process) (Bolivia) Honduras DR Peru
1. Findings: Outcomes or results (knowledge and sharing) NA Total: (n=16) Total: (n=16)
2. Factors affecting the findings
NA
Interviewees
participating in
workshop (n=1)
Interviewees
participating in
workshop (n=2)
Assumption: DR: MOH’s official (6), Reform Unit at SESPAS (3/4), State Reform, Congress and President’s Advisor and all partners (3) and NGO (1)
must know about this experience.
Peru: MOH (8), Reform Unit at MINSA (2), NGO (1) and Partners and consultants (5) must know about this experience
Forum on Provider Payment Mechanisms Honduras DR Peru
1. Findings: Outcomes or results (knowledge, sharing and taking steps) NA Total: (n=15) Total: (n=16)
2. Factors affecting the findings
NA
Interviewees
participating in
forum (n=3)
Interviewees
participating in forum
(n=6)
Assumption: DR: Based on the advance on this activity in DR, the denominator is composed by: MOH (6), Reform Unit (4), Congress (1), the partners
(3) and NGO (1)
Peru: Based on the advance of this activity in Peru, the denominator is the total – NGOs.
Study Tour – Panama Honduras DR Peru
1. Findings: Outcomes or results (knowledge, sharing and taking steps) Total: (n=13) Total: (n=12) NA
2. Factors affecting the findings Interviewees
participating in study
tours (n=3)
Interviewees
participating in study
tours (n=4)
NA
Assumption: Honduras: Denominator is composed by MOH (8) and partners (5)
DR: Denominator is composed by MOH (6), Reform Unit (2/4), NGO (1) and partners (3)
Study Tour Colombia Honduras DR Peru
1. Findings: Outcomes or results (knowledge, sharing and taking steps) Total: (n=13) Total: (n=12) Total: (n= 14)
2. Factors affecting the findings Interviewees
participating in study
tours (n=2)
Interviewees
participating in study
tours (n=2)
Interviewees
participating in study
tours (n=1)
Assumption: Honduras: Denominator is composed by MOH (8) and partners (5)
DR: Denominator is composed by MOH (6), Reform Unit (2/4), NGO (1) and partners (3)
Peru: MOH (8), Reform Unit (2) and Partners – MSH (4)
Study Tour- Canada Honduras DR Peru
1. Findings: Outcomes or results (knowledge, sharing and taking steps) NA Total: (n=12) NA
2. Factors affecting the findings
NA
Interviewees
participating in study
tours (n=1)
NA
Assumption: DR: Denominator is composed by MOH (6), Reform Unit (2/4), NGO (1) and partners (3)
NGO’s in Decentralization and NGO’S Quality Assurance (knowledge,
sharing and taking steps)
Honduras
NA
DR
1 case
Peru
NA
Assumption: Based on the Initiative’s institutional strategy for the dissemination and training of these tools, only NGO must know/use them.
APPENDICES
16
APPENDIX D
INTERVIEW FORMATS MODEL
APPENDICES
18
INTERVIEW FORMAT 1/3
CUESTIONARIO / ENTREVISTA PARA INSTITUCIONES – ACTORES CLAVE
EN LOS PAISES
PREGUNTAS RELATIVAS A EFECTIVIDAD Y SUSTENTABILIDAD
Intermediate Result 3.4.1: Methodologies and tools developed, tested and disseminated
for analysis and design, implementation and monitoring of country health sector reforms.
Indicator 3.4.1: All methodologies and tools used by key actors in 50% of countries
where introduced.
Intermediate Result 3.4.3: Reform processes, specifically related to equitable access,
and outcomes monitored and feedback provided to countries, donors and other partners.
Indicator 3.4.3 a. All LAC Initiative countries monitor health sector reform using
framework established by PAHO.
Indicator 3.4.3.b: Regional monitoring system for comparative analysis for health sector
reform institutionalized by PAHO.
Nombre del entrevistado:__________________________________________________
Institución:______________________________
Cargo:______________________________________
Fecha:______________________________________
Nombre del entrevistador:_________________________________________________
1. ¿Qué institución u organización a nivel internacional le parece que hace más en favor
de la reforma del sector salud en la región?
________________________________________________________________________
________________________________________________________________________
2. ¿Qué institución a nivel internacional le parece que hace más en favor de la reforma
del sector salud en su país?
________________________________________________________________________
________________________________________________________________________
3. ¿Qué institución a nivel internacional le parece que hace más en favor de la reforma
del sector salud en su institución?
________________________________________________________________________
________________________________________________________________________
4. ¿Cuáles son las debilidades que tiene la institución encargada de la reforma para el
diseño, análisis, implementación y monitoreo de la reforma del sector salud?
________________________________________________________________________
________________________________________________________________________
APPENDICES
19
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. ¿Qué herramienta o metodología (s) se utilizan para apoyar el diseño, análisis,
implementación y monitoreo y para el establecimiento de políticas y estrategias
relacionadas a la reforma o modernización del sector salud?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I) Herramientas para la reforma en general (broad refoms)
A) Herramienta: Marco para la implementación de planes maestros y planes de
inversión (Sólo válido para Honduras)
1. ¿Qué herramientas utiliza usted o su institución para la formulación de planes
específicos de inversión orientados a poner en marcha y hacer avanzar la reforma del
sector salud? (para medir conducta)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Instrucción: si el entrevistado reconoce la herramienta, salte la próxima pregunta, en caso contrario
continúe en el orden establecido)
2. Usted conoce la herramienta “Marco para la implementación de planes maestros y
planes de inversión” desarrollada por la Iniciativa Reforma del Sector Salud (USAID,
OPS, PHR, FPMD y DDM)? (para medir conocimiento)
Si______________________________________________________________________
No_____________________________________________________________________
3. ¿Cómo supo usted de la existencia de la herramienta?
________________________________________________________________________
________________________________________________________________________
4. ¿Cómo se capacitó en su uso?
Taller o seminarios
No hubo capacitación de la herramienta
No hubo capacitación personal
NA
APPENDICES
20
5. ¿Esta herramienta responde a las necesidades y problemas del sector salud de su país?
(percepción)
Si
No
No sabe
NA
6. ¿Qué opinión le merece la herramienta como instrumento para formular planes
específicos de inversión para poner en marcha y hacer que avance la reforma del
sector salud? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
7. ¿Cuáles son los impedimentos que existen en su país para el uso institucional de esta
herramienta? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
8. ¿Cuáles han sido los factores o variables que han facilitado la aplicación de esta
herramienta? (fortalezas y oportunidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
9. ¿Qué se requeriría para que esta herramienta fuera utilizada a nivel institucional y
para que permanezca en el tiempo a pesar de los cambios que se puedan dar en su
institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I. B) Herramienta: Cuentas Nacionales de Salud (National Health Accounts)
(República Dominicana, Honduras, Bolivia, Ecuador, El Salvador,
Guatemala, México, Nicaragua, Perú, Panamá y Jamaica)
1. ¿Qué herramienta (s) utiliza usted o su institución para llevar las cuentas nacionales
de salud en su país (organizar información de financiamiento y gasto público y
privado)? (para medir conducta)
APPENDICES
21
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Instrucción: si el entrevistado reconoce la herramienta, salte la próxima pregunta, en caso contrario
continúe en el orden establecido)
2. Usted conoce la herramienta “Cuentas Nacionales de Salud” desarrollada por la
Iniciativa Reforma del Sector Salud (USAID, OPS, PHR, FPMD y DDM)? (para
medir conocimiento)
SI______________________________________________________________________
No_____________________________________________________________________
3. ¿Cómo supo usted de la existencia de la herramienta?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. ¿Cómo se capacitó en su uso?
Taller o seminarios
No hubo capacitación de la herramienta
No hubo capacitación personal
NA
5. ¿Esta herramienta responde a las necesidades y problemas del sector salud de su país?
(percepción)
Si
No
No sabe
NA
6. ¿Qué opinión le merece la herramienta como instrumento llevar las cuentas
nacionales en salud? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
7. ¿Cuáles son los impedimentos que existen en su país para el uso institucional de esta
herramienta? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
APPENDICES
22
8. ¿Cuáles han sido los factores o variables que han facilitado la aplicación de esta
herramienta? (fortalezas y oportunidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
9. ¿Qué se requeriría para que esta herramienta fuera utilizada a nivel institucional y
para que permanezca en el tiempo a pesar de los cambios que se puedan dar en su
institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
C) Metodología: Seguimiento y evaluación de las Reformas del Sector Salud en
América Latina y El Caribe (Monitoring Health Sector Reforms)
1. ¿Qué metodología (s) utiliza usted o su institución para hacerle el seguimiento y
evaluación del proceso de reforma del sector salud en su país? (para medir conducta)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Instrucción: si el entrevistado reconoce la metodología, salte la próxima pregunta, en caso contrario
continúe en el orden establecido)
2. Usted conoce la metodología “Monitoreo de la Reforma del Sector Salud”,
metodología marco establecida por la OPS, desarrollada por la Iniciativa Reforma del
Sector Salud (USAID, OPS, PHR, FPMD y DDM)? (para medir conocimiento)
Si______________________________________________________________________
No_____________________________________________________________________
3. ¿Cómo supo usted de la existencia de esta metodología ?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. ¿Cómo se capacitó en su uso?
Taller o seminarios
No hubo capacitación de la metodología
No hubo capacitación personal
NA
APPENDICES
23
5. ¿Qué actividad regional le ha sido más útil a usted para recoger experiencias y
conocimientos en la aplicación y uso de esta metodología?
Evento de Venezuela (ptación metodología)
Evento de Bolivia (reforma del salud)
Otro evento:
No sabe
Ninguna
NA
6. ¿Esta metodología responde a las necesidades y problemas del sector salud de su
país? (percepción)
Si
No
No sabe
NA
7. ¿Qué opinión le merece la metodología como instrumento para hacer el seguimiento
de la reforma? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
8. ¿El uso de esta metodología, así como de los perfiles de los otros países de la región
que se prepararon con base a la misma, le han permitido hacer análisis comparativos
de su país con la situación de los sistemas de salud y los procesos de reforma en otros
países? ¿Cómo?
Me ha permitido hacer comparaciones
No me lo ha permitido - no hecho
comparaciones
No sabe
9. ¿Cuáles son los impedimentos que existen en su país para el uso institucional de esta
metodología? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
10. ¿Cuáles han sido los factores o variables que han facilitado la aplicación de esta
metodología? (fortalezas y oportunidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
APPENDICES
24
11. ¿Qué se requeriría para que esta metodología fuera utilizada a nivel institucional y
para que permanezca en el tiempo a pesar de los cambios que se puedan dar en su
institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
II) Herramientas de Política (POLICY)
A) Herramienta: Asistencia técnica para el proceso político asociado a la reforma -
Guidelines for assessing the policy process—Health Policy Process Applied
Research (DDM) (Aplicada sólo en Honduras)
1. ¿Qué apoyo (s) o asistencia técnica ha recibido su institución para manejar (gerenciar)
el proceso político que implica la formulación y la puesta en marcha (llevar adelante)
de la reforma del sector salud en su país? (para medir conducta)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Instrucción: si el entrevistado reconoce la herramienta, salte la próxima pregunta, en caso contrario
continúe en el orden establecido)
2. Usted recibió asistencia técnica del proyecto Data por Decision Making (Harvard)
usando la “Guía para el manejo del proceso político de la reforma” desarrollada por la
Iniciativa Reforma del Sector Salud (USAID, OPS, PHR, FPMD y DDM)? (para
medir conocimiento)
SI______________________________________________________________________
NO_____________________________________________________________________
3. ¿Esta asistencia técnica responde a las necesidades y problemas del sector salud de su
país? (percepción)
Si
No
No sabe
NA
4. ¿Qué opinión le merece la asistencia técnica hacer el análisis político de la reforma?
(para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
APPENDICES
25
5. ¿Cuáles son los impedimentos que existen en su país para el uso institucional de lo
aprendido en esta experiencia? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. ¿Cuáles han sido los factores o variables que han facilitado su aplicación
institucional? (fortalezas y oportunidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
7. ¿Qué se requeriría para que las herramientas aprendidas en esta experiencia fueran
utilizadas a nivel institucional y para que permanezca en el tiempo a pesar de los cambios
que se puedan dar en su institución? (sostenibilidad)
_______________________________________________________________________
________________________________________________________________________
III) Herramientas para sociedad entre gobierno y ONG (Govt. – NGO Partnership)
A) Contracting NGO service provision (PHR) (Guatemala, Costa Rica,
Colombia, Perú, República Dominicana) y NGO in the policy process
(Bolivia, Ecuador, Perú, República Dominicana)
1. ¿Qué experiencias tiene usted o está adelantando para incoporar las ONG en el
proceso de reforma en salud y para el diseño de nuevas formas de interrelación y
contratación entre el sector público y privado?
________________________________________________________________________
________________________________________________________________________
2. ¿Usted participó en los encuentros para preparar los trabajos: “Public Sector
Contracting of NGO´s for the provision of Health Services: State of the Practice
paper” o NGO involvement in Health Policy que adelantó PHR en el marco de la
Iniciativa para la Reforma del Sector SALUD – USAID-PAHO ?
SI______________________________________________________________________
NO_____________________________________________________________________
3. ¿Este encuentro responde a las necesidades y problemas del sector salud de su país?
(percepción)
Si
No
No sabe
NA
4. ¿Qué opinión le merece este taller para avanzar en la incorporación de las ONG en la
reforma en salud? (para medir percepción)
APPENDICES
26
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
5. ¿Cuáles son los impedimentos que existen en su país para aplicar las experiencias
aprendidas en este taller? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. ¿Cuáles serían los factores o variables que facilitarían su aplicación? (fortalezas y
oportunidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
7. ¿Qué se requeriría para que las experiencias aprendidas en el taller se utilicen a nivel
institucional y para que permanezca en el tiempo a pesar de los cambios que se
puedan dar en su institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
IV) Herramientas para temas especiales
A) Decentralization – guidelines for assessment using decision space (DDM)
1. En su país se está impulsando el proceso de descentralización de la salud entre los
distintos niveles del sistema sanitario?
SI______________________________________________________________________
NO_____________________________________________________________________
2. ¿Qué experiencias o estudios están utilizando usted para impulsar ese proceso en
su país?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3. ¿Usted conoce el papel de trabajo relativo a la descentralización preparado por
DDM en el marco de la Iniciativa, que se preparó con la data de Chile, Colombia
y Bolivia o leyó el artículo que apareció en el Boletín (newsletter) denominado
Reform in Motion, o Reforma en movimiento
APPENDICES
27
SI______________________________________________________________________
NO_____________________________________________________________________
4. ¿Este estudio responde a las necesidades y problemas del sector salud de su país?
(percepción)
Si
No
No sabe
NA
5. ¿Qué opinión le merece este estudio? (para medir percepción)
Excelente
Muy bueno
Bueno
Regular
Malo
NA
No sabe
6. ¿Cuáles son los impedimentos que existen en su país para aplicar los resultados de
esta investigación? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
7. ¿Cuáles serían los factores o variables que facilitarían su aplicación? (fortalezas y
oportunidades)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
8. ¿Qué se requeriría para que los resultados de esta investigación se utilicen a nivel
institucional y para que permanezca en el tiempo a pesar de los cambios que se
puedan dar en su institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
COMENTARIOS SOBRE LA ENTREVISTA
___________________________________________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Notas relativas al IR 3.4.1.
1. No se pregunta en los países sobre las siguientes herramientas porque están en
proceso de diseño y prueba:
APPENDICES
28
ß Monitoreo de la equidad (Monitoring Equitable access to basic health
services) (PAHO)
ß “Guidelines for social insurance” (Iniciativa)
ß Toolkit (PHR).
ß Equity policy primer (Policy primer on decision making for equity in Health
sector reform (PHR)
ß Provider payment mechanisms policy primer series (PHR)
ß Targeting methodologies (PHR)
2. Las siguientes herramientas son papeles de trabajo, documentos técnicos que no
se han llevado a worshops o talleres:
ß Indicator Handbook for Health System Development (PHR)
ß Case study of the hospital reform process in Colombia (PHR)
APPENDICES
29
INTERVIEW FORMAT 2/3
CUESTIONARIO / ENTREVISTA PARA INSTITUCIONES – ACTORES
CLAVE EN LOS PAISES. PREGUNTAS RELATIVAS A EFECTIVIDAD Y
SUSTENTABILIDAD
Para uso del entrevistador:
Intermediate Result 3.4.4: Opportunities and means to share experience and advice
among countries are established.
Indicator 3.4.4: 5O% of participants surveyed report taking steps based on lessons
learned in Study tours and fora.
Nombre del entrevistado:______________________________________________
Institución:________________________Cargo:_____________________________
Fecha:__________________________________________
Nombre del entrevistador:_________________________
Preguntas
A) FOROS y TALLERES
Foro sobre mecanismo de pago a los proveedores (PAHO) (Perú y República
Dominicana)
1. ¿Usted o su institución han implementado algunos mecanismos de pago a prestadores
tomando en consideración los diferentes impactos que se generan en el sistema de
salud?
_________________________________________________________________
_________________________________________________________________
2. ¿Qué actividades o insumos ha utilizado usted para este fin y le han sido más útiles?
(identifique en orden de importancia)
· _____________________________________________________________________
· _____________________________________________________________________
· _____________________________________________________________________
3. Usted participó en el foro organizado por la OPS sobre mecanismos de pago, en el
marco de la Iniciativa para la Reforma del Sector SALUD – USAID-PAHO ?
SI______________________________________________________________________
NO_____________________________________________________________________
APPENDICES
30
4. ¿Los temas que se discutieron en el foro responden a las necesidades y problemas del
sector salud de su país? (percepción)
Si
No
No sabe
NA
5. ¿Qué opinión le merece el foro? (para medir percepción)
Excelente
Muy bueno
Bueno
Regular
Malo
NA
No sabe
6. ¿Cuáles son los impedimentos que existen en su país para diseñar nuevos mecanismos
de pago a prestadores en su sistema de salud? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
7. ¿Cuáles serían los factores o variables que facilitarían su aplicación? (fortalezas y
oportunidades)
________________________________________________________________________
________________________________________________________________________
8. ¿Qué se requeriría para que lo que aprendió en el foro se utilice a nivel institucional y
para que permanezca en el tiempo a pesar de los cambios que se puedan dar en su
institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
B) Study Tours
1. Giras OPS y PHR (Panamá y Colombia) (Perú, Panamá, Bolivia, Nicaragua,
República Dominicana y Panamá, Jamaica, Honduras, El Salvador) (Perú a
Colombia, Honduras a Panamá y Colombia)
1. ¿Usted o su institución ha promovido la reforma de los hospitales para impulsar la
descentralización y para el logro de hospitales públicos autónomos?
SI______________________________________________________________________
NO_____________________________________________________________________
2. ¿Qué actividades o insumos ha utilizado usted para este fin y le han sido más útiles?
(identifique en orden de importancia)
· _____________________________________________________________________
· _____________________________________________________________________
· _____________________________________________________________________
APPENDICES
31
3. ¿Usted participó en una gira de estudios para conocer la experiencia en Panamá del
Proyecto de San Miguelito sobre descentralización de servicios de salud y Hospital
Autónomo organizado por la Iniciativa para la Reforma del Sector SALUD – USAID￾PAHO ?
SI______________________________________________________________________
NO_____________________________________________________________________
NA
4. ¿Usted participó en una gira de estudios para conocer la experiencia en Colombia
sobre reforma de Hospitales Públicos organizado por la Iniciativa para la Reforma del
Sector Salud – USAID-PAHO?
SI______________________________________________________________________
NO_____________________________________________________________________
NA
5. ¿La temática de la gira responde a las necesidades y problemas del sector salud de su
país? (percepción)
Si
No
No sabe
NA
6. ¿Qué opinión le merece la gira de estudio? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
7. ¿Cuáles son los impedimentos que existen en su país para poner en marcha una
experiencia como la de San Miguelito o Colombia? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
8. ¿Cuáles serían los factores o variables que facilitarían su aplicación? (fortalezas y
oportunidades)
________________________________________________________________________
________________________________________________________________________
9. ¿Qué se requeriría para que lo que aprendió en la gira se utilice a nivel institucional y
para que permanezca en el tiempo a pesar de los cambios que se puedan dar en su
institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
APPENDICES
32
2. Gira Canadá (PHR) (Sistema de salud de Canadá) (Sólo República Dominicana)
1. ¿Qué experiencias se están utilizando en su país para poner en marcha e impulsar la
reforma integral del sistema de salud?
________________________________________________________________________
________________________________________________________________________
2. ¿Qué actividades o insumos ha utilizado usted para este fin y le han sido más útiles?
(identifique en orden de importancia)
· _____________________________________________________________________
· _____________________________________________________________________
· _____________________________________________________________________
3. Usted participó en una gira de estudios para conocer la experiencia de reforma de
Canadá organizado por la Iniciativa para la Reforma del Sector SALUD – USAID￾PAHO ?
SI______________________________________________________________________
NO_____________________________________________________________________
NA
4. ¿La temática de la gira responde a las necesidades y problemas del sector salud de su
país? (percepción)
Si
No
No sabe
NA
5. ¿Qué opinión le merece la gira de estudio? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
6. ¿Cuáles son los impedimentos que existen en su país para poner en marcha una
experiencia como la de Canadá? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
7. ¿Cuáles serían los factores o variables que facilitarían su aplicación? (fortalezas y
oportunidades)
________________________________________________________________________
________________________________________________________________________
APPENDICES
33
8. ¿Qué se requeriría para que lo que aprendió en la gira se utilice a nivel institucional y
para que permanezca en el tiempo a pesar de los cambios que se puedan dar en su
institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
COMENTARIOS DE LA ENTREVISTA
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
APPENDICES
34
INTERVIEW FORMAT 3/3
CUESTIONARIO / ENTREVISTA PARA NGOs - ACTORES CLAVE EN LOS
PAISES
PREGUNTAS RELATIVAS A EFECTIVIDAD Y SUSTENTABILIDAD
Intermediate Result 3.4.1: Methodologies and tools developed, tested and disseminated
for analysis and design, implementation and monitoring of country health sector reforms.
Indicator 3.4.1: All methodologies and tools used by key actors in 50% of countries
where introduced.
Intermediate Result 3.4.3: Reform processes, specifically related to equitable access,
and outcomes monitored and feedback provided to countries, donors and other partners.
Indicator 3.4.3 a. All LAC Initiative countries monitor health sector reform using
framework established by PAHO.
Indicator 3.4.3.b: Regional monitoring system for comparative analysis for health sector
reform institutionalized by PAHO.
Nombre del entrevistado:___________________________________________
Institución:_____________________Cargo:____________________________
Fecha:___________________________________________________________
Nombre del entrevistador:__________________________________________
1. ¿Qué institución u organización a nivel internacional le parece que hace más en favor
de la reforma del sector salud en la región?
________________________________________________________________________
________________________________________________________________________
2. ¿Qué institución a nivel internacional le parece que hace más en favor de la reforma
del sector salud en su país?
________________________________________________________________________
________________________________________________________________________
3. ¿Qué institución a nivel internacional le parece que hace más en favor de la reforma
del sector salud en su institución?
________________________________________________________________________
________________________________________________________________________
4. ¿Cuáles son las debilidades que tiene la institución responsable de la reforma para el
diseño, análisis, implementación y monitoreo de la reforma del sector salud?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
APPENDICES
35
5. ¿Qué herramienta (s) se utilizan usted para apoyar el diseño, análisis, implementación
y monitoreo y para el establecimiento de políticas y estrategias relacionadas a la
reforma o modernización del sector salud?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. Dado que su organización o institución está interesada en una participación más
activa en el sector salud, cuáles son las herramientas clave que su institución debería
manejar para facilitar ese proceso? Establezca un orden jerarquía de estas
herramientas:
· ____________________________________________________________________
· ____________________________________________________________________
· ____________________________________________________________________
7. ¿Hay alguna organización del sector público o privado que le proporcione esas
herramientas o asistencia técnica con dichas herramientas?
8. ¿Considera usted que dichas herramientas responden a las necesidades del sector
salud en su país?
Si
No
No sabe
NA
(Instrucción para el entrevistador: Si en esta respuesta inicial, reconocen CORE y
MOST, sistema de incentivos, descentralización, control de calidad seguir con las
próximas 5)
1) Herramienta: Cost – revenue tool (CORE) Herramienta de costo – beneficio
(NGO ASHONPLAFA HONDURAS)
1. ¿Qué herramienta (s) utiliza usted o su institución para hacer los análisis de costo –
beneficio de los servicios que provee y para manejar los factores que inciden sobre
los ingresos y los costos de los mismos? (para medir conducta)
________________________________________________________________________
________________________________________________________________________
(Instrucción: si el entrevistado reconoce la herramienta, salte la próxima pregunta, en caso contrario
continúe en el orden establecido)
2. Usted conoce la herramienta “CORE” desarrollada por FPDM en el marco de la
Iniciativa Reforma del Sector Salud (USAID, OPS, PHR, FPMD y DDM)? (para
medir conocimiento)
SI______________________________________________________________________
NO_____________________________________________________________________
APPENDICES
36
3. ¿Cómo supo usted de la existencia de esta herramienta?
4. ¿Cómo se capacitó en su uso?
Taller o seminarios
No hubo capacitación de la herramienta
No hubo capacitación personal
NA
5. ¿Esta herramienta responde a las necesidades y problemas del sector salud de su país?
(percepción)
Si
No
No sabe
NA
6. ¿Qué opinión le merece la herramienta como instrumento para hacer el análisis de
costos e ingresos? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
7. ¿Cuáles son los impedimentos que existen en su país para el uso institucional de esta
herramienta? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
8. ¿Cuáles han sido los factores o variables que han facilitado la aplicación de esta
herramienta? (fortalezas y oportunidades)
________________________________________________________________________
________________________________________________________________________
9. ¿Qué se requeriría para que esta herramienta fuera utilizada a nivel institucional y
para que permanezca en el tiempo a pesar de los cambios que se puedan dar en su
institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
APPENDICES
37
2) Herramienta: The Management and Organizational Sustainability tool -
Herramienta de sostenibilidad gerencial y organizacional (MOST) (NGO Perú
INPPARE y República Dominicana INSALUD)
1. ¿Qué herramienta (s) utiliza usted o su institución para hacer el diagnóstico de los
cambios que se requieren en componentes de la organización y de la gerencia y
también para diseñar los planes necesarios para la implementación de esos cambios
hacia el logro de la sostenibilidad? (para medir conducta)
________________________________________________________________________
________________________________________________________________________
(Instrucción: si el entrevistado reconoce la herramienta, salte la próxima pregunta, en caso contrario
continúe en el orden establecido)
2. Usted conoce la herramienta “MOST” desarrollada por FPDM en el marco de la
Iniciativa Reforma del Sector Salud (USAID, OPS, PHR, FPMD y DDM)? (para
medir conocimiento)
SI______________________________________________________________________
NO_____________________________________________________________________
3. ¿Cómo supo usted de la existencia de esta herramienta?
________________________________________________________________________
________________________________________________________________________
4. ¿Cómo se capacitó en su uso?
Taller o seminarios
No hubo capacitación de la herramienta
No hubo capacitación personal
NA
5. ¿Esta herramienta responde a las necesidades y problemas del sector salud de su país?
(percepción)
Si
No
No sabe
NA
6. ¿Qué opinión le merece la herramienta como instrumento para hacer el análisis de
capacidad institucional? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
APPENDICES
38
7. ¿Cuáles son los impedimentos que existen en su país para el uso institucional de esta
herramienta? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
8. ¿Cuáles han sido los factores o variables que han facilitado la aplicación de esta
herramienta? (fortalezas y oportunidades)
________________________________________________________________________
________________________________________________________________________
9. ¿Qué se requeriría para que esta herramienta fuera utilizada a nivel institucional y
para que permanezca en el tiempo a pesar de los cambios que se puedan dar en su
institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
3) Performance Incentive System (FPDM) (sólo preguntar en Honduras)
1. ¿Qué herramientas está utilizando para diseñar un sistema de incentivos para mejorar
la eficiencia de su institución?
________________________________________________________________________
________________________________________________________________________
2. ¿Usted participó en la recolección de la data sobre sistemas de incentivos en
Honduras que se llevó adelante en el marco del proyecto del FPDM (MSH) Human
Development Resource Cluster, (Iniciativa para la Reforma del Sector SALUD –
USAID-PAHO ?
SI______________________________________________________________________
NO_____________________________________________________________________
3. ¿Cómo supo usted de la existencia de esta herramienta?
________________________________________________________________________
________________________________________________________________________
4. ¿Cómo se capacitó en su uso?
Taller o seminarios
No hubo capacitación de la herramienta
No hubo capacitación personal
NA
5. ¿Esta herramienta responde a las necesidades y problemas del sector salud de su país?
(percepción)
Si
No
No sabe
NA
APPENDICES
39
6. ¿Qué opinión le merece la herramienta como instrumento para desarrollar un sistema
de incentivos en salud? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
7. ¿Cuáles son los impedimentos que existen en su país para el uso institucional de esta
herramienta? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
8. ¿Cuáles han sido los factores o variables que facilitarían su aplicación? (fortalezas y
oportunidades)
________________________________________________________________________
________________________________________________________________________
9. ¿Qué se requeriría para que esta herramienta se utilice a nivel institucional y para que
permanezca en el tiempo a pesar de los cambios que se puedan dar en su institución?
(sostenibilidad)
________________________________________________________________________
________________________________________________________________________
4. NGOs in decentralized health system (FPDM)
1. En su país se está impulsando el proceso de descentralización de la salud con
participación de las ONGs?
________________________________________________________________________
________________________________________________________________________
2. ¿Qué experiencias está utilizando usted para impulsar ese proceso en su país?
________________________________________________________________________
________________________________________________________________________
3. ¿Usted participó en el grupo de trabajo que discutió este tema, que está siendo
desarrollado por FPMD en el marco de la Iniciativa para la Reforma del Sector
SALUD – USAID-PAHO ? ¿Qué opinión le merece?
SI______________________________________________________________________
NO_____________________________________________________________________
APPENDICES
40
4. ¿Este estudio responde a las necesidades y problemas del sector salud de su país?
(percepción)
Si
No
No sabe
NA
5. ¿Qué opinión le merece este estudio? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
6. ¿Cuáles son los impedimentos que existen en su país para aplicar los resultados de
esta investigación? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
7. ¿Cuáles serían los factores o variables que facilitarían su aplicación? (fortalezas y
oportunidades)
________________________________________________________________________
________________________________________________________________________
8. ¿Qué se requeriría para que los resultados de esta investigación se utilicen a nivel
institucional y para que permanezca en el tiempo a pesar de los cambios que se
puedan dar en su institución? (sostenibilidad)
________________________________________________________________________
________________________________________________________________________
5. NGOs for Quality Assurance (FPDM)
1. ¿Qué experiencias está utilizando para impulsar el control de calidad en la provisión
de servicios por parte de las ONG?
________________________________________________________________________
________________________________________________________________________
2. ¿Usted participó en el grupo de trabajo que discutió este tema, que está siendo
desarrollado por FPMD en el marco de la Iniciativa para la Reforma del Sector
SALUD – USAID-PAHO ? ¿Qué opinión le merece?
SI_____________________________________________________________________
NO____________________________________________________________________
APPENDICES
41
3. ¿Este estudio responde a las necesidades y problemas del sector salud de su país?
(percepción)
Si
No
No sabe
NA
4. ¿Qué opinión le merece este estudio? (para medir percepción)
Excelente
Muy buena
Buena
Regular
Mala
NA
No sabe
5. ¿Cuáles son los impedimentos que existen en su país para aplicar los resultados de
esta investigación? (limitaciones y debilidades)
________________________________________________________________________
________________________________________________________________________
6. ¿Cuáles serían los factores o variables que facilitarían su aplicación? (fortalezas y
oportunidades)
________________________________________________________________________
________________________________________________________________________
7. ¿Qué se requeriría para que los resultados de esta investigación se utilicen a nivel
institucional y para que permanezca en el tiempo a pesar de los cambios que se
puedan dar en su institución? (sostenibilidad)
________________________________________________________________________
Comentarios de la entrevista:
________________________________________________________________________
APPENDICES
42
LAC Regional Health Sector Reform Initiative
Midterm Evaluation Interview Format
Partners
Name_______________________
Organization_________________
Date_______________________
Results Framework
1. How long have you been acquainted with the LAC Project and in what capacity?
2. Does the USAID results framework of intermediate results or indicators work for
this type of Project.
a. Which ones specifically apply to your part of the project (show chart)?
b. Are there any Changes you would recommend to it?
3. Do you believe that you are tracking the right indicators to measure intermediate
changes that occur before the results are achieved?
4. Do you have systems in place that can tract output or interim outcome measures?
Please give examples
APPENDICES
43
Progress and Achievements
5. How much Progress have you made towards achievement of the Intermediate
Results by successfully accomplishing specific activities in your part of the
project? Which results and through what activities?
6. From your perspective what is the vision of this Initiative
7. What is the value added of this initiative
8. Which elements of your part of the project do you believe can be scaled-up?
9. Which elements of your part of the initiative do you believe are sustainable?
Please explain why.
10. Since FY99 The Initiative has tried to focus on identifying and working to build
the capacity of key institutions rather than individuals. Is this a good idea?
Have it been successful.
How can it be improved?
11. How can the collective expertise and experience of the partner’s staff be used to
identify new areas and improve performance?
APPENDICES
44
12. What are other ways we could obtain inputs from our clients and institutions
responsible for reform processes in shaping our annual work plans and defining
new areas for work?
Initiative Structure
13. What are the strengths and weaknesses of the management structure of the
Initiative with respect to other partners, USAID, USAID missions and country
support?
Strengths
Weaknesses
14. How effective are the coordinating mechanisms of the initiative?
TAG Steering
Committee
NGO Task
Force
Information
Dissemination
Task Force
Indicator
Task Force
Study Tour
Task Force
Outstanding
Very
effective
Moderately
Effective
Marginally
Effective
Not
Effective
Please give examples to indicate the basis of your response.
Specifically do we have the right individuals on the TAG?
APPENDICES
45
What can be done to increase the contribution of the TAG to Initiative results?
15. What other more agile decision making mechanisms might be used?
Administration
16. How effective has the management and oversight of the Initiative been by
USAID/LAC.
Outstanding ___
Very Effective___
Moderately Effective___
Somewhat Effective ___
Not effective at all ___
Please give examples supporting your answer.
17. How would you describe the quality of reports work plans and other Products
Submitted to USAID?
Excellent ___ On time? ______ Appropriate information? ___
Very Good ___
Good___
Adequate ___
Poor ___
Please give examples supporting your answer.
Use of Resources
18. To What extent have project resources been used appropriately and effectively
e.g. staff and other inputs?
APPENDICES
46
19. Do you believe that this initiative should be continued? If so what do you believe
should be done to increase the likelihood that LAC and PAHO funding decision
makers will continue to see it as a high priority.
20. The Initiative is not well known by many of those who benefit from it? Is this a
problem? Should we do anything to correct it? If so, What?
APPENDICES
47
PERCEPCIONES SOBRE LA INFORMACION/COMUNICACION EN EL AREA
DE LA REFORMA DEL SECTOR SALUD
Nombre:
 Institucion:
Pais:
Fecha de llenado del formulario:
1. Que es la Iniciativa Regional para la Reforma del Sector Salud
(puede seleccionar mas de una alternativa)
? Un programa financiado por la OEA
? Una iniciativa resultado de la Cumbre Presidencial de las Americas de 1994 celebrada
en Miami, Estados Unidos.
? Un programa de la Organizacion Panamericana de la Salud
? Una iniciativa ejecutada por instituciones del sector publico y privado, financiada por
la AID y la OPS
? Una idea de los paises del MERCOSUR
? Todo lo anterior
2. A traves de que medio de comunicacion se entero de la existencia de la Iniciativa
? (puede seleccionar mas de una alternativa)
? A traves de los medios de comunicacion tradicionales (radio, TV, prensa escrita)
? A traves del Sitio Internet de la Iniciativa
? A traves de presentaciones de colegas del sector Salud
? A traves de las publicaciones escritas de la Iniciativa.
? Otros medios, sirvase expllicar:
3. Cuales deberian ser las audiencias objetivo que deberian tomarse en cuenta para los mensajes
comunicacionales sobre la Reforma del Sector Salud por parte de la Iniciativa Regional?
(puede seleccionar mas de una alternativa)
? Los tomadores de decisiones a nivel de los Ministerios de Salud
? Los tomadores de decisiones a nivel del Sector Privado de Salud.
? Los tomadores de decisiones a nivel de las ONGs del Sector Salud
? Los tomadores de decisiones a nivel del Banco Mundial, el BID y otras agencias multi
y bilaterales.
? Los periodistas encargados de los temas de Salud
? Los parlamentarios de las Comisiones de Salud de los Congresos
? El sector academico
? Los gremios y sindicatos
? La opinion publica en general
? Los profesionales del Sector Salud (medicos, enferemeras, tecnicos, etc)
? Tomadores de decisiones en las instituciones de Seguridad Social
? Todos los grupos anteriores
? Otros , sirvase explicar:
APPENDICES
48
4. Que opinion le merecen los mensajes emitidos por la Iniciativa en publicaciones
y en el Sitio de Internet ?
(seleccione una alternativa)
? La mayoria de los mensajes son claros, concisos y tocan problemas e intereses
sentidos en la region
? La mayoria de los os mensajes son claros pero no siempre tienen que ver con
problemas e intereses sentidos en la region
? La mayoria de los mensajes son poco claros y rara vez tienen que ver con problemas e
intereses sentidos en la region
? En la mayoria de los casos los mensajes no son claros ni tienen que ver con los
problemas e intereses sentidos en el pais
5. Que piensa sobre la vehiculos seleccionados para la emision de dichos mensajes
(publicaciones y sitio en Internet) (seleccione una alternativa)
? Son muy efectivos para captar la atencion del usuario
? Su contenido es claro , aunque resultan poco atractivos
? Son poco efectivos para captar el interes de los usuarios
? Son totalmente inefectivos
6. Le parece que seria necesario introducir nuevos vehiculos de comunicacion (puede seleccionar mas
de una alternativa)
? Si, videos de corta duracion ya que la imagen vale mas que mil palabras
? Si, articulos en las paginas de opinion de la prensa regional para que se fomente el
debate sobre la Reforma del Sector Salud
? Si, se deberian hacer teleconferencias para intercambiar experiencias
? Si, se deberian tratar de llegar a los programas de TV y Radio
? Otros, favor explicar………………………………………………………………
? No, con los vehiculos usados en la actualidad es suficiente
APPENDICES
49
CUESTIONARIO 3
Para los Socios del Proyecto –Comunicacion￾1. Considera Ud, que el proyecto tiene una estrategia de comunicacion?
? Si hay una estrategia que todos compartimos y que establece con nitidez el impacto
buscado en las audiencias objetivo y los instrumentos a ser usados
? Si hay una estrategia pero no la conozco al detalle
? No conozco la estrategia de comunicacion
? No existe una estrategia de comunicacion
2. Cuales deberian ser las audiencias objetivo que deberian tomarse en cuenta en la
estrategia de comunicacion?
? Los tomadores de decisiones a nivel de los Ministerios de Salud
? Los tomadores de decisiones a nivel del Sector Privado
? Quienes dirigen a las ONG’s
? Los tomadores de decisiones a nivel del Banco Mundial, el BID y otras agencias multi
y bilaterales.
? Los periodistas encargados de los temas de Salud
? Los parlamentarios de las Comisiones de Salud de los Congresos
? La opinion publica en general
? Los medicos
? Todos los grupos anteriores
3. Considera Ud, que el proyecto presenta una imagen corporativa consistente?
? Si, en todas las oportunidades
? En algunos casos
? Rara Vez
? Nunca
4. Que opinion le merecen los mensajes comunicacionales
? Sus mensajes son claros, concisos y tocan problemas e intereses sentidos en la region
? Los mensajes son claros pero no siempre tienen que ver con problemas e intereses
sentidos en la region
? Los mensajes son poco claros y rara vez tienen que ver con problemas e intereses
sentidos en la region
? En la mayoria de los casos los mensajes no son claros ni tienen que ver con los
problemas e intereses sentidos en la region
APPENDICES
50
5. Que piensa sobre la vehiculos seleccionados para la emision de dichos mensajes
(publicaciones y sitio en Internet)
? Son muy efectivos para captar la atencion del usuario
? Son efectivos en algunos casos, aunque resultan poco atractivos
? Son poco efectivos para captar el interes de los usuarios
? Son totalmente inefectivos
6. Le parece que seria necesario introducir nuevos vehiculos de comunicacion?
? Si, videos de corta duracion ya que la imagen vale mas que mil palabras
? Si, articulos en las paginas de opinion para que se fomente el debate sobre la Reforma
del Sector Salud
? Si, se deberian hacer teleconferencias para intercambiar experiencias
? Si, se deberian tratar de llegar a los programas de TV y Radio
? No, con los vehiculos usados en la actualidad es suficiente
APPENDICES
51
Informacion sobre la Reforma del Sector Salud
Nombre:
 Institucion:
Pais:
Fecha de llenado del formulario:
1. Es Ud una persona que para su trabajo necesita informacion impresa (folletos,
cuadernillos, etc) sobre los procesos de reforma del Sector Salud en las Americas???
? Si, es imprescindible
? Si es necesario
? Solo algunas veces
? No, no necesito informacion impresa
2. Cuales son los temas que mas le interesan en relacion a la Reforma del Sector Salud
en las Americas? (Seleccione cinco como maximo)
3. Recibe Usted materiales impresos sobre dichos temas ?
? Si, regularmente
? Solo algunas veces
? Nunca
4. De quien recibe Usted informacion sobre dichos temas?
5. Recibe Ud materiales impresos de la Iniciativa Regional para la Reforma del Sector
Salud?
6. Si la respuesta anterior fue positiva, con que regularidad los recibe?
7. Quien se los envia?
8. Considera Ud. que esos materiales, son utiles para su trabajo cotidiano?
? Si son imprescindibles para mi trabajo
? Si, son muy utiles
? Si, son utiles
? Son utiles en algunas oportunidades
? En realidad no son muy utiles
? No son utiles
9. Explique por que decidio elegir alguna de las alternativas de la pregunta anterior
APPENDICES
52
10. Es Ud una persona que utiliza la Internet para obtener la informacion que le interesa?
? Si, lo hago con regularidad
? Solo a veces
? No, prefiero los mecanismos mas tradicionales
11. Si en la pregunta anterior selecciono alguna de las dos primeras alternativas, que tres
sitios de Internet consulta en orden de importancia para obtener informacion sobre los
temas que mas le interesan (temas de la pregunta 2)
a)
b)
c)
12. Ha visitado Ud el sitio de Internet de la Iniciativa Regional de Reforma del Sector
Salud?
? Al menos una vez por semana
? Al menos una vez por mes
? En alguna oportunidad
? Nunca
13. Si en la pregunta anterior selecciono cualquiera de las tres primeras alternativas, que
opinion le merece la calidad de dicho sitio?
? Excelente
? Muy Buena
? Buena
? Regular
? Mala
14. Siendo Ud un visitante asiduo o esporadico de dicho sitio de Internet, para que utiliza
las posibilidades que dicho sitio ofrece?
? Para guiar mi toma de decisiones
? Para conocer otras experiencias y tratar de adaptarlas a mi pais
? Para no repetir errores que otros han cometido
? Para contactarme con otros profesionales de otros paises
? Para colocar alli informacion de mi institucion para que sea diseminada
? Para obtener bibliografia
? Para obtener herramientas y metodologias utiles para la Reforma del Sector salud
? Para obtener informacion sobre los Perfiles del Sector Salud en otros paises
? Para todo lo anterior.
? Otros usos,favor explicar:
APPENDIX E
CONCEPTUAL AND METHODOLOGICAL FRAMEWORK
APPENDICES
54
CONCEPTUAL FRAMEWORK
In order to define the analytical framework for data collection and analysis, a conceptual
model was designed relating conditional factors and expected results for each instrument,
methodology, and experience. The following premises support the analytical framework
proposed:
1. It is necessary to evaluate separately each of the tools, methodologies, and
experiences designed, developed, tested, disseminated, and implemented for the
Initiative. Taking this into account it is necessary to prepare a list of questions in the
interview format for each Initiative activity. The analysis of the results will therefore
need to be done for each tool, methodology, and experience. Based on these partial
outcomes, trends and common denominators can be recommended.
2. It is necessary to analyze the results framework of the Initiative, comparing the IR,
indicators, and specific expected results for each Initiative activitiy in order to define
the specific indicators to be used for the evaluation of the progress and achievement
concerning each activity. For example, expected outcomes at this time for NHA (not
only in use but also in the process of institutionalization) is not the same as the
expected result concerning the tool for plans investment (use and testing of the tool).
3. The evaluation of the level of accomplishment of the results depends on the specific
expected results in each case. These results vary from knowing the tool through
testing, using, and sharing it until institutionalization of the tool or methodology, and
even taking steps after the Initiative experience. The final expected outcomes are
integrating—at an institutional level—lessons learned from the Initiative and building
institutional in-country capacity for health reform.
4. The expected outcomes upon which the Initiative’s operation depends are related to
the Initiative performance but also to other factors beyond Initiative control.
Therefore, the factors that affect the Initiative’s progress, achievements, and
outcomes can be classified by:
ß factors within the Initiative’s control,
ß factors beyond the Initiative’s control but which can be influenced, and
ß pre-existing conditions.
FACTORS AFFECTING PROJECT’S SUCCESS ON IRS 3.4.1, 3.4.3 AND 3.4.4
Within the Control of the Initiative
ß Quality of tools, methodologies, forum, and study tours
ß Selection of themes/experiences for dissemination, training and sharing
(demand-driven tool)
ß Characteristics of training and technical assistance
ß Initiative’s approach strategy:
· Regional strategy,
· Regional strategy accompanied by national in-country orientation.
ß Initiative institutional strategy: selection of institutions/key stakeholders to be
targeted (national—MOH, Ministry of Finance or similar, reform units,
NGOs, other governmental organizations (Congress, state reforms unit) other
agencies (World Bank and IADB).
ß Efficiency in partner coordination at central level (partnership efficiency)
APPENDICES
55
ß Communication and dissemination strategy: Regional level (this is a fix factor
for all tools and experiences; for this reason, it is not necessary to evaluate its
effect on results)
Beyond the Control of the Initiative but Can Be Influenced
ß Communication and dissemination strategy: National level
ß Customization of the tool, methodology, and experience to national
requirements
ß Initiative partnership at the local level (national level)
ß Partners’ role on health reform at national level (PAHO, IAD, PHR, FPDM
and DDM)
ß Headquarters and local alignment in partnership efforts (for each tool and
activity) (PAHO and USAID)
ß In-country partners-consultants (i.e., PHR or FPMD) with specific tool￾related terms of reference
ß Key staff turnover at national level (MOH, other units and ministries related
to health reform) (stability of key actors favor Initiative’s activity)
ß Interrelationship between the partners and other agencies (World Bank and
IADB) at in-country level and interagency committees in place (there are no
data for the characterization of this factor)
ß Internal and specific process on health reform going on in the country
(demand-driven tool) (this factor is going to be estimated through “selection
of theme”)
ß Political decision on health reform and specifically to the tool or experience
ß Political will to introduce changes in health system
ß Political will to introduce the specific Initiative’s tool or experience
ß Inclusion of health reform in the national agenda
ß Inclusion of the specific theme related to the Initiative’s activity in the
national agenda
ß Adoption of a public policy on health reform
ß National consensus on health reform (see communication strategy)
ß National consensus related with the specific Initiative’s activity
ß National institutional capacity for health reform (trained personnel, strength of
public administration and of the institutional design, etc.)
ß National institutional capacity for the specific Initiative’s activity
ß Parallelism between MOH and reform units
ß Participation of Civil Society (there are no data for the characterization of this
factor)
APPENDICES
56
Pre-existing Conditions2
ß Traditional values/perceptions on health system by public opinion
ß Current way of operating of the health system
ß Degree of decentralization of the state and of the health system
(federal/regional/local)
ß Political interference in decision making
ß Type and quality of MIS in place
ß Availability of data/information
ß Investment possibilities for health reform and for the specific Initiative’s
activity
ß Political system
 
2
 These pre-conditions are not studied or evaluated since we don’t have the data to build the indicators.
Methodological Framework for Database Preparation and Analysis
Table E-1
Outcomes or Results: Indicator, Operational Definition and Sources of Information with Interview’s Questions Identified
Indicator Operational Definition Sources of Information
Tool development and
testing
Identification if the tool is still in process of
development and test
Result: Yes/No
Secondary information: Initiative’s annual reports and partners’ reports
Tool or experience
knowledge
Key stakeholders saying they know the tool,
research, technical assistance, or experience/total
key informants (see appendix C, table H for
denominator definition)
Result: Ratio
Well Known = ³ ¾
Known = < ¾ but > ½
Not Known = < ½
Interview:
Examples of questions:
1. ¿Usted conoce la herramienta o metodología “X” desarrollada por la Iniciativa?
2.¿Usted recibió asistencia técnica del proyecto X desarrollado por la Iniciativa?
3.¿Usted participó en los encuentros para preparar los trabajos: “X” que adelantó PHR en el marco de la
Iniciativa?
4.¿Usted conoce el trabajo sobre X que se esta haciendo en el marco de la Iniciativa?
5. Usted participó en el foro organizado por la OPS sobre mecanismos de pago, en el marco de la Iniciativa
para la Reforma del Sector SALUD?
6. ¿Usted participó en una gira de estudios para conocer la experiencia en X organizado por la Iniciativa?
Tool or experience use Key stakeholders saying they use the tool,
research, technical assistance, or experience/total
key informants
Result: Ratio
Clearly Used = ³ ¾
Used = < ¾ but > ½
Not used = < ½
Interview:
Examples of questions:
1.¿Qué herramientas utiliza usted o su institución para llevar las cuentas nacionales de salud?
2. ¿Qué apoyo (s) o asistencia técnica ha recibido su institución para manejar (gerenciar) el proceso político
que implica la formulación y la puesta en marcha de la reforma del sector salud en su país?
3.¿Qué experiencias tiene usted o está adelantando para incoporar las ONGS en el proceso de reforma en salud
y para el diseño de nuevas formas de interrelación y contratación entre el sector público y privado?
4.¿Qué experiencias o estudios están utilizando usted para impulsar la descentralización en su país?
Taking steps after
experiences (only for
forum and study tour)
Use of Initiative’s experience as input/Number of
participants in forum or study tour
Result: Ratio
Taking steps = ³ ¾
Presumably taking steps = < ¾ but > ½
Not taking steps = < ½
Interview:
Example of questions used to get the indicator:
1¿Usted o su institución ha promovido la reforma de los hospitales para impulsar la decentralización y para el
logro de hospitales públicos autónomos?
2. ¿Qué actividades o insumos ha utilizado usted para este fin y le han sido más útiles?
3. ¿Usted participo en una gira de estudios para?
Tool’s institutionalization
(only for NHA and MHR)
NHA
1. Option 1:
MOH gives to MOF or similar agency (Central
Bank) necessary data/information on health as a
routine on a regular basis to build the NHA and
ask or demand results and findings on NHA as a
routine
2. Option 2:
MOH with a specific unit posted responsible for
NHA (with trained personnel accomplishing
NHA
Option 1 and Option 2:
Evaluation team conclusion based on general interview findings
MHR
Interview:
Answer to part C question:
¿Qué metodología (s) utiliza usted o su institución para hacerle el seguimiento y evaluación del proceso de
reforma del sector salud en su país?
ordinary tasks as part of available MIS)
MHR
MOH’s board of directors acknowledge PAHO
framework for monitoring HSR
Indicator:
MOH’s Board of directors saying they use PAHO
framework/total MOH and Health Reform Unit
informants (see appendix C, table H)
Result: Ratio
Institutionalization = ³ ¾
Table E-2
Factors affecting Initiative’s Results: Indicator, Operational Definition and Sources of Information with Interview’s Questions
Identified
Factor Indicator Operational Definition Sources of Information
Within the control of the Initiative
Quality of tools,
methodologies, forum,
and study tours
Key stakeholders
perceptions of tool or
experience quality
Key stakeholders perceptions of tool’s
quality/interviewees knowing the tool (see
appendix C, table H)
Result: Ratio
High Quality = ³ ½
Excellent and Very good
Good Quality: ³ ½ Good
Fair Quality: ³ ½ Fair
Bad Quality: ³ ½ Bad
Interview question used:
¿Que opinión le merece la herramienta o metodología para?
Selection of
themes/experiences for
dissemination, training and
sharing (demand-driven
tool)
Key stakeholders
perceptions of tool or
experience applicability
and pertinence
Key stakeholders perceptions of tool’s
applicability and pertinence
(yes)/interviewees knowing the tool
Result: Ratio
Demand-driven tool (need for the tool) = ³
½
Interview question used:
¿Esta herramienta responde a las necesidades y problemas del
sector salud de su país?
Characteristics of training Key stakeholders
perceptions of actual
training for tool’s use
Key stakeholders perception of actual
training/interviewees knowing the tool
Result: Ratio
Proper Training = ³ ½
No Training = ³ ½ (no personal training or
no training for this methodology)
Interview question used:
¿Cómo se capacitó en su uso?
Initiative’s approach
strategy
Team’s observation of
approach strategy to
disseminate, test, and put
into place the tool or
experience
Types of approach strategy:
· Only regional focus
· Regional strategy accompanied by
national in-country orientation
Interviews to partners and secondary information:
Initiative’s and partners documents
Partner’s institutional
strategy
Team’s observation of each
partner’s institutional
strategy to disseminate,
test, and put into place the
tool or experience
Types of institutional national strategy:
· MHO
· MOH, Ministry of Finance or similar
· Reform units
· Other governmental organizations
(Congress, state reforms unit, etc.)
· Other agencies (World Bank and
IADB)
· NGOs
Interviews to partners and secondary information:
Initiative’s and partners documents
· Individual key actors
Efficiency in partner
coordination at central
level
Team’s conclusion of
partnership and
coordination regards the
tool at central level
Existence of coordinated actions among
partners—at central level—to design,
develop, test, disseminate, and put into
place the tool
Interviews to partners and secondary information:
Initiative’s and partners’ documents
Beyond the Control of the Initiative but can be Influenced
Communication and
dissemination strategy:
national level
Team’s observation
regarding the
communication and
dissemination strategy at
the national level
Type of communication and dissemination
process implemented at in-country level to
develop, test, disseminate, and put into
place the tool:
· A participatory consensual
development process with key
stakeholders and institutions
· An interactive process among different
Institutions and key stakeholders with
the tool
· No existence of a communication and
dissemination strategy at in-country
level
Observation in field by the evaluation team
Customization of the tool,
methodology, and
experience
Combined indicator: key
stakeholders perceptions of
medium of information and
dissemination of the tool;
key stakeholders
perceptions of quality of
the tool and applicability to
the country among the
factors explaining
limitations for institutional
use
Option 1: Key stakeholders perceptions that
the medium of information and
dissemination of the tool is participatory
(event or through a national
process)/interviewees’ knowing the tool
Result: Ratio
Customization = ³ ¾
Option 2: Relative position of the answer
concerning tool quality and applicability to
the country are among the factors
explaining limitations for institutional use
(number of answers)
Result: Relative place (1st, 2nd, 3rd, xth)
Interview questions used:
¿Cómo supo usted de la existencia de la herramienta?
¿Cuáles son los impedimentos que existen en su país para el uso
institucional de esta herramienta?
Initiative partnership—at
National level—regarding
the tool
Team’s observation of
Initiative’s partnership at
local level
Existence of Initiative’s partnership at local
level regarding the tool
Observation in field by the evaluation team
Partner’s role on health
reform at national and
institutional level
Key stakeholders
perception on role on
health reform
Relative position of the partners in
comparison with other agencies regarding
role of health reform (number of answers)
Result: Relative place (1st, 2nd, 3rd)
Interview Question used:
¿Qué institución a nivel internacional le parece que hace más en
favor de la reforma del sector salud en su país?
Headquarters and local
alignment in partnership
efforts (for each activity)
(PAHO and USAID)
Evaluation team’s
observation of PAHO and
USAID officials’ positions
regarding the specific tool
PAHO and USAID accountability with
respect to the tool
Result:
Yes/No
Observation in field by the evaluation team
In-country partners—
consultants with specific
tool related to terms of
reference
Evaluation team’s
identification of
consultants with terms of
reference related to the tool
Existence of in country partners-consultants
(i.e. PHR or FPMD) with specific tool–
related terms of reference
Result: Yes/No
Observation in field by the evaluation team
Stability of key actors
favor Initiative’s activity
Team’s perception of the
permanence of the officials
with responsibility
concerning the tool
Existence of stable key actors favor
Initiative’s activity
Result: Yes/No
Observation in field by the evaluation team
Political decision
specifically regarding the
tool or experience (In some
cases, “adoption of a public
policy regarding the tool”
will be analyzed
separately)
Key stakeholders
perceptions of political will
in MOH to introduce the
tool
Key stakeholders’
perception about health
reform as public policy
1. Relative position of “political will in
MOH to introduce the tool” among factors
limitations and weaknesses for Institutional
use (number of answers)
Result: Relative place (1st, 2nd, 3rd)
2. Relative position of “reform as a public
policy: lack of definition” among factors
explaining limitations and weaknesses for
HSR
Result: Relative place (1st, 2nd, 3rd)
Interview Question used:
¿Cuáles son los impedimentos que existen en su país para el uso
institucional de esta herramienta?
1. Tool’s inclusion in the
reform agenda
2. Consensus related with
the specific Initiative’s
activity
Key stakeholders
perceptions of the
relevance of the tool in
health process reform
Key stakeholders of the MOH acknowledge
the theme in reform agenda/total MOH and
Health Reform Unit informants
Result 1: Ratio
Tool in Reform Agenda = ³ ½
Result 2: Ratio
Consensus = ³ ¾
Interview Question related to the use of the tool (first question of
each block/tool).
National institutional
capacity for specific
Initiative’s activity
Key stakeholders
perceptions of country
weaknesses for HSR
Relative position national institutional
capacity among factors explaining
limitations and weaknesses for the
implementation of the specific tool (number
of answers)
Result: Relative place (1st, 2nd, 3rd)
Interview question:
¿Cuáles son los impedimentos que existen en su país para el uso
institucional de esta herramienta?
Parallelism between MOH
and reform units
Key stakeholders
perceptions of country
weaknesses for HSR
Relative position of parallelism between
MOH and reform units among factors
explaining MOH weaknesses for HSR and
for tool (number of answers)
Result: Relative place (1st, 2nd, 3rd)
Interview
Question:
¿Cuáles son las debilidades que tiene la institución encargada de la
reforma para el diseño, análisis, implementación y monitoreo de la
reforma del sector salud?
Table E-3
Indicator, Operational Definition and Source of Information with Interview’s Questions Identified
(Initiative’s Sustainability Analysis)
Indicator Operational Definition Sources of Information
Tool and experiences sustainability Key stakeholders perceptions of
requirements for institutional use and
sustainability of the tool
Interview question related to the sustainability of each tool (last question of each
block/tool)
¿Qué se requeriría para que esta herramienta fuera utilizada a nivel institucional y para
que permanezca en el tiempo a pesar de los cambios que se puedan dar en su
institución?
APPENDICES
63
Operational Definition of Categories of Interview Questions on “Limitations and
weaknesses for institutional use,” “factors facilitating its application,” and
“requirements for sustainability”
1. PERCEPTION OF INSTITUTIONAL AND COUNTRY WEAKNESSES FOR DESIGN,
ANALYSIS, IMPLEMENTATION AND MONITORING OF HEALTH REFORM
TYPE OF WEAKNESS
Health reform leadership, political decision-making, and process management
Identify decision-makers/falta dirección política—crisis de liderazgo sectorial
Incapacidad o limitaciones para tomar decisiones del MINSAL
Lack of continuity of Ministers and staff (different approaches)
Proceso poco democrático en conducción de reforma
Estilo de reforma desatinado
Es un tema político: es un proceso político
Dependencia de la reforma de salud de la del estado
Paralelismo con la Seguridad Social
Resistencia al cambio a lo interno del MOH
Viceministros nombrados por el Presidente de la República
Antagonismos y contradicciones a lo interno del MHO. Diferentes proyectos de reforma
Institutional capacity of MOH
Lack of reform's counterparts (política y técnica)
Falta de capacidad ejecutiva y de experticia del Ministerio. Administracion Pública (RRHH)
Incapacidad gerencial del MOH y de encargados de la reforma—falta de experiencia (RD)
Corrupción en el MOH
Sistema centralizado. Incapacidad técnica para asumir la decentralización
Respuesta desorganizada del estado frente a la reforma
Poco éxito para la institucionalización
Reform’s unit functioning and parallelism with MOH
Ministerios paralelos (Ministry and reform unit)
Grupo de reforma cerrado CLUB
No hay transferencia de la Unidad al MINSAL
El proceso de reforma se inicia fuera del MINSAL
La experiencia de reforma la tienen los consultores
Falta de transparencia en el proceso de reforma (concursos)
No hay coordinación entre proyectos BM y BID
Information availability
Lack of information system and of information
Reform’s information, communication, and diffusion
La información se maneja como poder
No hay acceso a la información sobre reforma
Prejuicios por desconocimiento de la reforma (amenaza)
Reform as a public policy: definition, fomulation, and internal and external consistency
No hay política del estado para la reforma en salud
No hay planificación de largo plazo en relación a la reforma
Falta de conocimiento de experiencias de reforma en otros países
Resistencia social a los cambios por desinformación
Falta de Monitoreo de la reforma
Complejidad del proceso con diferentes representaciones
La reforma no ha estado asociada a resultados de salud ni ha mostrado Rs
No se tiene claro que es la reforma y sus objetivos (proceso embrionario)
El tiempo de reforma ha sido muy largo y no se ha logrado impacto
La reforma olvida lo epidemiológico
Se piensa en términos del mercado
APPENDICES
64
Olvido los aspectos institucionales
Falta de articulación de reforma salud con la del Estado
La reforma es intersectorial, escapa del MINSAL
La reforma toca los valores de la sociedad
Falta de integración del proceso de reforma/muchos haciendo sin coordinación (they have to put the basic
elements together)
No hay convencimiento del Congreso
Reforma depende de las tendencias ideológicas internacionales (proyecto de Bancos)
Escuela de Medicina se opone a la reforma
No hay reforma, sólo documentos
Agency cooperation: coordination and country support
Pobre coordinación y tensión entre agencias y país (duplicación y solapamiento de proyectos)
Legal framework
Inexistencia de marco legal y de leyes
Community participation
Lack of community participation
Financial and budgeting constraints
Presupuesto: Budget austerity y forma como se ejecuta el presupuesto
External constraints
Heterogeneidad y diversidad epidemiológica
Coyuntura electoral
Resistencia a la reforma de grupos políticos: sindicatos, partidos
2. USE OF PLANS OF HSR AND MASTER PLANS FOR INVESTMENT
Question 7: Limitations and weaknesses for institutional use
Health reform leadership, political decision-making, and process management
En el gobierno no se entiende la visión del secretario de salud
Falta de apoyo del gobierno central
El limitado avance del proceso de desarrollo organizacional del MOH
No se toman decisiones basadas en los PMIS
Cambios de ministros
MOH institutional capacity
Cultura organizacional: no acostumbrada a trabajar con carteras de proyectos
Rigidez de la estructura del MOH
Carencia de RRHH con le perfil y la capacitación en Unidad de Planeamiento
Falta de conocimiento a nivel local
Information, communication and diffusion
Falta de difusión
Financial and budgeting constrains
Manejo centralizado de los recursos financieros
Instrument applicability to country
El proceso no ha continuado, ni avanzado
El análisis es descriptivo y macro, falta aterrizarlo
Se hizo con consultor externo
El proceso no se llevó a las regiones, no se culminó
En el proceso no se involucró a las regiones, sólo nivel central
Costo y tiempo: alineación entre tiempos consultor y tiempo del país
Agency cooperation: coordination and country´s support
Necesidad de cooperación interagencial para apoyar PMIS
None
NA
QUESTION 8: FACTORS FACILITATING ITS APPLICATION
Leadership, political decision-making, MOH will, and process management
Voluntad política del Ministro o Secretaría de salud
Decisión del Ministro y tres subsecretarios del nivel central
APPENDICES
65
MOH como actor activo en planificación y ejecución
MOH institutional capacity
Central Bank institutional capacity and will
Proceso de reforma adelantado en el MOH
Information system
El sistema de planificación usado en el MOH
Agency cooperation: coordination and country support
El proyecto PMIS es prioridad del MOH con apoyo interagencial canalizado
Instrument technical quality and applicability to country
Capacitación en proceso de formulación de PMIS
Herramienta muy bien vista (consenso)
Un buen instrumento
Information, communication, and diffusion
It is a government demand-driven tool
External factors
Huracan Mitch
NA
NI
Question 9: Requirements for sustainability
Leadership, political decision-making, MOH will, and process management
Voluntad del Ministro
Necesidad de consenso entre nivel central y operativo
Apoyo político
Hacer métodos de transición al próximo gobierno
MOH institutional capacity
Institucionalización en Unidad de Planeamiento del MOH
Necesidad de que se sustente en el nivel de las regiones sanitarias
Montar plan de monitoreo y seguimiento permanente
Instrument applicability to country
Completar el ciclo del PMIS
Additional financial and human resources and infrastructure
Capacitación de recursos humanos de la Unidad de planeamiento
Apoyo tecnológico: infraestructura y computadoras
Agencies support and technical assistance
Necesidad de fortalecimiento de la Unidad de Planeamiento del MOH
Proceso de apoyo interagencial para ccoperación técnica
NA
3. USE OF NATIONAL HEALTH ACCOUNTS
Question 7: Limitations and weaknesses for institutional use
Health reform leadership, political decision-making, and process management
No hay liderazgo en salud y de la reforma
El Ministro no conoce su importancia
No se ha incorporado a la burocracia, a rutina y no hay unidad responsible
El abordaje poco sistémico de la reforma
Resistencia al cambio por temor a la evaluación
Falta de apoyo de la oficina de despacho de la presidencia
Antagonismos y contradicciones a lo interno del MHO; diferentes proyectos
Falta de compromiso interinstitucional
Resistencia a la herramienta por el fantasma de la privatización
Debilidad para tomar decisiones en MOH
MOH institutional capacity
Debilidad Instituc. y escacez de personal capacitado
Periodo de maduracion normal de la institucion
APPENDICES
66
La mala organización administrativa
Falta de apropiación de la herramienta por parte de MOH
No haya transferencia de consultores a MOH
Poca institucionalizacion de esa especialidad en función pública
Necesidad de recursos, computadoras
Reform unit functioning and parallelism with MOH
Se hizo en Unidad de Coordinacion del prestamo BID fuera del MINSA
Rotacion de consultores—cambios equipos tecnicos
Estudios desarrollados por entidades ajenas al MINSAL
Information, communication and diffusion
Falta de difusion y de conocimiento o necesidad de inf.
Periodo de convencimiento de su utilidad
Financial and budgeting constraints
Forma de manejo del presupuesto nacional
Limitaciones presupuestarias
Information system available
Problemas con informacion de algunos sectores
Disponibilidad y Acceso a la informacion
Lack of community participation
Demand-driven tools
No es una demanda del MOH
Needs to be a tool for public adm. and not only MOH
Instrument consistency, technical quality, and applicability to country
Instrumento complicado y de poco aplicabilidad en la práctica
Limitaciones del instrumento y rigidecez de autores
Es un estudio útil para PHR
Necesidad de simplificar los resultados para su uso
Agency cooperation: coordination and country’s support
Needs of monitoring of and training on the tool
None
NA
Question 8: Factors facilitating its application
Leadership, political decision-making, MOH will, and process management
Decisión o voluntad política del gobierno
Convertirla en un instrumento de negociacion y regulacion del Ministerio
Manejo de actores con sentido de oportunidad
Se nombró a una unidad responsible
Elemento clave para la reforma
Apropiación por parte de las regiones
Apoyo político del gobierno
MOH institutional capacity
Contar con personal capacitado—cap. nacional
Mejoramiento de sistemas operativos del MOH
Desarrollar un proyecto para institucionalizar NHA
Refoma y modernizacion del MOH e instituc. publicas
Technical incentives for the team
Persistencia en el trabajo, cumpliendo cronogramas
Credibilidad del jefe unidad de planeamiento
Technical assistance, agencies advocacy, and financing support
Apoyo de la PAHO, PHR, USAID, Harvard
Desarrollo de la propuesta en el marco del proyecto BID
Financiamiento de proyectos (entrada de prestamos)
Acompañamiento permanente de PHR, BM y Harvard
Consultor residente de PHR ha sido el impulso
Information, communication and diffusion
Entendimiento por parte del MINSAL: pensar el sector en su totalidad
APPENDICES
67
Evento de difusión
It is a government demand-driven tool
NA
Question 9. Requirements for sustainability
Leadership, political decision-making, MOH will, and process management
Lograr consenso
Designar responsible en Institución pública
Resolucion ministerial—ley—institucionalizacion
Political decision and MOH will
Que se la apropien las regiones sanitarias
Mostrar resultados en la región 5 (piloto)
Que se utilicen las cuentas para decisiones presupuestarias
Coordinar esfuerzos con otras instituciones
MOH institutional capacity
Contar con personal capacitado
Contar con la capacidad institucional
Asumir responsabilidad en unidad de planeamiento
Incluirlo en el SISGAF
Establecerlo como rutina—proceso regular MOH—legitimarlo via uso
Financial and budgeting actions
Reorganizacion de la Oficina de Presupuesto y sistema presupuestario
Additional financial and human resources
Contar con recursos adicionales
To make it demand driven
Crear la necesidad de NHA
Agencies support and technical assistance
Necesidad de acompañamiento por parte de agencias
Continuar capacitación e intercambio entre países
Avalailability of information
Information, communication, diffusion, and training
Crear el flujo de informacion y difusion (vender el producto)
Contar con publicaciones adecuadas
Seminarios de sensibilizacion y diseminacion Rs.
Capacitacion del personal
Legal framework
NA
NO INFORMATION
4. USE OF MONITORING HEALTH SECTOR REFORMS
Question 9: Limitations and weaknesses for institutional use
Leadership, political decision-making, MOH will and process management
No hay una decisión política
Crisis de liderazgo y de dirección del MOH
La reforma se manejaba como tema politico dificil de medir
Indefinicion de reglas
Resistencia a la evaluación
No hay confianza en el MOH por parte del gobierno central
Dependencia de la reforma de salud de la del estado
Paralelismo con la Seguridad Social
MOH institutional capacity
No es rutina de la institucion, ni practica permanente
Mala administración y organización
No hay experiencia y limitada capacidad gerencial
Reform unit’s functioning and parallelism with MINSA
APPENDICES
68
Era responsabilidad de Ministerio paralelo no de la oficina
No hubo participación de equipos de BM y BID
Reform as a public policy: definition and internal consistency
¿Qué es reforma? Alto nivel de incertidumbre en la definicion de reforma
Tener una política nacional de reforma
Information, communication, and diffusion
Falta de difusion y de conocimiento de la metodología
Information system
Los sistemas de soporte de informacion limitados, multiples y desordenados
Not an MOH demand-driven tool
No es una necesidad sentida del pais
Instrument consistency, technical quality, and applicability to country
Instrumento extenso, complejo y demasiados indicadores, receta
Tiempo de adaptacion de la metodologia a RD
Necesidad de negociar y concertar la metodologia
La metodología de OPS venía por solicitud de esa oficina
Se preparan los resultados, se mandan pero no tenemos respuesta (feedback)
Falta d apoyo técnico de la OPS
External constraints
No limitations
NA
10: Factors facilitating its application
Leadership, political decision, MOH will, and process conduction
Political decision and MOH will
Technical will
Comision de la Ofic. de Estad. e Inform. Del MINSAL para ordenar el SIS
National process favoring health sector reform (commitment, agreement, advocacy, and negotiation)
Methodology adaptation to country reality and needs (indicators selection)
Need to define health reform policy and objectives; the matrix defines the reform
Es necesario demostrar resultados de reforma (inversión social) condonación de deuda
MOH institutional capacity
Incremento de la capacidad instalada y nivel gerencial del MOH
Agency cooperation: coordination and country support
International agreement with PAHO: cumplir con PAHO, acuerdo de Ministros
Interagency agreement and collaborative support to the country (PAHO, PHR, USAID)
External factors
Exigencia de Consejo de Ministros o necesidad politica de mostrar Rs
Information, communication, diffusion, and training
NGO participation
None
NA
11: Requirements for sustainability
Leadership, political decision, MOH will, and process conduction
Decisión política de priorizar la salud e impulsar la reforma y su monitoreo
Que una unidad del MOH asuma la responsab.–tablero de mando estrategico
Institucionalizar el proceso
Que sea parte de instrumentos cotidianos (apropiacion)
To achieve different actor’s consensus and agreement on the matrix
MOH institutional capacity
Contar con personal capacitado y capacidad instalada
Articulación con SIGAF
Reform as a public policy: definition and internal consistency
Tener claridad de objetivos y definir obj. de mediano plazo., definir la reforma
Agency cooperation: coordination and country support
APPENDICES
69
Technical assistance of MHO on monitoring matrix from the agencies
Necesidad de apoyo interagencial para aplicar la metodología
To approve the legal framework
To make it demand driven
Crear la necesidad de la metodología y que se adapte a las necesidades del pais
Information, communication, diffusion, and training
Crear el flujo de informacion y difundir la herramienta, venderla
Additional financial and human resources
Contar con recursos adicionales
NA
5: NGOs IN HEALTH SECTOR POLICY AND PUBLIC SECTOR CONTRACTING
NGOs (PHR)
5. Limitations and weaknesses for institutional use
Leadership, political decision, MOH will, and process conduction
History of relationship MHO and NGOs (subsidio y clientelismo) tensión y desconfianza
Resistencia del MINSAL y no hay interés
No se conocen las reglas de juego de la reforma, descentralización y participación del sector privado
No se sabe el papel de las ONGs y si las leyes actuales permiten su participación
MOH institutional capacity
MOH no tiene capacidad para regular (regulación financiera)
No hay historia ni tradición
El MHO no tiene la capacidad institucional para relacionarse con ONGs
NGOs institutional capacity
No se cuenta con personal capacitado para instrumentar
Debilidad institucional de las ONG para negociación y manejo de fondos
Legal framework
Marco legal existente (asignación clientelar a ONGs)
Information, communication, and diffusion
Falta de difusion y de conocimiento
External constraints
El terrorismo dificultó organización popular
NA
6: Factors facilitating its application
Leadership, political decision, MOH will, and process conduction
Tener obj. precisos y mostrar Rs, concretos
El MINSA sea promotor
Lograr la concertación y cooperación de todos los sectores sobre el tema
La aceptación de roles distintos de cada actor
Decisión política: cambiar las reglas de relación MHO–NGO
MOH institutional capacity
La experiencia del CLAS
Reform achievements: transparency, building capacity
La privatización de servicios obliga a competencia
Identificar y fortalecer mecanismos de contratación
Legal framework and regulation
Se está creando la base legal para la regulación
NGOs institucional capacity
Reunir a todas las organizaciones
Vocación de fortalecimiento rectoría del MOH
Agency cooperation: coordination and country support
Interagency support (MINSA–OPS–USAID)
Visitas para conocer experiencias (Boston–PHR)
Workshop quality and government and NGO participation and dialogue
APPENDICES
70
Incorporación de sector público y ONG en los talleres–diáologo y negociación
NA
7: Requirements for sustainability
Leadership, political decision, MOH will, and process conduction
Ley de descentralización, claridad en proceso y definición relación público-privado
Llevar a concertación y discusión el marco legal (proceso similar a matriz): lograr consenso y
confianza
Decisión política: Cambiar las reglas de relación MHO–NGO
Necesidad de mostrar resultados concretos
Definir espacios claros donde las ONG puedan trabajar y participar en ambiente de confianza
MOH institutional capacity
Institutional redesign of relationship MHO and NGOs
Accountability entre gov. y NGOs
Fortalecer al MHO
NGOs institutional capacity
Reacomodo final de los CLAS
Capacidad de movilización de fondos de los ONGs
Fortalecer a NGOs
Legal framework
Aprobación de ley de salud
Community participation
Information, communication, and diffusion
Adecuación de la experiencia de otros
Mostrar resultados de los CLAS
Información sobre la reforma
NA
6: USE OF GUIDELINES FOR ASSESSING THE POLICY PROCESS (DDM)
5. Limitations and weaknesses for institutional use
Institutional capacity
No hay suficiente capacidad gerencial
Information
Falta de difusion y de conocimiento
NA
6: Factors facilitating its application
Agency cooperation: coordination and country´s support
Apoyo de PHR
NA
7: Requirements for sustainability
Institutional capacity
Capacidad gerencial y RRHH en MOH
NA
7: USE OF DECENTRALIZATION STUDY/DECISION SPACE (DDM)
6: Limitations and weaknesses for institutional use
Health reform leadership, political decision, and process conduction
Falta de voluntad política
Diferencias entre distintas toldas políticas frente a trans., de poder
Dependencia de la reforma de salud de la del Estado—contradicción
Legal framework
Information
Falta de difusion, conocimiento y análisis
Research´s technical quality and applicability to country
Hacer la investigación en Honduras
None
APPENDICES
71
NA
7. Factors facilitating its application
Health reform leadership, political decision, and process conduction
Decisión política del MOH
Interés de la asociación municipal
Research´s technical quality and applicability to country
Que se discuta, se aplique y se valide en Hoduras
Community participacion
Agencies promotion
NA
8. Requirements for sustainability
Health Reform Leadership, political decision and process conduction
Decisión política del MOH respaldada por nivel central
Institutional capacity
Quedará institucionalizado en el SIGAF
Fortalecer capacidad institucional del MOH
Que el proceso de análisis y decisión se haga por el MOH y no por consultores externos
NA
8. TAKING STEPS AFTER PAYMENT MECHANISMS FORUM
6. Limitations and weaknesses for institutional use
Leadership, political decision, MOH will, and process conduction
Falta de decisión política
No hay avances del Ministerio de la Presidencia
MOH institutional capacity
Debilidad institucional de la Adm. Pública y del MINSA
Cultura del sector público: no identificación de metas
Falta de complementación sector público, Seguridad Social y sector privado
No se han incorporado contratos de gestión
Formas de conatratación del personal
Legal framework
Leyes actuales de presupuesto
Se deben aprobar las leyes de salud y Seguridad Social
Finance system, financial and budgeting constrains
Financiamiento fragmentado del MINSA
Sistema de financiamiento vigente para Seguros
Information System
Debilidad de sistemas de información
Ausencia de sistemas de costo
No information
NA
7. Factors facilitating its application
Leadership, political decision, MOH will, and process conduction
Decisión política
Mostrar capacidad de negociación con base a metas
Voluntad institucional para ordenar el gasto—Rs. prioritarios
Logro de consenso
MOH Institutional capacity
Contar con el sistema integral de Adm. Financiera (SIAF)
Tener una estructura funcional programática
Incorporación de esquemas sencillos—incentivos
Realocación de presupuesto por programas
Afinamiento de la metodología e instrumentos
Information system available
Sistemas de información operando
APPENDICES
72
Other agencies’ projects
Proyectos FONSOL, FONHOS y FONAP con el BID
Financing system
Unificación del presupuesto del MINSA
Legal framework
Aprobar el marco legal ley de salud y de SS
External factors: Economic recession
No information
NA
8. Requirements for sustainability
Leadership, political decision, MOH will, and process conduction
Voluntad política de actores
Que exista la oportunidad y voluntad con capacidad institucional
MOH institutional capacity
Capacidad institucional del MINSA a nivel local
Change the financing system of the governments
Implementation systems of payment on place and functioning
Seguro escolar y seguro materno-infantil
Financiar seguros escolar y materno con gastos de inversión
Definir mecanismos de asignación
Poner en macrha el Seguro Único
Que se demuestre el éxito en proyecto piloto
Information system on production and costs
Contar con sistema de información sobre producción y auditoría
Montar sistema de vigilancia de costos y control
Community participation on quality control and audit
No information
NA
9. TAKING STEPS AFTER STUDY TOUR HOSPITAL AUTONOMY IN PANAMA
6. Limitations and weaknesses for institutional use
Health reform leadership, political decision, and process conduction
Lack of political decision
Resistencia al cambio de RRHH
El Ministro no tiene respaldo político
MOH institutional capacity
MOH and hospitals’ institutional capacity and institutional design
Health policy of the state and of MHO
Reform as a public policy: definition and internal consistency
MOH lack of conceptual framework on hospital
Legal framework
Lack of financial resources
Study tour’s technical quality and applicability to country
Study tour applicability
Study tour quality consistency
Study tour actor selection
Information, communication, and diffusion
Campaña dirigida a sindicatos
External factors
Inestabilidad política que genera inseguridad laboral
Situación económica-social del país
Oposición de sindicatos a la privatización
None
NA
7. Factors facilitating its application
APPENDICES
73
Health reform leadership, political decision, and process conduction
Political decision of MHO ministries
Technical will
MOH institutional capacity
Capacidad institucional del MOH
Proceso de modernización de los hospitales en marcha
MHO needs to be efficient
Agency’s technical asisstance and interagency coordination
Community participation
Health needs of the population
Community participation
Legal framework covenant
Study tour’s applicability to country, customization, and participant selection
Study Tour actors selection
Study Tour diffusion
Demand driven
Convencer a los que tienen la capacidad de decisión política
None
NA
8. Requirements for sustainability
Political decision and will
Decisión y voluntad política
Promote the decentralization process
Generar un ambiente de confianza y transparente en el proceso
MOH and hospital institutional capacity
Selección y capactación de gerentes y nuevo sistema de incentivos
Fortalecer instituciones de salud
Cuentas nacionales como instrumento de negociación y decisión política
Agency’s technical asisstance and study tours for MHO staff
Asistencia técnica para gerentes adaptada a nuestra realidad
Transference of knowledge to MHO staff
Study tour actor selection (technicians and stakeholders)
Additional financial resources
Legal framework covenant
To have concrete results to show
NA
10. TAKING STEPS AFTER STUDY TOUR OF HOSPITAL AUTONOMY IN
COLOMBIA
6. Limitations and weaknesses for institutional use
Health reform leadership, political decision, and process conduction
Lack of political decision
Resistencia al cambio de RRHH
El Ministro no tiene respaldo político
MOH institutional capacity
MOH and hospitals’ institutional capacity and institutional design
Health policy of the state and of MHO
Reform as a public policy: definition and internal consistency
MOH lack of conceptual framework on hospital
Legal framework
Lack of financial resources
Study tour’s technical quality and applicability to country
Study tour applicability
Study tour quality consistency
APPENDICES
74
Study tour actor selection
Information, communication, and diffusion
Campaña dirigida a sindicatos
External factors
Inestabilidad política que genera inseguridad laboral
Situación económica-social del país
Oposición de sindicatos a la privatización
None
NA
7. Factors facilitating its application
Health reform leadership, political decision, and process conduction
Political decision of MHO Ministries
Technical will
MOH institutional capacity
Capacidad institucional del MOH
Proceso de modernización de los hospitales en marcha
MHO needs to be efficient
Agency’s technical asisstance and interagency coordination
Community participation
Health needs of the population
Community participation
Legal framework covenant
Study tour’s diffusion and applicability to country
Study tour actor selection
Study tour diffusion
Demand-driven
Convencer a los que tienen la capacidad de decisión política
None
NA
8. Requirements for sustainability
Political decision and will
Decisión y voluntad política
Promote the decentralization process
Generar un ambiente de confianza y transparente en el proceso
MOH and hospital institutional capacity
Selección y capactación de gerentes y nuevo sistema de incentivos
Fortalecer instituciones de salud
Cuentas nacionales como instrumento de negociación y decisión política
Agency’s technical assistance and study tours for MHO staff
Asistencia técnica para gerentes adaptada a nuestra realidad
Transference of knowledge to MHO staff
Study tour actor selection (technicians and stakeholders)
Additional financial resources
Legal framework covenant
To have concrete results to show
NA
11.TAKING STEPS AFTER STUDY TOUR HEALTH SYSTEM (CANADA)
6. Limitations and weaknesses for institutional use
Study tour’s technical quality and applicability to country
The selection of the study participants: need of participation of decision-makers and technicians
The selection of the experiences and countries
The applicability of country experiences (el modelo que se está siguendo aquí es el chileno)
Legal framework
APPENDICES
75
Las leyes que están en el Congreso de Seguridad Social va en contra del modelo Canadiense
12. USE OF THE MANAGEMENT AND ORGANIZATIONAL SUSTAINABILITY
TOOL
7. Limitations and weaknesses for institutional use
Instrument consistency and technical quality (incomplete and superficial)
None applicable to different types of NGOs (only small NGOs)
None designed for Peru's NGOs
NA
8. Factors facilitating its application
MOST has not been applied in NGO
9. Requirements for sustainability
NA
13. USE OF COST REVENUE TOOL
7. Limitations and weaknesses for institutional use
Difficulties with tool implementation and need for adjustment
Human resources resistant to change
NA
8. Factors facilitating its application
Accomplishment of goals on schedule
Legal agreement with USAID
USAID support
Institutional commitment
9. Requirements for sustainability
It is instutionalized yet based on our agreement with USAID
Difficulties in getting the cost data from regional offices
14. USE OF PERFOMANCE INCENTIVE SYSTEM
7. Limitations and weaknesses for institutional use
Cultural factors
Budget system
NA
8. Factors facilitating its application
The results: it improves the productivity and efficiency
Institutional commitment
NA
9. Requirements for sustainability
Availability of financial resources
15. NGOs IN DECENTRALIZED SYSTEM (FPMD)
6. Limitations and weaknesses for institutional use
No participation of public sector in Initiative’s meeting
NA
7. Factors facilitating its application
In-country process (habilitación y acreditación de NGOs)
8. Requirements for sustainability
Keep going in the process and demanding public sector
NA
APPENDICES
76
16. NGOs QUALITY ASSURANCE (FPMD)
6. Limitations and weaknesses for institutional use
No participation of public sector in Initiative’s meeting
Meeting’s quality (material and meeting conduction)
Lack of information and documents on QA
Less relevance to quality assurance in country process
NA
7. Factors facilitating its application
Start de process of Quality Assurance
In-country process (habilitación y acreditación de NGOs)
Agency support and technical assistance
8. Requirements for sustainability
Keep going in the process and demanding public sector
NA
APPENDIX F
RESULTS FRAMEWORK ANALYSIS
IRs, Indicators and Expected Results of Tools,
Methodologies, Instruments, Experiences, Forum, and Study Tours
(March 2000)
TOOLS,
METHODOLOGIES,
AND EXPERIENCES
EXPECTED RESULTS BASED ON
INTERMEDIATE RESULTS
EXPECTED
RESULTS BASED
ON INDICATORS
EXPECTED RESULTS BASED ON
INITIATIVE’S DOCUMENTS AND
ANNUAL REPORT FY99 (quoting)
EXPECTED RESULTS (INDICATORS)
FOR MIDTERM EVALUATION BASED
ON INITIATIVE’S IR, INDICATORS, AND
REPORTS
Tools and
Methodologies
INTERMEDIATE RESULT 3.4.1 Intermediate Result
3.4.1
Tool for Plan Investment
(TPI)
3.4.1 TPI developed, tested and
disseminated for analysis and design,
implementation and monitoring of
country health sector reforms
3.4.1. TPI used by
key actors
· The framework for detailediImplementation
plans of health sector reform (HST) and
master plans of investment has already been
developed
· The tool was pilot tested in Honduras
· Use of the tool
· Development and testing of the tool
National Health
Accounts (NHA)
3.4.1 NHA developed, tested and
disseminated for analysis and design,
implementation and monitoring of
country health sector reforms
3.4.1. NHA used by
key actors
· The tool is in process of institutionalization
· The tool is in process of application and
adaptation to countries (customization)
· Use of the tool
· Application and adaptation to countries
· Institutionalization of the tool
Performance Incentive
System (PYS)
3.4.1 PYS developed, tested and
disseminated for analysis and design,
implementation and monitoring of
country health sector reforms
3.4.1. PIS used by
key actors
· PYS helps the NGOs to explore new
strategies for linking employee compensation
to performance and productivity
· NGOs know the tool
· NGOs applying or using PYS to explore
and apply incentive system
Cost Revenue Analysis
(CORE)
3.4.1 CORE developed, tested and
disseminated for analysis and design,
implementation and monitoring of
country health sector reforms
3.4.1. CORE used by
key actors
· CORE helps the NGOs to analyze the costs
and revenues in order to improve the
efficiency, coverage, and financial viability
of clinic services
· NGOs know the tool
· NGOs applying or using CORE to do an
analysis of costs and revenues
Management and
Organizational
Sustainability Tool
(MOST}
3.4.1 MOST developed, tested and
disseminated for analysis and design,
implementation and monitoring of
country health sector reforms
3.4.1. MOST used by
key actors
· MOST helps organizations identify needed
changes in essential management
components and plan for implementing these
changes toward sustainability
· NGOs know the tool
· NGOs applying or using MOST for
management and organizational purposes
as a tool for sustainability
Guidelines for Policy
Process: Health Policy
Process Applied
Research (GPP)
3.4.1 GPP developed, tested and
disseminated for analysis and design,
implementation and monitoring of
country health sector reforms
3.4.1.GPP used by
key actors
· Draft country reports are under review
· Two country workshops accomplished
· Development of guidelines has begun
· Draft synthesis report almost complete
· Initiation of training module
· Technical assistance on policy process
provide in Honduras
· Guidelines in development and testing
process
· Recognition (knowledge) by MOH of
technical assistance received for policy
process on HSR
Decentralization Applied
Research (Decision
Space) (DAR)
3.4.1 DAR developed, tested and
disseminated for analysis and design,
implementation and monitoring of
country health sector reforms
3.4.1. DAR used by
key actors
· Article based on concept paper published in
Social Science and Medicine
· Concept paper distributed
· Article in LAC HSR Newsletter: Reform in
Motion
· Guidelines for decentralization policy in
development
· Results of research are known by people of
MOH
TOOLS,
METHODOLOGIES,
AND EXPERIENCES
EXPECTED RESULTS BASED ON
INTERMEDIATE RESULTS
EXPECTED
RESULTS BASED
ON INDICATORS
EXPECTED RESULTS BASED ON
INITIATIVE’S DOCUMENTS AND
ANNUAL REPORT FY99 (quoting)
EXPECTED RESULTS (INDICATORS)
FOR MIDTERM EVALUATION BASED
ON INITIATIVE’S IR, INDICATORS, AND
REPORTS
Contracting NGO
Services (DR) (C-NGOs)
3.4.1 C-NGOs developed, tested and
disseminated for analysis and design,
implementation and monitoring of
country health sector reforms
3.4.1. C-NGOs used
by key actors
· Discussion of the issues and experiences on
topic by LAC countries in a regional meeting
· Participants of the meeting learn from one
another’s experiences directly
· Create connections for sharing of information
· Paper and tool on C-NGOs in
development and test
· Use of the experience
· Sharing of information
NGO in the Health
Reform (Policy Process)
(Bolivia) (NGOs-HSR)
3.4.1 NGOs-HSR developed, tested and
disseminated for analysis and design,
implementation and monitoring of
country health sector reforms
3.4.1. NGOs-HSR
used by key actors
· Discussion of the issues and experiences on
topic by LAC countries in a regional meeting
· Participants of the meeting learn from one
another’s experiences directly
· Create connections for sharing of information
· Paper and tools on NGOs-HSR in
development and testing
· Use of the experience
· Sharing of information
Reform Process
Monitoring
Intermediate Result 3.4.3 Indicator 3.4.3.
Methodology or
Framework for
Monitoring HSR (MHR)
3.4.3. Reform processes, specifically
related to equitable access, and outcomes
monitored and feedback provided to
countries, donors and other partners
3.4.3.a. Country
monitors health sector
reform using
framework
established by PAHO
· Reports based on the framework have been
prepared by 11 of the 13 target countries
· The framework has been revised
· The database began to be developed
· To build national capacities to use the
framework, one subregional training
workshop would be conducted during FY99
· Methodology is known by MOH
· MOH’s team monitors HSR using PAHO
framework
· Some degree of institutionalization after
workshops
Sharing experiences
and taking steps based
on lessons learned
Intermediate Result 3.4.4. Indicator 3.4.4.
Forum on Provider
Payment Mechanisms
3.4.4. Forum on provider payment
mechanisms as an opportunity and means
to share experiences and advice among
countries
3.4.4. 5O% of
participants in forum
report taking steps
based on lessons
learned in forum
· Networking
· Promote exchange of experience and advice
among individuals and organizations
· Sharing: Exchange of experience and
advice on topic
· Participants taking steps after forum
Study Tour—Panama 3.4.4. ST Panama as an opportunity and
mean to share experience and advice
among countries
3.4.4. 5O% of
participants in study
tour report taking
steps based on
lessons learned in
study tour
· Promote exchange of experience and advice
among individuals and organizations
· Promote participants in study tours taking
steps based on lessons learned
· Sharing: Exchange of experience and
advice on topic
· Participants in study tours taking steps
based on lessons learned
Study Tour—Colombia 3.4.4. ST Colombia as an opportunity
and means to share experiences and
advice among countries
3.4.4. 5O% of
participants in study
tour report taking
steps based on
lessons learned in
study tour
· Promote exchange of experience and advice
among individuals and organizations
· Promote participants in study tours taking
steps based on lessons learned
· Sharing: Exchange of experience and
advice on topic
· Participants in study tours taking steps
based on lessons learned
Andean Region Forum in
Bolivia, Santa Cruz,
Bolivia, 1999
3.4.4. Andean forum on health as an
opportunity and means to share
experiences and advice among countries
3.4.4. 5O% of
participants in forum
report taking steps
· Networking
· Promote exchange of experience and advice
· Sharing: Exchange of experience and
advice on topic
TOOLS,
METHODOLOGIES,
AND EXPERIENCES
EXPECTED RESULTS BASED ON
INTERMEDIATE RESULTS
EXPECTED
RESULTS BASED
ON INDICATORS
EXPECTED RESULTS BASED ON
INITIATIVE’S DOCUMENTS AND
ANNUAL REPORT FY99 (quoting)
EXPECTED RESULTS (INDICATORS)
FOR MIDTERM EVALUATION BASED
ON INITIATIVE’S IR, INDICATORS, AND
REPORTS
based on lessons
learned in forum
among individuals and organizations · Participants taking steps after forum
NGOs in
Decentralization
3.4.4. NGOs in decentralization working
group as an opportunity and mean to
share experience and advice among
countries
3.4.4. 5O% of
participants in
working group report
taking steps based on
lessons learned in
working group
· Networking
· Promote exchange of experience and advice
among individuals and organizations
· Sharing: Exchange of experience and
advice on topic
· Participants taking steps after workshop
NGOs Quality Assurance 3.4.4. NGOs QA working group as an
opportunity and means to share
experiences and advice among countries
3.4.4. 5O% of
participants in
working group report
taking steps based on
lessons learned in
working group
· Networking
· Promote exchange of experience and advice
among individuals and organizations
· Sharing: Exchange of experience and
advice on topic
· Participants taking steps after workshop
APPENDIX G
CRITERIA FOR ASSESSING COMMUNICATIONS COMPONENTS IN
DEVELOPMENT PROGRAMS
APPENDICES
82
The criteria selected are applicable to both a Dissemination/Information and
Communications Strategy. It does not assume that a Development Communications
Strategy was in place.
ß Selection of targeted audiences. Why were some audiences selected as
priorities and how does this selection relate to the project overall design.
What kind of audience screening was done? What kind of change in terms of
knowledge, attitudes, behavior or pattern is expected to be achieved as a result
of the use of the information delivered by the Strategy?
ß Are the results of the Strategy in terms of both output performance and
expected impact defined clearly and with measurable indicators or
benchmarks?
ß Messages crafted and developed. Are the messages consistent with the desired
impact of the strategy? Are the messages clear, and do they take into account
the key audience’s problems and interests?
ß Is the media selected for carrying out the messages consistent with the
audiences to be reached.
ß Is there a corporate branding in place? Is it working?
ß Are the products and services delivered by the strategy consistent with the
messages and the overall brand of the Strategy?
ß Message delivery. Are we using the right channels for addressing the targeted
audiences? Is there a better way? Are we enlisting other groups that may
influence the audiences?
ß Is the Regional Approach of the Strategy consistent with the changes expected
at the national level?
ß Is there a sustainable institutional capacity to carry out the strategy?
ß Is there a Monitoring and Evaluation system established in order to improve
the strategy’s performance?
ß Is there a Risk Assessment of the Strategy, specifying the external factors that
could affect its effectiveness?
APPENDIX H
DATABASE IRs 1, 3, and 4 (RAW DATA)
CONFIDENTIAL DATA–PLEASE CONTACT MEDS FOR INFORMATION
APPENDICES
84
APPENDIX I
TOOLS, METHODOLOGIES, EXPERIENCES, EXCHANGES FORUM, AND STUDY
TOUR EVALUATION RESULTS: EFFECTIVENESS BY TOOL OR EXPERIENCE AND
COUNTRY EVALUATION RESULTS IRS 1, 3 AND 4
QUALITATIVE DATA INCLUDED
CONFIDENTIAL RATA DATA EXCLUDED –
PLEASE CONTACT MEDS FOR INFORMATION
APPENDICES
86
A. PLANS OF HSR AND MASTER PLANS FOR INVESTMENT (MPI) EVALUATION
RESULT
Framework for Detailed Implementation Plans of HSR and Master Plans for Investment
(MPI) (PAHO)3
The tool has been implemented in one country, Nicaragua (for which data were not available to
the evaluators) and is in the process of being tested and implemented in Honduras.
Factors that help in understanding the finding for use of this tool are the following:
1. This tool is in the development and testing stage in Honduras and key MOH staff is
knowledgeable of it. It is not possible to draw broad conclusions, patterns, or trends because
of the lack of data for Honduras.
2. The following are the perceived characteristics of the tool:
ß It is a high quality methodology
ß There is a need for the instrument (i.e., it is a demand-driven tool).
ß The training and technical assistance were consistent with national expectations but
tool implementation to this point has been centralized.
ß There has been an interactive process among different Institutions and key
stakeholders in developing the tool’s testing in Honduras.
ß There is alignment in PAHO headquarters and country office partnership efforts.
ß There has been stability and continuity of key actors favoring use of MPI.
ß There is a political coalescence regarding the need for the tool and for its inclusion on
the reform agenda.
ß The lack of adaptation to the country is perceived as an important limitation for
institutionalization.
ß There is a lack of Initiative partnership at the country level.
ß The tool is not part of the terms of reference of the in-country partners/consultants.
ß There is a perception of weak MOH institutional capacity to carry out MIP
development, testing, and implementation.
3. Lessons learned based from the experience in Honduras that need to be compared with the
results from Nicaragua are:
ß The macro nature of this tool requires that implementation take into account the
central level, local government, and local health systems.
ß Given its newness and comprehensive nature and because of the need for its
decentralization, a greater degree of technical assistance and adaptation to the country
is required.
Alignment of PAHO headquarters and country office staff is an important condition for successful
development, testing, and implementation of the tool.
 
3
 The midterm evaluation indicator for this tool is that it is being developed, tested and used in the health sector
reform process. See MPI evaluation results for detailed data, information, and specific analysis.
APPENDICES
87
B. NATIONAL HEALTH ACCOUNTS EVALUATION RESULTS (PAHO,
PHR, AND DDM)
Results Analysis
Finding 1: National Health Accounts is successfully implemented in two of the three
countries observed.
1. The common factors to the countries studied that are perceived as necessary to develop and
implement an NHA process are:
ß The tool is well known by the key stakeholders.
ß The methodology is considered to be of good to high quality.
ß There is a need for the methodology (i.e., it is demand-driven).
ß The regional approach has been complemented by country implementation.4
ß There is a strong partnership at the central (Washington) level supporting use of the tool.
2. The findings show a different outcome for the same key factors identified in Peru and
Honduras on the one hand and the Dominican Republic on the other. The factors clearly
perceived in Honduras and Peru5
 but missing in the Dominican Republic that result in
successful use of the tool are:
ß The NHA is actually part of the reform agenda of the MOH.
ß There is a consensus of key stakeholders on NHA.
ß There is continuity and stability of key staff working with and supporting NHA.
ß There is an interactive process among different institutions and key stakeholders around
the tool.
ß There is an Initiative partnership at the national level regarding the tool (Peru: PAHO and
Proyecto 2000 and Honduras: PAHO, USAID, and PHR).
ß Headquarters and local partner offices are aligned in supporting efforts to use NHA.
ß Political will to introduce NHA existed in Peru and Honduras6
 but in the Dominican
Republic there is a perception that the MOH does not have the political will or interest to
promote and support NHA.
ß NHA is now being used in Peru and Honduras by the MOH and the MOF but only by the
Central Bank in the Dominican Republic.7
 
4 The regional approach has been accompanied by national focus on NHA particularities.
5
 Peru is using satellite accounts as its version of NHA; Honduras is using the NHA itself. The key stakeholders in
Honduras perceived that the training they received was appropriate. In addition, there is a PHR consultant on site
with specific Terms of References related to NHA.
6Although in Honduras there is a perception of political will, the key stakeholders see political interference in MOH
decision-making in use of the methodology problematic. In the Dominican Republic, key stakeholders mentioned the
lack of a leadership of the MOH on health and health reform as the main limitation for the use of NHA.
7
 In the Dominican Republic, the MOH does not give the Central Bank health data and information routinely or on a
regular basis sufficient to build the NHA nor does it request or use results and findings from NHA. The problem is
not who has the leadership for implementing NHA. The development and implementation of NHA might be
undertaken by MOH, MOF, or the Central Bank, provided the information flows among the key institutions and yet
be utilized for the design and implementation of health policy. If this hypothesis is correct, then the partner
institutional strategy must include both the MOH and the MOF (or Central Bank). The selection of the institution for
the institutionalization of NHA would depend on the political will and institutional capacity of each organization in
the different countries.
APPENDICES
88
Finding 2: The tool is not institutionalized in any of the three countries observed.
There is some progress on NHA institutionalization in Peru. That is, there was a perception by
respondents that it was valuable to institutionalize use of the tool and they are working to
accomplish this goal. However, there was also a perception that the MOH does not have a specific
unit responsible for NHA nor trained personal carrying out regular tasks that use the available
management information system.8
 A visible similarity in the findings related to the analysis of
key factors was found explaining the lack of success in the institutionalization process. The
majority of key respondents perceived that:
ß There is no health reform policy.
ß The capacity needed for institutionalizing the NHA is weak at the MOH.
ß There are parallel, duplicative or competitive efforts between the MOH and other reform
units in the Dominican Republic and Peru and political interference in decision-making in
the Honduran MOH limit progress.
ß There is a limited training process for NHA implementation in Peru (the majority of key
stakeholders perceived that they did not receive personal training) and an inadequate
adaptation to national requirements in the Dominican Republic.
C. MONITORING HEALTH REFORM (PAHO) EVALUATION RESULTS
Results Analysis
Finding 1: The framework for monitoring health reform is well known in the Dominican
Republic, is known in Honduras, and is not known in Peru.
Information and data relevant to understanding this finding are the following:
ß The methodology was only in active use by the Dominican Republic and, in this case,
because it was adapted to national conditions. The final discussion and acceptance of the
matrix, which is the Dominican adaptation to monitoring health sector reform, was put in
place while the evaluation team was in the country.
ß In the Dominican Republic, the development and adaptation of the framework to national
conditions is having a high degree of success and is a facilitating factor for moving the
health sector reform agenda forward.
ß There is a visible difference in the findings of the factors that support the active use of the
tool in the Dominican Republic on one hand and the lack of use in Peru and Honduras on
the other. There are a number of factors that may help in understanding this apparent
anomaly.
Factors clearly perceived as being evident in the Dominican Republic and not present in Peru and
 
8
 See appendix E, excel sheet on NHA – Peru, answer to question 7: “Limitations and weaknesses for Institutional
Use”.
APPENDICES
89
Honduras are the following:
ß The (matrix) methodology in the Dominican Republic is perceived as one of high quality.
ß There is a clear and visible need for the methodology in the Dominican Republic and it is
demand-driven. Although 4 out of 8 key stakeholders in Honduras identified the
methodology as applicable and pertinent, only 2 out of 8 MHO officials perceived the
need for the framework.
ß There was a deliberate adaptation to national conditions.
ß Training and technical assistance met national expectations.
ß It was a case of thinking regionally and acting nationally.
ß There is a strong alignment of Initiative partners at the local level. They are working with
the PAHO framework with PHR’s Indicators Handbook for Health Systems Development.
ß There is an alignment of headquarters and local partner’s efforts.
ß In-country partners/consultants have the methodology as part of their specific tool related
terms of reference.
ß There is a participatory consensual development process with key stakeholders and
institutions.
ß There is stability and continuity of key actors supporting use of the MHR.
ß There is a tool inclusion in the reform agenda (see the operational definition of the
indicator in appendix E).
ß There is a national consensus on the need for MHR (the matrix).
ß The MOH (SESPAS) is perceived as having the institutional capacity to drive and perfect
the use of MHR.
Finding 2: The MHR Methodology is not institutionalized in the visited countries.
In Peru and Honduras, only one MOH official from one of the reform units in Peru acknowledged
or recognized the use and pertinence of the PAHO framework for MHR. But in the Dominican
Republic, 5 out of 6 MOH officials and 4 out of 4 units of reform personnel acknowledge or
recognize the use of the matrix for beginning to monitor health reform. Because of the use of this
adaptation of the tool, the Dominican Republic reinforcement through additional technical
assistance is advised to ensure success and institutionalization.
There are a number of possible explanations for the non-institutionalization of the methodology,
including those cited in the Results Framework section:
ß There is generally a lack of political will and decision to monitor health reform. In the case
of the Dominican Republic, the difference is the current leadership factor. The secretary of
SESPAS is pushing for the matrix and actually using it as a way of creating a coalition for
health sector reform.
ß There is a lack of a public policy on health reform.
ß There are parallel, duplicative, and competing organizations in the MOH and reform
units (Dominican Republic and Peru) and political interference in decision-making at
the MOH (Honduras).
APPENDICES
90
D. DECENTRALIZATION: DECISION SPACE (DDM) EVALUATION
RESULTS
Results Analysis
1. The tool is in the development and testing process and can be assessed only on that basis. It is
not possible to make a final evaluation of the degree of knowledge and application of this
technical assistance based only on Honduras’ data. There were a very small number of key
informants which does not lend itself to general conclusions or trends.
2. The particular results indicate that this technical assistance is known and used in a limited way
in Honduras (6 out of 13 respondents know it and 3 out of 13 use it). However, it appears to
be demand-driven since they are promoting health system decentralization (12 out of 13
respondents acknowledge it). The guidelines for decentralization policy are perceived as
useful and desirable (5 out of 6 respondents consider them necessary and pertinent).
Decentralization is a central part of the reform agenda, albeit supported by other donors
(Scandinavian countries).
3. The development, testing, and implementation of this activity have followed a different
approach than the rest of the tools and methodologies. The approach so far has been more
regional in focus than some others in that it is focused on academic targets and multilateral
agencies, such as the World Bank and its Flagship course. It could be seen as an important
factor facilitating the application of the research results to particular health system
decentralization. This is because participation in WB Flagship courses by MHO staff and
reform unit consultants is promoted and gives them the opportunity to learn and analyze the
research findings on decentralization from various countries.
E. HEALTH POLICY PROCESS APPLIED RESEARCH (DDM)
EVALUATION RESULTS
Results Analysis
1. As with the former activity, this tool is in the development and testing process and can be
assessed only on that basis. It is not possible to make a final evaluation of the degree of
knowledge and application of this technical assistance based only on Honduras’ data. There
were a very small number of key informants, which does not lend itself to general conclusions
or trends.
2. The particular results indicate that this technical assistance is known and is in limited use in
Honduras (only 4 out of 15 respondents know it and 5 out of 15 use it).9
 
9
Nevertheless, during the field work, organizational development was identified as a key activity. The Ministry of Health of
Honduras has had the benefit of technical assistance that helped set the vision and mission for the MOH. This is one of the
processes, which needs to be followed up by the MOH as part of a second phase of the organizational development project and
related directly to the need for a capable leader with authority to provide direction and stewardship to HSR in the country.
Because of this, it seems particularly relevant to support the MOH with additional technical assistance on policy process. The
results show that some factors would contribute to it. First, this topic is on the health reform agenda and the respondents
identified the “lack of health reform leadership, political decision-making, and process management” as the main factor affecting
health reform progress in the country. There is a PHR consultant with Terms of References related to this activity who is using
some of the policy tools in the selection of key actors and clients for dissemination of methodologies, documents, and experience
in HSR (Initiative and others).
APPENDICES
91
3. As with the previous activity, the approach for dissemination so far has been more regional in
focus than some others, given that it is focused on academic targets and multilateral agencies,
such as the World Bank and its Flagship course. It can be seen as an important factor
facilitating the application of the research results on policy process to promote specific health
reform. This is because participation in the WB Flagship courses by MOH staff and reform
unit consultants is promoted which gives them the opportunity to review and analyze the
research findings on health policy process.
F. NGOS IN HSR (HEALTH POLICY) (PHR) EVALUATION RESULTS
Results analysis for NGOS in HSR and public sector contracting NGOS
1. These types of tools are in the development and testing process and can be assessed only on
this basis.
2. Comparing the use and sharing of information of the two experiences between the Dominican
and Peruvian participants, some important differences were identified. In the Dominican case,
there is sharing of information with other workshop participants (based on the key stakeholder
information) and also the workshop’s results are been used to help the incorporation process
of NGOs into the health system in the Dominican Republic.
3. In the Dominican Republic, although there were only 1–3 participants in the experience, 12/16
and 11/16 key informants, respectively acknowledge the utilization of the workshop
conclusions for NGOs participation in HSR and for developing new forms of contracting
NGOs in the health system. This probably means that the participants have circulated and
disseminated the results of the workshop widely among key actors. From Peru, only 1 or 2
respondents participated and there is no evidence of dissemination of the workshop results. In
this case, these specific topics are not now on the health sector reform agenda.
4. In the Dominican case, the workshops have come to support a country process and key
informants see the experience as very useful for what they are trying to do (“acreditación y
habilitación de las NGOs). In Peru, local participation is being promoted through the Centros
locales de atención a la salud (CLAS), which is perceived differently from NGOs taking part
in health provision.
5. An important issue that the Dominican Republic participant raised during the interview was
the significance of having the private and public sectors together, participating and
collaborating in the workshop.
6. It is important to mention that in both countries, there is a perception of a lack of institutional
capacity on the part of both the MOH and NGOs and this limits MOH contracting NGOs for
health delivery.
7. In the Dominican Republic, it was evident that there is an interest in having NGOs as a new
partner in the health system. The evaluation process showed that there is a lack of partnership
with respect to the development of a tool in this area. In fact, one of the partners (OPS)
perceived it as a PHR/USAID Initiative.
8. Some of the lessons learned are based on the differences between the two countries with the
same Initiative experience. The first is that it is useful to define the specific need for technical
assistance consistent with the particular process in countries concerning NGO participation.
The second is related to the institutional strategy of the Initiative to work with NGOs.
 
APPENDICES
92
Respondents believed that it would be better to have a combination of public official
administrators with NGOs managers together in workshops. Finally, and perhaps as important
if not more important, is that it is necessary that the partners agree on private sector and,
specifically, NGO participation in health system and health sector reform.
G. FORUM ON PROVIDER PAYMENT MECHANISMS (PAHO)
EVALUATION RESULTS
Results analysis
The payment mechanisms forum did not achieve the midterm evaluation indicators in the two
countries that participated.
The following observations help in understanding this finding:
1. Key stakeholders interviewed in Peru and the Dominican Republic (Honduras did not
participate) related that no steps had been taken after this forum. In the Dominican Republic,
only two informants recognized the actual implementation of new payment mechanisms in the
health system. In Peru, even though 11 informants recognized the implementation of new
payment mechanisms, only one informant recognized the forum as having provided
information for the implementation of these mechanisms.
2. The findings show that the same key factors analyzed in Peru and the Dominican Republic
were responsible for similar results regarding this activity: “no steps taken based on the
forum or using forum experience as input.” In addition,
ß this was not a demand-driven issue,
ß there was only a regional approach,
ß there was no institutional strategy by partners,
ß there was no communication or dissemination strategy at the national level,
ß the experience was not adapted to national conditions,
ß headquarters and country partners were not aligned, and
ß there was a lack of institutional capacity and/or legal framework for the
implementation of new payment mechanisms.
The findings show a different outcome for the same key factors analyzed in Peru and the
Dominican Republic that may help explain the different results. Peru is implementing new
payment mechanisms (11 out of 16 informants recognize that implementation is occurring in
Peru) and the Dominican Republic has not yet initiated any action. Reasons that help explain this
are that
ß there is an Initiative partnership at the national level in Peru regarding payment
mechanisms (Proyecto 2000/USAID, OPS, and PHR),
ß there is a political decision in Peru supporting payment mechanisms,
ß the topic is on the health sector reform agenda in Peru, and
ß there is a national consensus regarding the need for new payment mechanisms in the
health system.
APPENDICES
93
H. COLOMBIA STUDY TOUR (PHR) EVALUATION RESULTS
Result Analysis
There is a perception of the key informants from the Dominican Republic and Honduras that they
are promoting hospital autonomy. However, only the respondents of the Dominican Republic
acknowledge the study tour to Colombia as providing input into the implementation of steps in
hospital autonomy and modernization.
Factors that help in understanding this finding are:
1. In the Dominican Republic, key informants recognize the use of the study tour input to the
implementation experience and in Honduras while the experience of the study was used, it
was not used by those who participated in the Colombia study tour. There are some important
differences among the three countries that need to be analyzed in order to explain the different
progress towards hospital modernization and autonomy.
2. In the Dominican Republic and Honduras there is a perception that they are promoting
hospital autonomy (8 out of 12 and 9 out of 13 informants), but in Peru only 3 out of 14
respondents recognize that they are working on hospital modernization and autonomy.
3. In the Dominican Republic, key informants recognized the use of the study tour as providing
inputs into the implementation of steps in hospital modernization and autonomy. Curiously,
the key actors perception is that steps have been taken in Honduras but not as a result of the
study tour experience. Accordingly, none of the two participants report taking steps based on
lessons learned in the study tour. There are some important differences among the three
countries that require further analysis in order to explain the different in progress towards
hospital modernization and autonomy. Some of the possible explanations are:
ß common factors among the three countries: there was no communication and
dissemination strategy perceived at the national level and the experience was not
adapted to national needs for implementation purposes.
ß There are different factors that must be considered between the Dominican Republic
on the one hand and Honduras and Peru on the other:
ß The study tour to Colombia is used as an input for hospital autonomy promotion in the
Dominican Republic.
ß The study tour was perceived as pertinent and applicable in the Dominican Republic.
ß The perception of quality of the study tours varies among the three countries. In the
Dominican Republic and Peru informants perceived it as being of high quality, while
in Honduras the informant perceived its quality to be between fair and good.
ß Study tour participants from the Dominican Republic were not only from the MOH but
some were also hospital directors, as was the MOH official from Honduras. The
participant from Peru was a consultant to USAID project.
ß There is an Initiative partnership at the national level regarding hospital autonomy in
the Dominican Republic.
ß Key informants of the Dominican Republic perceived that a political decision and
policy promoting hospital autonomy exists and is helping in taking steps.
APPENDICES
94
4. There are some common factors between the Dominican Republic and Honduras: there is
headquarters and local hospital alignment in the hospital autonomy effort and the hospital
autonomy issue is on the health reform agenda.
I. PANAMA STUDY TOUR (PAHO) EVALUATION RESULTS
Results Analysis
The Dominican Republic and Honduras perceive themselves as promoting and taking actions to
increase hospital autonomy and in both cases the key informants recognized the use of the study
tour as providing input into the implementation of steps in hospital modernization and autonomy.
The hospital autonomy issue is on the health reform agenda of both countries and both of the
countries are promoting hospital autonomy. There are a number of factors that help explain why
the study tour was apparently successful:
ß Key informants perceived the study tour experience as providing them with inputs for
hospital autonomy.
ß The tours were perceived as being of high quality.
ß The study tour is perceived as pertinent and applicable in both countries. In the Dominican
Republic, the MOH and reform unit officials recognized the applicability and pertinence
of the study tour but the hospital director did not. In Honduras, there is a perception of
greater applicability of the Panama experience.
ß Study tour participants were from both the MOH and the hospital directorate organization.
ß In both cases, modernization and hospital autonomy are on the health sector reform
agenda.
ß The experience was not prepared for adaptation to the two countries.
ß There is no communication and dissemination strategy at the national level with
respect to hospital modernization and autonomy.
APPENDIX J
RESULTS ON DISSEMINATION STRATEGY
CONFIDENTIAL DATA–PLEASE CONTACT MEDS FOR INFORMATION
APPENDICES
96
APPENDIX K
HSR LAC NEWSLETTER CONCEPT PAPER
APPENDICES
 98 
Background 
The Latin America and Caribbean Regional Health Sector Reform Initiative has 
identified four groups of activities as strategies for capacity building. One group of 
activities focuses on gathering information on health reform efforts and experiences and 
making them widely available to interested parties in the Americas as well as health 
sector donors. A newsletter that is published periodically has been proposed as a means 
of disseminating both general information and special reports on health sector reform in 
printed format. 
There is widespread and growing interest in Latin American and Caribbean countries 
about health sector reform policies, instruments, and results. Although electronic 
communication systems are rapidly developing, many technological barriers to 
information on health reform still exist in the region. In some situations, print formats 
may be more appropriate for dealing with particular materials and for reaching specific 
audiences. The newsletter is meant to complement electronic dissemination methods and 
help facilitate access to information. 
Rationale and Purpose 
The newsletter remains a popular mass media tool because it possesses certain 
advantages when used strategically. It is an effective communication instrument for 
niche audiences interested in information that is not easily found elsewhere and for 
stakeholders who want to know about different perspectives and significant developments 
in defined areas. The use of newsletters allows the publishing organization(s) to exercise 
greater control over the choice of subject matter, timing and mode of presentation. 
The original proponents of this component of the Initiative saw the newsletter as a 
vehicle for actively disseminating information about health sector reform and the 
development of the project. The newsletter was expected to be comprehensive in scope, 
Que es la Iniciativa Regional para la Reforma del 
Sector Salud
6%
16%
16%
46%
0%
0%
16% Programa financiado por la
OEA 
Iniciativa de la Cumbre
Presidencial de 1994
Programa de la OPS 
Iniciativa ejecutada por inst
publ/privadas
idea del Mercosur
Todo lo anterior
No sabe/no responde
APPENDICES
99
containing general information as well as special reports on health sector reform and
covering a variety of topics and activities taking place in the countries. Through the
newsletter, the partners of the Initiative could communicate findings of studies supported
by the project, summaries or highlights of developments in important issues, and
interesting reports on people and events associated with health reform.
Audiences
Dissemination targets referred to in the proposed work plan are widely inclusive. They
include institutions and individuals engaged in implementing reform activities, health
sector donors, as well as other interested parties. These categories of potential audiences
typically comprise policymakers, health care managers/providers, researchers,
international cooperative agencies and nongovernmental organizations. In addition to
sharing a common interest in health sector reform matters, different subgroups are also
likely to favor varying emphasis on the technical, policy, academic, or other aspect of
information delivery. To enhance its appeal to this diverse readership, the newsletter
could combine instructional elements and activity- or event-based articles with a public
relations–oriented approach.
Contents, Structure and Other Specifications
In an effort to capture the spirit behind the goal of publishing a newsletter (or periodic
bulletin) as articulated in the original proposal, the contents will be characterized and
organized in the following manner:
APPENDICES
100
PROPOSED ORGANIZATION OF CONTENTS
SECTIONS SECTION A SECTION B SECTION C SECTION D SECTION E
TITLES FEATURE
PRESENTATIONS
INITIATIVE TOOLBOX REFORM JOURNAL
RESOURCES AND
SERVICES
PREVIEWS AND
REVIEWS
GENERAL DESCRIPTION
OF CONTENTS
Features pertinent
to the thematic
focus of a
particular issue;
articles on topics
of special interest
Updates on the development and
application of tools and
methodologies
Write-ups on
significant issues
in HSR in LAC,
using actual events
to anchor the who,
what, where, and
when
Marketing
information on
resources and
services offered
through the
Initiative web
site
Bulletins on selected
regional activities,
abstracts of Initiative
publications.
EXAMPLES OF ITEMS
SELECTED
[Based on
proposed thematic
focus for first issue:
Raising
Awareness of HSR in
LAC by highlighting
accomplish-ments of
the regional Initiative
in the 1st year]
Item A-1
Welcome or
Introduction
Article
Item A-2
Article
highlighting
utilization of the
Clearinghouse
Item B-1
COST tool
Item B-2
Decentralization
Item B-3
Health sector analysis
Item B-4
Implementation and investment
plans
Item B-5
MOST tool
Item B-6
Monitoring equitable access
Item B-7
Monitoring HSR
Item B-8
National Health Accounts
Item B-9
Policy process
Item C-1
Steering role of
ministries of health
in HSR
Item C-2
Monitoring HSR
Item C-3
National Health
Accounts
Item C-4
Provider payment
mechanisms
Item D-1
Thesaurus on
Health Sector
Reform and
Grey Literature
Database
Item D-2
Network of Key
Actors in Health
Sector Reform
Item E-1
4
th National Health
Accounts’ Meeting in
El Salvador
Item E-2
Subregional Andean
Forum on HSR, Bolivia
Item E-3
Study Tours:
Hospital Reform,
Colombia
Hospital
Autonomy, Panama
Item E-4
LAC HSR Publications
[Titles and Abstracts]
Other proposed specifications include:
ß Title: REFORMATICS, a combination of the two words reform and
informatics
ß Frequency of publication: twice a year
ß Length of newsletter: 8 pages
ß Page size and column width: standard 81/2 x 11”, 3 columns
ß Use of color: 2 colors
TAG ‘s views on the Newsletter
Format: the articles within the newsletter will be short extracts to generate demand for
reports
Authors: Each partner will be responsible for authoring extracts for those activities in
which it is involved. Topics for the newsletter will correspond to recent
events. Each extract should provide a short synthesis of the event itself and
highlight its broader significance in terms of health sector reform and
educational value. The newsletter (and all of the extracts) needs to be
technically reviewed prior to publication. The partners need to schedule a
follow-up meeting to discuss in further detail comments and suggestions on
the concept paper and the overall objective/strategy of the newsletter.
APPENDIX L
HITS RECORDED ON THE LAC/RSS WEB SITE
APPENDICES
102
February 23, 1998–Friday November 26, 1999
Total page hits: 534,027
Total bytes sent: 4,380,613,342
Number of pages summarized: 2392
Number of days spanned: 616
November 27, 1999–December 12, 1999
Total page hits: 25,500*
*Estimated average hits for the 17 days that the statistics administrator was offline (based on an estimate that the
average daily hits were at 1,500 per day).
December 13, 1999–Thursday, March 2, 2000
Total page hits: 216,651
Total bytes sent: 2,092,813,258
Number of pages summarized: 2315
Number of days spanned: 97
Grand total for 730 days (February 23, 1998–March 2, 2000): 776,178 hits
(Figures provided by PAHO)
APPENDIX M
OFFICIAL DOCUMENTATION OF THE STRATEGY
(MESSAGES DEFINED BY THE STRATEGY)
APPENDICES
104
According to the official internal documents from the Initiative, the audiences are defined as
follows:
“HRI publications and communications materials will reach a wide range of audiences. Some
publications will be developed for only one or two specific audiences, while others will be
developed to reach multiple audiences. Design of materials and decisions about dissemination
mechanisms, including, electronic tools will take into account the audiences and their access to
different technologies. These audiences include:
ß senior Ministry of Health policymakers and officials,
ß senior NGO managers,
ß midlevel managers in NGOs and government agencies, and
ß national and regional researchers.
In a later document. the audiences were almost defined in the same way, with the addition of
some internal customers and other governmental institutions.
Intended Audiences
“USAID Missions, PAHO field offices, multilateral development banks, bilateral development
agencies, multilateral development institutions, ministries of health, health sector reform
researchers, Social Security institutes, private sector health representatives, ministries of finance,
ministries of planning, decentralized health authorities, NGO representatives, health sector reform
teams”
— The goals and strategies of the Initiative are well founded and respond to important concerns
of these audiences. The implementation process is horizontal, not topdown.
— AID and PAHO are committing substantial resources to the Initiative so that it can make a
difference.
— The Initiative works in partnership with the target countries; reform groups work in countries
with a collaborating team of support agencies (the partners).
— The Initiative is a team effort which draws on the complementary skills and expertise of the
partner agencies. Who are the partners? Emphasize their nature as USAID projects first and as
agencies second. The partners can offer high-caliber assistance in very relevant areas. [There is
no separate information on the firms.]
ß The process of implementing the Initiative is participatory. The Initiative welcomes
the ideas of colleagues active in the field of health sector reform in Latin America and
the Caribbean.
ß Objective: to raise the profile of the Initiative and generate demand.
APPENDIX N
TRADITIONAL COMMUNICATIONS APPROACHES
APPENDICES
106
Table N-1
Social Marketing Public Relations Media Advocacy
ß Developing
messages to increase
knowledge and
model behaviors
ß Enhancing image of
sponsoring
organizations
ß Developing messages and cultivating
relationships in order to enhance the
organization's associations with key
publics
ß Setting the agenda
ß Shaping the debate
ß Advancing the policy
A) Target
ß Individuals with risk
factors
ß General public
B) Target
ß Customers, clients,
shareholders and current
funders
ß Potential supporters and
funders
ß General public
C) Target
ß Power holders and
policymakers
ß Producers and marketers
of health-affecting
products
ß Other advocates
ß General public
D) Impact
ß Knowledge and
behavior
E) Impact
ß Knowledge, familiarity,
name recognition
F) Impact
ß Power and resources
G) Actions
ß Reduce the target
audience’s perceived
barriers to accepting
the product while
simultaneously
making the product
as appealing as
possible
ß
H) Actions
ß Cultivate relationships and
project desired image;
maintain visible community
involvement to promote
favorable associations with
key publics
ß Use earned news media and
paid advertising to gain
exposure for organization
I) Actions
ß Use earned news media
and paid advertising in
conjunction with
community organization
strategies to put pressure
on policymakers and to
reframe public debate on
an issue
ß Can be used in
isolation, or as part
of larger efforts
ß Can be used alone, or as part
of integrated communication
efforts
ß Used in combination with
other community
organization and
advocacy efforts
Source: Advancing Public Health Goals through the Mass Media by L. Winnett and L. Wallack, in Journal of Health
Communication, Vol 1, pp173-196, 1996
APPENDIX O
PARTNERS’ OPINIONS ON AUDIENCES AND MEDIA
(OPINION DE SOCIOS SOBRE AUDIENCIAS Y MEDIOS)
APPENDICES
108
Audiencias a ser Tomadas en Cuenta por Estrategía de Comunicación Segun PHR y
DDM
Audiencias Socios de la Iniciativa
Tomadores de decisión Ministerio de Salud DDM, PHR
Tomadores de decisión sector privado DDM, PHR
Quienes dirigen las ONG DDM, PHR
Tomadores de decisión BM, BID, otros DDM, PHR
Los periodistas encargados de salud DDM, PHR
Los parlamentarios de comisión salud DDM, PHR
Opinión pública en general PHR
Los medicos PHR
Todos los grupos anteriores
Nuevos Medios de Comunicacion a ser Usados segun los Socios
Medios Socios
Artículos en paginas de Opinión MSH, PAHO, USAID
Teleconferencias MSH, USAID,
Videos de Corta Duración PAHO, PHR,
Llegar a programas de radio y televisión USAID, PAHO, PHR
APPENDIX P
THE DEVELOPMENT COMMUNICATION STRATEGIC CYCLE
APPENDICES
 110 
THE DEVELOPMENT COMMUNICATIONS STRATEGIC CYCLE 
Steps For Designing, Implementing, Monitoring And Evaluating A Communications 
Strategy 
1. Establish 
the objectives 
and expected 
impact and 
benchmarks of 
the Strategy in 
relation to
project 
objectives 
2. Select targeted 
audiences and analyze 
problems and 
interests at stake
3. Enlist groups that 
can influence behavior 
of targeted audiences 
4. Craft key 
messages
5. Select media 
channels 
8. Pretest 
messages 
6. Establish M&E 
System 
7. Develop risk 
assessment and timing 
9 Develop 
implementation plan, 
roles, and responsibilities 
10. Implement 11. Evaluate impact 
and monitor progress 
12. Lessons 
Learned and 
best practices