Enhancing Health Systems Performance Initiative
How EHSPI was initiated
The need for establishing a stronger relationship between development of strategies and evaluation of performance has been in line for quite sometime now. In the recent past, several countries have approached the World Health Organization in order to improve their systems by creating policies based on performance. As an answer to these requests, Enhancing Health Systems Performance Initiative, called EHSPI, was begun. This initiative comes following requests by over thirty countries. The countries belong to different development levels and income groups.

The reason that these countries have given for the requirement of EHSPI was mainly to assess the performance of the health systems of their countries with the help of WHO framework. They also requested WHO to take up an initiative that will help in evaluating their own performance levels with the help of WHO database. This initiative by WHO was requested so that countries can judge their levels in comparison to other countries and gather information about medical practices taking place in different parts of the world. Armed with all these information, countries hope to develop their medical practices and make it on par with world level medical care. The pressure on WHO has increased following the release of WHR2000 report.

What is the purpose of EHSPI ?
The purpose of EHSPI is to help policy makers of different countries attain a good understanding about the health systems of their countries and evaluate their performance in relation with other countries on a global level. The results of evaluation need to be compressed into policies and implemented so as to improve the medical and health efficiency of the country. Having a WHO benchmark also helps countries monitor and maintain a high level of performance. EHSPI aids enhancement of intangible agendas and methods that can improve efficiency of medical system. The concept helps in enhanced international policy recommendations based on solid evidence.

Three basic concepts are taken into consideration while working out the scope and purpose of EHSPI. These stages can broadly be termed as analyzing, implementation and reflection. While all these stages are included in the diagnostic stage of treatment, each stage has to be well conceived and elucidated. Every act involved in these three stages has to be evaluated on the basis of WHO benchmarks. WHO also provides assistance for whichever country desires tem. Reflection is one of the most useful activities of the concept. In reflection, different health providers meet and share their experiences with patients and during their duties. The feedback and response obtained from such intellectual gatherings can help in improving the performance of medical treatments and practices on a global level.

How are policy and evidence linked in the implementation stage?
Owing to the implementation stage, which is highly beneficial in spreading awareness about the evidence of medical procedures, several countries have begun to rope in a larger number of policy makers so that they an also be aware of the medical treatments and the performance of their country. Seminars and conferences are held at the national level to increase the scope of the plan. The seminars and conferences can serve as a means of accumulating information from different parts of the country, organize information that is obtained from various sources and formulate new policies for the improvement of medical provision. Small countries are provided direct support for the policies by the WHO.

Evaluating performance in sub-national level
Decentralized countries prefer having EHSPI implemented on a sub-national level. They have indicated that having a performance evaluation on a sub-national level help in better assessment of the medical facilities. Their facilities can easily be improved if evaluation is for smaller pockets of the country, thus making administration and monitoring easy. WHO has indicated that the organization is taking steps to develop EHSPI on a sub-national level for better assessment. Six countries are being worked with in order to bring about a more compressed format of EHSPI.

Monitoring performance by developing information systems
Recognizing the necessity of improving their respective information systems, many countries have requested a solution for long term efforts. Assessment at the benchmark level is a very important factor in this regard and countries have said that they would like to have a better a model that presents a better relationship between such a benchmark and efforts put in on a long term basis. Various activities of the system are evaluated regularly in this regard. In order to develop information systems, it is important to scrutinize all the essential data more specifically. This stands especially important if data is acquired through surveys, in addition to conventional modes of data assimilation. A comprehensive health support system can only be possible if all required measures are taken to ensure accuracy and establish better links between the above mentioned parameters.

More on creating capacity for assessing performance and analyzing health support systems
Two important functions have to be fulfilled in order to assess the performance of health systems accurately and more precisely on a national-level. Medical providers can employ a varied number of means to build capacity and ensure implementation of the format. Some of the activities that can be undertaken are holding seminars and conferences to brief respective people on the method of use. Analysts and those associated with WHO can be provided with technical support in order to help in developing and implementing performance evaluation. Countries are open to suggestions regarding holding formal workshops to train technically eligible people. In order to ensure the success of these methods, the different methods formulated have been piloted in different countries. South Africa and Indonesia were selected for pilot testing. These seminars have invitees and participants from all over the world attending. Seminars have also been organized in China as well for the large Chinese analysts and those from surrounding Asian countries. In the beginning few months of 2002, a similar seminar has been scheduled in Cote d’lvoire for the huge French speaking population of Europe and other parts of the world.

Enhancing Health Systems Performance Initiative
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