30 November 2009

STUDENT HANDBOOK lanjutan

4. CURRICULUM

Except for unusual circumstances, each class you take is worth 3-credit hours. Basically, the required courses are those identified by the Clinical Division and by the Department. These requirements involve 54 hours of the 72 hours of course work you must complete for the Ph.D., leaving 18 hours of electives. Some requirements for course work are not single courses but actually constitute generic requirements; that is, you must choose one course from a group of several possibilities. As a result, 15 of the total 54 hours of required course work are "flexible" requirements in that you can select from several options. All options for meeting this requirement are listed in this section.

4.1. Clinical Core. To acquire a solid foundation in the theory and method of clinical psychology, all clinical students are required to complete the following:

Psychopathology (Psych 446)
Intellectual and Personality Testing (Psych 432)
One Advanced Assessment Course (in Adult or Child area)
Introduction to the Profession of Clinical Psychology (Psych 412)
Theories of Psychotherapy and Behavior Change (Psych 469)
Practicum in Psychotherapy (Psych 464); 2 semesters
Ethics and Professional Practice (Psych 510)
Human Diversity
One advanced therapy course to be selected from the available electives

In the second year, all students participate in a year-long practicum and are supervised by one of our clinical faculty. This practicum occurs in the fall and spring semesters of the second year and operates within the Wellness Center. Students register for Practicum in Psychotherapy (464) in each semester of their second year. Each class is 3-credit hours.


During the first year in the program, students take Introduction to the Profession of Clinical Psychology (412) which is spread out over the entire academic year. Students in this class participate in professional issues seminars, receive an introduction to the operation and procedures of the Wellness Center, receive didactic and practical instruction on basic clinical, research, and professional issues, and observe clinical work.

4.2. Research and Methodology. To acquire a comprehensive background in the science and methodology of psychology, students are required to take the following:

History and Systems of Psychology (Psych 401)
Advanced Statistics I (Psych 480)
Advanced Statistics II (Psych 482)
Clinical Research Methods (Psych 418)


4.3. General Psychology Core. As part of the Ph.D. Qualifying Procedure, all Psychology Department students must take one course in each of the following 3-areas:
Area A
Sensory Processes (421)
Information Processing (435)
Physiological (426)
Learning and Memory (424)
Theory and Research in Psycholinguistics (440)
Thinking and Problem Solving (459)
Neuropsychology (518)

Area B
Social Psychological Theories (460)
Attitude Organization and Change (461)
Cognitive Social Psychology (462)
Research in Group Dynamics (474)
Community Psychology (465)

Area C
Personality Theory (405)
Psychopathology (446)
Developmental (455)
Cognitive Development (475)
Social Development (473)

In addition, APA requires that students in all accredited clinical programs acquire basic knowledge in each of four areas described as "general psychology core areas." Note that the Department and APA requirements overlap in several respects. One class can simultaneously satisfy both APA and Departmental requirements.

To acquire a broad background in the primary content areas designated by APA, clinical students are required to complete one course from each of the following areas:

Biological Bases of Behavior [APA - AREA 1]
Physiological Psychology (Psych 426)
Sensation and Perception (Psych 421)
Neuropsychology (518)

Cognitive-Affective Bases of Behavior [APA - AREA 2]
Learning (Psych 424)
Information Processing (Psych 435)
Cognitive Development (Psych 475)

Social Bases of Behavior [APA - AREA 3]
Cognitive Social Psychology (Psych 462)

Social Psychological Theory (Psych 460)
Organizational Psychology (Psych 472)
Attitude Organization and Change (Psych 461)
Community Psychology (Psych 465)
Social Development (Psych 473)

Individual Behavior [APA - AREA 4]
Developmental Psychology (Psych 455)
Psychology of Mature Years (Psych 450)
Personality Theory (Psych 405)
Psychopathology (Psych 446)

NOTE. What accounts for these requirements? The Boulder Model emphasis of our clinical program demands that we provide students with sound training in both research and clinical practice. Moreover, APA asserts (and we concur) that the very best Ph.D.'s are broadly trained. This same philosophy explains why the Department requires that all students advancing toward the Ph.D. receive sound generalist training in research methodology and exposure to several broad areas of psychology regardless of the student's individual program.

4.4. Electives

Within the structure of the clinical program, students have considerable freedom to pursue individualized interests through elective courses. Electives constitute one-fourth of the total program of studies. These electives are selected by the student, in consultation with his/her advisor, and should be chosen to provide greater depth in the student's specialized interest areas as well as a richer contextual framework for his/her clinical interests.

A fairly up-to-date listing and description of both required and elective courses can be found in the most recent Graduate School Catalog. In addition to those courses listed, the Program offers a Special Topics Seminar in Clinical Psychology (Psych 518). The seminar is used to give seminars on advanced clinical or research topics of special relevance or interest to students. For example, seminars offered under this title have included: Cognitive Behavior Therapy; Supervision and Consultation; Health Psychology; and Projective Assessment.

A word of advice: elective courses are usually offered once every two or three years. Since these courses tend to be more specialized, their scheduling also depends on the availability of a qualified instructor. It is wise to think about your electives well in advance and to consult with your advisor or the Director of Clinical Training concerning the scheduling of these courses.

If carefully planned, your elective schedule can allow you to develop expertise in special areas of interest within clinical psychology. For example, it is possible to pursue a sequence of electives relevant to community psychology, neuropsychology, or health psychology. It is also possible to combine electives with externship experience to pursue a clinical-child subspecialty (see Section 4.5).

4.5. Clinical-Child Subspecialty

Overview of the Program

The goal of the clinical-child subspecialty is to provide broad training for clinical-child psychologists that would enable them to work with children, adolescents, and families. Included in this training is coursework, externship and research experiences, and a pre-doctoral internship. Involvement in the subspecialty may begin upon matriculation into the clinical psychology program, but continued involvement is voluntary. An ongoing evaluation process, a “Brown Bag” colloquium series, and other activities are integrated into the program. The program is overseen by the DCT.


This training experience is a "track" within the existing clinical psychology program, rather than a separate subprogram (i.e., students who decide to enroll in this program are required to take the core courses required of all clinical psychology students). In other words, students in this track complete the clinical psychology program with a clinical-child subspecialty. Students and faculty in this subspecialty are encouraged to interact with the students and faculty of the Developmental Division (division meetings, social gatherings, brown bags, etc.).

All students in the Clinical Program may take clinical-child courses and acquire child-related experiences. However, students should only report that they have been trained as a clinical-child psychologist if they have completed all of the requirements listed below.


Requirements of the Subspecialty

1. Each student's dissertation must be directly related to child, adolescent, or family issues. Also, at least one faculty member from the child-track must serve on each student's Thesis and Dissertation Committees.

2. After the Second Year Practicum, students in the Child -Clinical Subspecialty must complete an advanced Child/Adolescent/Family Externship that is approved by the Subspecialty Coordinator.

3. Students are required to complete an internship where at least 33% of one's time is spent with child, adolescent, or family clients.

4. Student's in this track are required to take the following five courses:

Child Psychopathology (451)
Child Assessment (438)
Child Psychotherapy (452)
Cognitive Development (475)
Social Development (473)

STUDENT HANDBOOK

1. INTRODUCTION

This handbook is designed to provide you with a guide for planning your graduate program in clinical psychology at Loyola. As such, it is hoped that this handbook will prove to be a valuable resource regarding the requirements, procedures, and opportunities of the Clinical program. It should be noted that, for the most part, the handbook deals with Program and Departmental procedures. On matters concerning Graduate School or University policy, the most recent Graduate School Catalog or the Loyola Student Handbook should be consulted.

While the handbook provides the basic information necessary for successfully negotiating the requirements of the Program, it is not meant to serve as a substitute for our advisory system. You are encouraged to schedule frequent meetings with your advisor to discuss your goals and plans, as well as your progress in the Program. The Program offers many opportunities and options and your advisor's guidance is important to help you maximize your educational experience at Loyola.

GRADUATE SCHOOL STATUS: Students are admitted to the Graduate School of Loyola University in order to study Clinical Psychology within the Department of Psychology. That is, students must follow all the procedures and guidelines established by the Graduate School for such matters as registration, receiving payment of stipends, ensuring full-time status in terms of graduate study, meeting graduation deadlines, etc. Staff within the Graduate School (773) 508-3396 (Granada Center, 4th Floor, Lake Shore Campus) are willing to help students as long as students follow Graduate School procedures. Do not ignore notices, requests or memos issued by the Graduate School and be sure that you are in compliance with Graduate School procedures.

IT IS YOUR RESPONSIBILITY TO CONSULT THIS HANDBOOK AND SEEK OUT ADDITIONAL INFORMATION so that you adhere to required Division, Departmental or Graduate School procedures. If you have questions or are confused, first ask your advisor and if that doesn't suffice, then consult the Director of Clinical Training, Grayson N. Holmbeck, Ph.D., DH-1020, (773) 508-2967. The Clinical Secretary, Jacquie Hamilton, DH-1046, (773) 508-2974 is also a good source of information. Finally, the Student Life Handbook provides helpful information on matters of relevance to your life as a graduate student.

2. GOALS OF THE CLINICAL PROGRAM

The clinical psychology program at Loyola University is based on the scientist-professional model. An attractive feature of our program is the flexibility and freedom presented to students to pursue careers in different areas of psychology. Our faculty feel that as a result of training with us, you will be well-prepared for careers in research, academic, and/or clinical settings.

The clinical program is designed to produce competent, creative professionals who are capable of functioning in both clinical and research settings. The overall goal of the program is to produce PhD’s in Clinical Psychology who:

1. Have a broad knowledge of scientific psychology;

2. Have specialized knowledge of (a) assessment (including the selection and use of psychological assessment procedures and the interpretation of assessment data), (b) psychopathology, and (c) clinical intervention (including selection and application of empirically-supported interventions and subsequent evaluation of psychological services);

3. Have knowledge and experience related to the planning, execution, evaluation, and dissemination of socially-relevant clinical research,

4. Can effectively communicate their knowledge of psychology across several contexts;

5. Are sensitive to cultural and individual differences and who demonstrate flexibility in the application of psychological principles and techniques to a wide variety of populations and across a range of settings; and


6. Have knowledge of and adhere to the ethical standards of the profession and who have the ability to demonstrate appropriate professional conduct and professional interpersonal relationships.

3. GENERAL PROGRAM REQUIREMENTS AND PROCEDURES

3.1. Degree Requirements

To receive the Ph.D. in Clinical Psychology, students must successfully complete
the following:

1. 72 semester hours of graduate course work beyond the bachelor's degree and entering prerequisites (Required course work is outlined in Section 4);

2. Departmental Masters Qualifying Procedure (see below);

3. Empirical M.A. Thesis (including Oral Defense of proposal and completed Thesis);

4. Clinical Qualifying Examination (written and oral sections);

5. Ph.D. Dissertation (including Oral Defense of proposal and completed Dissertation);

6. 800 hours of approved externship/practicum training experience;

7. A full-time, 1-year APA-approved clinical internship program.

3.2. Masters Degree Requirements

Although the Program is oriented toward the Ph.D., students receive the M.A. as they progress toward the Ph.D. For students who are progressing to the Ph.D., the Master's Degree is generally awarded upon completion of the following:

1. 24 semester hours of graduate course work beyond the bachelor's degree or entering prerequisites (including required clinical core);

2. Departmental Masters Qualifying Procedure (see below);

3. Empirical M.A. Thesis (including Oral Defense of proposal and completed Thesis);

4. Successful completion of the second year practicum sequence.

More specific information about Degree Requirements and the procedures for applying for graduation can be found in the Graduate School Catalog.


3.3. Time Requirements

Students in the Clinical Program are expected to devote full-time to graduate study and complete the requirements for the Ph.D. within 6 years (or less if one enters with advanced standing). The sample program of studies given in Table 1 illustrates a possible timetable for completion of degree requirements. While circumstances may require some adjustment of this timetable, students are encouraged to adhere to this schedule as closely as possible.


You will note from the Graduate School Catalog that the Graduate School deadlines for completion of degree requirements extend beyond those of the Clinical Program. According to Graduate School rules, students entering the University with a bachelor's degree must complete all requirements for the M.A. within 5 years and for the Ph.D. within 8 years. Students entering with advanced standing must complete all Ph.D. requirements within 6 years. It should be noted, however, that these deadlines are outlined with part-time and full-time students in mind. Because the Clinical Program accepts only full-time students, we expect students to complete the M.A. and the Ph.D. within the guidelines outlined by our Program.

Students are expected to complete the requirements for the M.A. and Ph.D. in an orderly, progressive sequence. Perhaps the greatest challenge in doing this is budgeting one's time and balancing the varied requirements of the Program; i.e., coursework, exams, independent research, and clinical work. A suggested calendar or timetable for doing this is presented in section 12. It is also important to work closely with your advisor in planning and setting goals for each year.

Important: Students may not register for more than 4 courses in any semester.


3.3.1. Table 1

Sample Course of Studies

Schedules will vary depending on the availability of courses. A typical program of study for a student entering with a Bachelor's degree is:

FIRST YEAR

Psychopathology (446) 3
Intellectual and Personality Testing (432) 3
Advanced Statistics I & II (480 and 482) 6
Introduction to the Profession of Clinical Psychology (412) 3
Clinical Research Methods (418) 3
General Psychology/APA Core or Electives 3
An Advanced Assessment Course or Elective 3


SECOND YEAR

Theories of Psychotherapy and Behavior Change (469) 3
Practicum in Psychotherapy (464; taken twice) 6
General Psychology/APA Core 6 – 9
Advanced Research Methods/Statistics Course Elective 3
Electives 6 - 9
Thesis Research (complete by end of 2nd year) 0

THIRD YEAR

History and Systems of Psychology (401) 3
Ethics and Professional Practice (510) 3
Human Diversity 3
General Psychology/APA Core 0 - 3
Advanced Therapy Course 3
Electives 9 - 12
Off-Campus Practicum 0

FOURTH thru SIXTH YEARS

Off-Campus Practicum 0
Dissertation Research 0
Internship 0
Clinical Qualifying Examination (after 3rd year) 0

3.4. Transfer of Credit


According to Graduate School regulations, all requirements for the M.A. must be earned at Loyola University Chicago. Students who enter with a M.A. in Clinical psychology from an accredited institution and who wish to begin Ph.D. work at an advanced level may petition for transfer of credit to the Advanced Credits Committee of the Clinical Division. To do this, students should submit a letter with a list of courses for which credit is being requested, plus transcripts, course descriptions, syllabi, reading lists, or any other available material to the Director of Clinical Training immediately after entering the program. The Director of Clinical Training will review the request, supporting material, and meet with the student. The amount of credit accepted for transfer is contingent upon the evaluation made by the Director of Clinical Training and subsequent approval by the Clinical Division and the Graduate Dean. The Clinical Division limits transfer credit to 24 hours or the amount required for the M.A. at Loyola.

3.5. Student Development/Advising Program

Objectives: The overall objective of the Advising Program is to maximize the professional growth and development of students in the Ph.D. Program in Clinical Psychology by:

1. providing structured advising and assistance in the planning of educational experiences at the beginning and end of each academic year;

2. maintaining contact with field training sites, monitoring the activities of students and their progress in clinical skill development;

3. providing consistent and detailed feedback to students in a personal format.

Both the student and advisor play key roles in the entire planning, monitoring, and feedback process. In essence, this plan provides a general structure for the advisor/student relationship and establishes the advisor as a key person in helping the student to integrate the multiple and diverse aspects of education in Clinical Psychology. Upon entrance to the program, students are assigned an Advisor and students also begin working with a research mentor. After consultation with faculty, the DCT makes these assignments, typically assigning an advisor who is not the same faculty member as the one who is mentoring the student’s research. In this way, the student is free to discuss with one’s advisor issues that may arise regarding any aspect of his/her training. Advisors also help students move through the Program in a timely manner by charting their progress on the different program requirements via Advisor-student meetings at least two times per year. Students are free to request changes in one’s advisors or research mentors at any time (although most of our students do not make such requests).



Advising and Feedback Plan: Students are responsible for scheduling regular meetings with their advisors to consult about the program and their professional development. At a minimum, these meetings should be held as outlined below.

1. At the Beginning of the Academic Year - meet to discuss tasks to be completed for the year, priorities for learning, and a plan for accomplishing goals for the year.

2. At the End of the Academic Year (Prior to the Annual Review) - meet to review
progress toward goals, assess status, make plans for summer. Assess strengths and
weaknesses.

3. After Annual Review - meet to discuss feedback from Annual Review.


3.6. Graduation


When a student thinks he/she will be ready to graduate at the end of a particular semester (August, December, or May), he/she should file an application for graduation with the Graduate School. Although degrees are conferred three times per year, a graduation ceremony is only held in May of each year. Thus, if your degree is conferred in August or December, you would participate in a ceremony the following May. The deadline for application is usually about two months prior to graduation (consult graduate calendar for exact dates; http://www.luc.edu/gradschool/index.shtml ). There is also a graduation fee which must be paid prior to graduation.

3.7. Maintenance of Student Status

Students who are on full-time internships and are not taking classes should register for PSYCH 596: Internship in Clinical Psychology for both the Fall and Spring semester when they are on internship. This is a non-credit course which allows students on internship to maintain their student status within the university. This is essential in assuring that the internship is officially recorded on the transcript.

Students who have completed the 72 required credit hours for the Ph.D., but have not completed the Dissertation and are not on internship, must also maintain continuous registration in the Graduate School. While working on the Dissertation Proposal, students should register for PSYCH 610: Doctoral Study. After the Dissertation Proposal has been approved, students must register for PSYCH 600: Dissertation Supervision.

All students who register for either Doctoral Study (PSYCH 610, which is to be taken before the Dissertation Proposal is formally approved) and Doctoral Supervision (PSYCH 600, which is taken after the Proposal is formally approved and while the student is completing the Dissertation) will receive credit for this course work only if the student is making "credit-able" progress during the relevant semester on the Dissertation (i.e., that you have accomplished something that merits receiving credit for 600/610).

Therefore, it is absolutely essential that you document all progress you are making on your Dissertation.


Berlanjut.......))))

Psychology and Law

This important book captures contemporary attempts to build bridges between the two very different disciplines of law and psychology, and establish the true nature of the interaction between the two.

It is unusual both in including contributions from lawyers, psychologists, sociologists and criminologists as well as in the very diverse range of jurisdictions from which they come, including the USA, Europe and Australia. The book sets out to bridge the inherent gap between the practice of law and the profession of psychology at an international level.

The authors show that bridges are needed for the many different contexts in which the law interacts with psychology. They throw light on how psychology connects with, inter alia, the courts, prisons, community care, clinics, long-stay hospitals, police investigations and legislative bodies. This allows coverage of well established areas such as the study of and challenges to eyewitness testimony, and the nature of Psychopathy for example. More recent contributions of social science to legal proceedings are also covered, such as the liability that arises from not preventing crimes happening or the systematic prediction of likely violence by an offender.

The book will be essential reading not only for academics and professionals in psychology, the law, and related disciplines, wishing to understand the broadening base of psychology within the legal process but also for students trying to form an understanding of the emerging science and the associated career opportunities for this exciting field.

The Psychology of Personality: Viewpoints, Research, and Applications

A TEXTBOOK WITH A PASSION FOR PERSONALITY

This engaging, comprehensive introduction to the field of personality psychology integrates discussion of personality theories, research, assessment techniques, and applications of specific theories. The Psychology of Personality: Viewpoints, Research, and Applications introduces students to many important figures in the field, including Freud, Jung, Adler, Horney, Erikson, Maslow, Allport, Cattell, Bandura, Mischel, and others. The book not only covers classic issues and research in personality, but also looks at genetics and personality, neurological considerations in personality, the evolutionary perspective, the “Big Five” model of personality, and other contemporary issues.

The second edition reflects significant changes in the field but retains much of the information and special features that made it a textbook from which instructors found it easy to teach and students found it easy to learn. Bernardo Carducci’s passion for the study of personality and teaching its concepts to students is evident on every page.

Special Features

- Balances theory, research, and the application of personality psychology in every chapter
- Examines important dimensions of personality, such as self-concept, gender identity, gender differences, self-monitoring, self-control, self-regulation, shyness, and anxiety
- Emphasizes how personality psychology relates to everyday life, and integrates examples that involve family, friends, work, and leisure - as well as biology, criminology, medicine, marketing, the military, and more
- A Closer Look sections highlight people or topics of interest, including “Mixing Athletics with Academics,” ,“The ‘Write’ Stuff?' and “Personality Correlates of Survival and Reproduction”
- Applications in Personality Psychology sections present extended examples of how personality psychology applies to a variety of areas in our everyday living experiences, such as “How Automobile Design and Advertising Are Being Driven by Personality Psychology” and “Six Simple Steps for Overcoming Test Anxiety'
- You Can Do It boxes give students the opportunity to complete a variety of exercises and projects designed to illustrate specific concepts, such as “Doing ‘Risky Business’: Will You Stick Your Neck Out to Get Ahead?” and “The Need for Cognition Scale: ‘I Think, Therefore I Am Having Fun’”
- Ancillaries include: Instructor’s Manual, Testbank, Student Study Guide, and Powerpoints – all written exclusively by the author to ensure a level of quality consistent with that of the textbook

New to this edition:

- Covers cultural and evolutionary theories plus new physiological and neurological contributions to personality psychology
- The Cultural Context of Personality Psychology sections encourage students to explore cultural dimensions of personality in various areas, such as “A Global Perspective on Worker Motivation,” “Cultural Diversity and the MMPI Validity Scale,” and “Personality Correlates of Mate Poachers and Their Targets: A Global Perspective”
- At the Cutting Edge of Personality Psychology sections feature unique and up-to-date research and applications in the study of personality psychology, such as “Virtual Reality Therapy,” “Searching for Genetic Explanations of Personality,” and “An Evolutionary Analysis of Tactical Fiscal Allocation”
- New chapter on “The Evolutionary Viewpoint: Personality as an Adaptive Process” (Chapter 9)
- Reorganized format into thirteen chapters for a better fit for instructors and students
- Summing It Up tables provide concise and informative summaries of significant concepts
- 'Mini-lectures' added to the Instructor's Manual

The 2009 Report on Project and Portfolio (PPM) Management Software: World Market Segmentation by City

Market Potential Estimation Methodology
Overview
This study covers the world outlook for project and portfolio (PPM) management software across more than 2000 cities. For the year reported, estimates are given for the latent demand, or potential industry earnings (P.I.E.), for the city in question (in millions of U.S. dollars), the percent share the city is of the region and of the globe. These comparative benchmarks allow the reader to quickly gauge a city vis-à-vis others. Using econometric models which project fundamental economic dynamics within each country and across countries, latent demand estimates are created. This report does not discuss the specific players in the market serving the latent demand, nor specific details at the product level. The study also does not consider short-term cyclicalities that might affect realized sales. The study, therefore, is strategic in nature, taking an aggregate and long-run view, irrespective of the players or products involved.

This study does not report actual sales data (which are simply unavailable, in a comparable or consistent manner in virtually all of the cities of the world). This study gives, however, my estimates for the worldwide latent demand, or the P.I.E. for project and portfolio (PPM) management software. It also shows how the P.I.E. is divided across the world’s cities. In order to make these estimates, a multi-stage methodology was employed that is often taught in courses on international strategic planning at graduate schools of business.

What is Latent Demand and the P.I.E.?
The concept of latent demand is rather subtle. The term latent typically refers to something that is dormant, not observable, or not yet realized. Demand is the notion of an economic quantity that a target population or market requires under different assumptions of price, quality, and distribution, among other factors. Latent demand, therefore, is commonly defined by economists as the industry earnings of a market when that market becomes accessible and attractive to serve by competing firms. It is a measure, therefore, of potential industry earnings (P.I.E.) or total revenues (not profit) if a market is served in an efficient manner. It is typically expressed as the total revenues potentially extracted by firms. The “market” is defined at a given level in the value chain. There can be latent demand at the retail level, at the wholesale level, the manufacturing level, and the raw materials level (the P.I.E. of higher levels of the value chain being always smaller than the P.I.E. of levels at lower levels of the same value chain, assuming all levels maintain minimum profitability).

The latent demand for project and portfolio (PPM) management software is not actual or historic sales. Nor is latent demand future sales. In fact, latent demand can be lower either lower or higher than actual sales if a market is inefficient (i.e., not representative of relatively competitive levels). Inefficiencies arise from a number of factors, including the lack of international openness, cultural barriers to consumption, regulations, and cartel-like behavior on the part of firms. In general, however, latent demand is typically larger than actual sales in a city market.

Another reason why sales do not equate to latent demand is exchange rates. In this report, all figures assume the long-run efficiency of currency markets. Figures, therefore, equate values based on purchasing power parities across countries. Short-run distortions in the value of the dollar, therefore, do not figure into the estimates. Purchasing power parity estimates of country income were collected from official sources, and extrapolated using standard econometric models. The report uses the dollar as the currency of comparison, but not as a measure of transaction volume. The units used in this report are: US$ Million.

For reasons discussed later, this report does not consider the notion of “unit quantities”, only total latent revenues (i.e., a calculation of price times quantity is never made, though one is implied). The units used in this report are U.S. dollars not adjusted for inflation (i.e., the figures incorporate inflationary trends) and not adjusted for future dynamics in exchange rates (i.e., the figures reflect average exchange rates over recent history). If inflation rates or exchange rates vary in a substantial way compared to recent experience, actually sales can also exceed latent demand (when expressed in U.S. dollars, not adjusted for inflation). On the other hand, latent demand can be typically higher than actual sales as there are often distribution inefficiencies that reduce actual sales below the level of latent demand.

As mentioned earlier, this study is strategic in nature, taking an aggregate and long-run view, irrespective of the players or products involved. If fact, all the current products or services on the market can cease to exist in their present form (i.e., at a brand-, R&D specification, or corporate-image level) and all the players can be replaced by other firms (i.e., via exits, entries, mergers, bankruptcies, etc.), and there will still be an international latent demand for project and portfolio (PPM) management software at the aggregate level. Product and service offering details, and the actual identity of the players involved, while important for certain issues, are relatively unimportant for estimates of latent demand.

The Methodology
In order to estimate the latent demand for project and portfolio (PPM) management software on a city-by-city basis, I used a multi-stage approach. Before applying the approach, one needs a basic theory from which such estimates are created. In this case, I heavily rely on the use of certain basic economic assumptions. In particular, there is an assumption governing the shape and type of aggregate latent demand functions. Latent demand functions relate the income of a country, city, state, household, or individual to realized consumption. Latent demand (often realized as consumption when an industry is efficient), at any level of the value chain, takes place if an equilibrium in realized. For firms to serve a market, they must perceive a latent demand and be able to serve that demand at a minimal return. The single most important variable determining consumption, assuming latent demand exists, is income (or other financial resources at higher levels of the value chain). Other factors that can pivot or shape demand curves include external or exogenous shocks (i.e., business cycles), and or changes in utility for the product in question.

Ignoring, for the moment, exogenous shocks and variations in utility across countries, the aggregate relation between income and consumption has been a central theme in economics. The figure below concisely summarizes one aspect of problem. In the 1930s, John Meynard Keynes conjectured that as incomes rise, the average propensity to consume would fall. The average propensity to consume is the level of consumption divided by the level of income, or the slope of the line from the origin to the consumption function. He estimated this relationship empirically and found it to be true in the short-run (mostly based on cross-sectional data). The higher the income, the lower the average propensity to consume. This type of consumption function is labeled 'A' in the figure below (note the rather flat slope of the curve). In the 1940s, another macroeconomist, Simon Kuznets, estimated long-run consumption functions which indicated that the marginal propensity to consume was rather constant (using time series data across countries). This type of consumption function is show as 'B' in the figure below (note the higher slope and zero-zero intercept). The average propensity to consume is constant.








Is it declining or is it constant? A number of other economists, notably Franco Modigliani and Milton Friedman, in the 1950s (and Irving Fisher earlier), explained why the two functions were different using various assumptions on intertemporal budget constraints, savings, and wealth. The shorter the time horizon, the more consumption can depend on wealth (earned in previous years) and business cycles. In the long-run, however, the propensity to consume is more constant. Similarly, in the long run, households, industries or countries with no income eventually have no consumption (wealth is depleted). While the debate surrounding beliefs about how income and consumption are related and interesting, in this study a very particular school of thought is adopted. In particular, we are considering the latent demand for project and portfolio (PPM) management software across some 230 countries. The smallest have fewer than 10,000 inhabitants. I assume that all of these counties fall along a 'long-run' aggregate consumption function. This long-run function applies despite some of these countries having wealth, current income dominates the latent demand for project and portfolio (PPM) management software. So, latent demand in the long-run has a zero intercept. However, I allow firms to have different propensities to consume (including being on consumption functions with differing slopes, which can account for differences in industrial organization, and end-user preferences).

Given this overriding philosophy, I will now describe the methodology used to create the latent demand estimates for project and portfolio (PPM) management software. Since ICON Group has asked me to apply this methodology to a large number of categories, the rather academic discussion below is general and can be applied to a wide variety of categories, not just project and portfolio (PPM) management software.

Step 1. Product Definition and Data Collection
Any study of latent demand across countries requires that some standard be established to define “efficiently served”. Having implemented various alternatives and matched these with market outcomes, I have found that the optimal approach is to assume that certain key countries or cities are more likely to be at or near efficiency than others. These are given greater weight than others in the estimation of latent demand compared to others for which no known data are available. Of the many alternatives, I have found the assumption that the world’s highest aggregate income and highest income-per-capita markets reflect the best standards for “efficiency”. High aggregate income alone is not sufficient (i.e., China has high aggregate income, but low income per capita and can not assumed to be efficient). Aggregate income can be operationalized in a number of ways, including gross domestic product (for industrial categories), or total disposable income (for household categories; population times average income per capita, or number of households times average household income per capita). Brunei, Nauru, Kuwait, and Lichtenstein are examples of countries with high income per capita, but not assumed to be efficient, given low aggregate level of income (or gross domestic product); these countries have, however, high incomes per capita but may not benefit from the efficiencies derived from economies of scale associated with large economies. Only countries with high income per capita and large aggregate income are assumed efficient. This greatly restricts the pool of countries to those in the OECD (Organization for Economic Cooperation and Development), like the United States, or the United Kingdom (which were earlier than other large OECD economies to liberalize their markets).

The selection of countries is further reduced by the fact that not all countries in the OECD report industry revenues at the category level. Countries that typically have ample data at the aggregate level that meet the efficiency criteria include the United States, the United Kingdom and in some cases France and Germany.

Latent demand is therefore estimated using data collected for relatively efficient markets from independent data sources (e.g. Euromonitor, Mintel, Thomson Financial Services, the U.S. Industrial Outlook, the World Resources Institute, the Organization for Economic Cooperation and Development, various agencies from the United Nations, industry trade associations, the International Monetary Fund, and the World Bank). Depending on original data sources used, the definition of “project and portfolio (PPM) management software” is established. In the case of this report, the data were reported at the aggregate level, with no further breakdown or definition. In other words, any potential product or service that might be incorporated within project and portfolio (PPM) management software falls under this category. Public sources rarely report data at the disaggregated level in order to protect private information from individual firms that might dominate a specific product-market. These sources will therefore aggregate across components of a category and report only the aggregate to the public. While private data are certainly available, this report only relies on public data at the aggregate level without reliance on the summation of various category components. In other words, this report does not aggregate a number of components to arrive at the “whole”. Rather, it starts with the “whole”, and estimates the whole for all cities and the world at large (without needing to know the specific parts that went into the whole in the first place).

Given this caveat, in this report we define the sales of project and portfolio management (PPM) software as including all commonly understood products falling within this broad category, such as tools for for analyzing and collectively managing a group of current or proposed projects based on numerous key characteristics, irrespective of product packaging, formulation, size, or form. Companies participating in this industry include CA (NYSE: CA), Compuware, Hewlett-Packard, Microsoft, and Serena Software. In addition to the sources indicated below, additional information available to the public via news and/or press releases published by players in the industry (including reports from AMR Research, Global Industry Analysts, Forrester Research, Frost & Sullivan, Gartner, IDC, and MarketResearch.com) was considered in defining and calibrating this category.

Step 2. Filtering and Smoothing
Based on the aggregate view of project and portfolio (PPM) management software as defined above, data were then collected for as many similar countries and cities as possible for that same definition, at the same level of the value chain. This generates a convenience sample from which comparable figures are available. If the series in question do not reflect the same accounting period, then adjustments are made. In order to eliminate short-term effects of business cycles, the series are smoothed using an 2 year moving average weighting scheme (longer weighting schemes do not substantially change the results). If data are available for a country, but these reflect short-run aberrations due to exogenous shocks (such as would be the case of beef sales in a country stricken with foot and mouth disease), these observations were dropped or 'filtered' from the analysis.

Step 3. Filling in Missing Values
In some cases, data are available for countries or cities on a sporadic basis. In other cases, data may be available for only one year. From a Bayesian perspective, these observations should be given greatest weight in estimating missing years. Assuming that other factors are held constant, the missing years are extrapolated using changes and growth in aggregate national income. Based on the overriding philosophy of a long-run consumption function (defined earlier), cities which have missing data for any given year, are estimated based on historical dynamics of aggregate income for that country.

Step 4. Varying Parameter, Non-linear Estimation
Given the data available from the first three steps, the latent demand is estimated using a “varying-parameter cross-sectionally pooled time series model”. Simply stated, the effect of income on latent demand is assumed to be constant across cities unless there is empirical evidence to suggest that this effect varies (i.e., the slope of the income effect is not necessarily same for all countries). This assumption applies across cities along the aggregate consumption function, but also over time (i.e., not all cities are perceived to have the same income growth prospects over time and this effect can vary from city to city as well). Another way of looking at this is to say that latent demand for project and portfolio (PPM) management software is more likely to be similar across cities that have similar characteristics in terms of economic development (i.e., African cities will have similar latent demand structures controlling for the income variation across the pool of African cities).

This approach is useful across cities for which some notion of non-linearity exists in the aggregate consumption function. For some categories, however, the reader must realize that the numbers will reflect a city’s contribution to global latent demand and may never be realized in the form of local sales. For certain category combinations this will result in what at first glance will be odd results. For example, the latent demand for the category “space vehicles” will exist for cities in “Togo” even though they have no space program. The assumption is that if the economies in these countries did not exist, the world aggregate for these categories would be lower. The share attributed to these cities is based on a proportion of their income (however small) being used to consume the category in question (i.e., perhaps via resellers).

Step 5. Fixed-Parameter Linear Estimation
Nonlinearities are assumed in cases where filtered data exist along the aggregate consumption function. Because the world consists of more than 2000 cities, there will always be those cities, especially toward the bottom of the consumption function, where non-linear estimation is simply not possible. For these cities, equilibrium latent demand is assumed to be perfectly parametric and not a function of wealth (i.e., a city’s stock of income), but a function of current income (a city’s flow of income). In the long run, if a city has no current income, the latent demand for project and portfolio (PPM) management software is assumed to approach zero. The assumption is that wealth stocks fall rapidly to zero if flow income falls to zero (i.e., cities which earn low levels of income will not use their savings, in the long run, to demand project and portfolio (PPM) management software). In a graphical sense, for low income cities, latent demand approaches zero in a parametric linear fashion with a zero-zero intercept. In this stage of the estimation procedure, low-income cities are assumed to have a latent demand proportional to their income, based on the city closest to it on the aggregate consumption function.

Step 6. Aggregation and Benchmarking
Based on the models described above, latent demand figures are estimated for all cities of the world, including for the smallest economies. These are then aggregated to get world totals and regional totals. To make the numbers more meaningful, regional and global demand averages are presented. Figures are rounded, so minor inconsistencies may exist across tables.

The 2009-2014 Outlook for Project and Portfolio (PPM) Management Software in Asia

WHAT IS LATENT DEMAND AND THE P.I.E.?

The concept of latent demand is rather subtle. The term latent typically refers to something that is dormant, not observable or not yet realized. Demand is the notion of an economic quantity that a target population or market requires under different assumptions of price, quality, and distribution, among other factors. Latent demand, therefore, is commonly defined by economists as the industry earnings of a market when that market becomes accessible and attractive to serve by competing firms. It is a measure, therefore, of potential industry earnings (P.I.E.) or total revenues (not profit) if a market is served in an efficient manner. It is typically expressed as the total revenues potentially extracted by firms. The “market” is defined at a given level in the value chain. There can be latent demand at the retail level, at the wholesale level, the manufacturing level, and the raw materials level (the P.I.E. of higher levels of the value chain being always smaller than the P.I.E. of levels at lower levels of the same value chain, assuming all levels maintain minimum profitability).

The latent demand for project and portfolio (ppm) management software is not actual or historic sales. Nor is latent demand future sales. In fact, latent demand can be lower or higher than actual sales if a market is inefficient (i.e. not representative of relatively competitive levels). Inefficiencies arise from a number of factors, including the lack of international openness, cultural barriers to consumption, regulations, and cartel-like behavior on the part of firms. In general, however, latent demand is typically larger than actual sales in a country market.

For reasons discussed later, this report does not consider the notion of “unit quantities”, only total latent revenues (i.e. a calculation of price times quantity is never made, though one is implied). The units used in this report are U.S. dollars not adjusted for inflation (i.e. the figures incorporate inflationary trends) and not adjusted for future dynamics in exchange rates. If inflation rates or exchange rates vary in a substantial way compared to recent experience, actually sales can also exceed latent demand (when expressed in U.S. dollars, not adjusted for inflation). On the other hand, latent demand can be typically higher than actual sales as there are often distribution inefficiencies that reduce actual sales below the level of latent demand.

As mentioned in the introduction, this study is strategic in nature, taking an aggregate and long-run view, irrespective of the players or products involved. If fact, all the current products or services on the market can cease to exist in their present form (i.e. at a brand-, R&D specification, or corporate-image level) and all the players can be replaced by other firms (i.e. via exits, entries, mergers, bankruptcies, etc.), and there will still be latent demand for project and portfolio (ppm) management software in Asia at the aggregate level. Product and service offering details, and the actual identity of the players involved, while important for certain issues, are relatively unimportant for estimates of latent demand.

THE METHODOLOGY

In order to estimate the latent demand for project and portfolio (ppm) management software in Asia, I used a multi-stage approach. Before applying the approach, one needs a basic theory from which such estimates are created. In this case, I heavily rely on the use of certain basic economic assumptions. In particular, there is an assumption governing the shape and type of aggregate latent demand functions. Latent demand functions relate the income of a country, city, state, household, or individual to realized consumption. Latent demand (often realized as consumption when an industry is efficient), at any level of the value chain, takes place if an equilibrium is realized. For firms to serve a market, they must perceive a latent demand and be able to serve that demand at a minimal return. The single most important variable determining consumption, assuming latent demand exists, is income (or other financial resources at higher levels of the value chain). Other factors that can pivot or shape demand curves include external or exogenous shocks (i.e. business cycles), and or changes in utility for the product in question.

Ignoring, for the moment, exogenous shocks and variations in utility across countries, the aggregate relation between income and consumption has been a central theme in economics. The figure below concisely summarizes one aspect of problem. In the 1930s, John Meynard Keynes conjectured that as incomes rise, the average propensity to consume would fall. The average propensity to consume is the level of consumption divided by the level of income, or the slope of the line from the origin to the consumption function. He estimated this relationship empirically and found it to be true in the short-run (mostly based on cross-sectional data). The higher the income, the lower the average propensity to consume. This type of consumption function is labeled 'A' in the figure below (note the rather flat slope of the curve). In the 1940s, another macroeconomist, Simon Kuznets, estimated long-run consumption functions which indicated that the marginal propensity to consume was rather constant (using time series data across countries). This type of consumption function is show as 'B' in the figure below (note the higher slope and zero-zero intercept). The average propensity to consume is constant.








Is it declining or is it constant? A number of other economists, notably Franco Modigliani and Milton Friedman, in the 1950s (and Irving Fisher earlier), explained why the two functions were different using various assumptions on intertemporal budget constraints, savings, and wealth. The shorter the time horizon, the more consumption can depend on wealth (earned in previous years) and business cycles. In the long-run, however, the propensity to consume is more constant. Similarly, in the long run, households, industries or countries with no income eventually have no consumption (wealth is depleted). While the debate surrounding beliefs about how income and consumption are related and interesting, in this study a very particular school of thought is adopted. In particular, we are considering the latent demand for project and portfolio (ppm) management software across all the countries in Asia. The smallest have fewer than 10,000 inhabitants. I assume that all of these counties fall along a 'long-run' aggregate consumption function. This long-run function applies despite some of these countries having wealth, current income dominates the latent demand for project and portfolio (ppm) management software in Asia. So, latent demand in the long-run has a zero intercept. However, I allow firms to have different propensities to consume (including being on consumption functions with differing slopes, which can account for differences in industrial organization, and end-user preferences).

Given this overriding philosophy, I will now describe the methodology used to create the latent demand estimates for project and portfolio (ppm) management software in Asia. Since ICON Group has asked me to apply this methodology to a large number of categories, the rather academic discussion below is general and can be applied to a wide variety of categories, not just project and portfolio (ppm) management software.

Step 1. Product Definition and Data Collection

Any study of latent demand across countries requires that some standard be established to define “efficiently served”. Having implemented various alternatives and matched these with market outcomes, I have found that the optimal approach is to assume that certain key countries are more likely to be at or near efficiency than others. These countries are given greater weight than others in the estimation of latent demand compared to other countries for which no known data are available. Of the many alternatives, I have found the assumption that the world’s highest aggregate income and highest income-per-capita markets reflect the best standards for “efficiency”. High aggregate income alone is not sufficient (i.e. China has high aggregate income, but low income per capita and can not assumed to be efficient). Aggregate income can be operationalized in a number of ways, including gross domestic product (for industrial categories), or total disposable income (for household categories; population times average income per capita, or number of households times average household income per capita). Brunei, Nauru, Kuwait, and Lichtenstein are examples of countries with high income per capita, but not assumed to be efficient, given low aggregate level of income (or gross domestic product); these countries have, however, high incomes per capita but may not benefit from the efficiencies derived from economies of scale associated with larger economies. Only countries with high income per capita and large aggregate income are assumed efficient. This greatly restricts the pool of countries to those in the OECD (Organization for Economic Cooperation and Development), like the United States, or the United Kingdom (which were earlier than other large OECD economies to liberalize their markets).

The selection of countries is further reduced by the fact that not all countries in the OECD report industry revenues at the category level. Countries that typically have ample data at the aggregate level that meet the efficiency criteria include the United States, the United Kingdom and in some cases France and Germany.

Latent demand is therefore estimated using data collected for relatively efficient markets from independent data sources (e.g. Euromonitor, Mintel, Thomson Financial Services, the U.S. Industrial Outlook, the World Resources Institute, the Organization for Economic Cooperation and Development, various agencies from the United Nations, industry trade associations, the International Monetary Fund, and the World Bank). Depending on original data sources used, the definition of “project and portfolio (ppm) management software” is established. In the case of this report, the data were reported at the aggregate level, with no further breakdown or definition. In other words, any potential product or service that might be incorporated within project and portfolio (ppm) management software falls under this category. Public sources rarely report data at the disaggregated level in order to protect private information from individual firms that might dominate a specific product-market. These sources will therefore aggregate across components of a category and report only the aggregate to the public. While private data are certainly available, this report only relies on public data at the aggregate level without reliance on the summation of various category components. In other words, this report does not aggregate a number of components to arrive at the “whole”. Rather, it starts with the “whole”, and estimates the whole for all countries and the world at large (without needing to know the specific parts that went into the whole in the first place).

Given this caveat, in this report we define the sales of project and portfolio management (PPM) software as including all commonly understood products falling within this broad category, such as tools for for analyzing and collectively managing a group of current or proposed projects based on numerous key characteristics, irrespective of product packaging, formulation, size, or form. Companies participating in this industry include CA (NYSE: CA), Compuware, Hewlett-Packard, Microsoft, and Serena Software. In addition to the sources indicated below, additional information available to the public via news and/or press releases published by players in the industry (including reports from AMR Research, Global Industry Analysts, Forrester Research, Frost & Sullivan, Gartner, IDC, and MarketResearch.com) was considered in defining and calibrating this category.

Step 2. Filtering and Smoothing

Based on the aggregate view of project and portfolio (ppm) management software as defined above, data were then collected for as many similar countries as possible for that same definition, at the same level of the value chain. This generates a convenience sample of countries from which comparable figures are available. If the series in question do not reflect the same accounting period, then adjustments are made. In order to eliminate short-term effects of business cycles, the series are smoothed using an 2 year moving average weighting scheme (longer weighting schemes do not substantially change the results). If data are available for a country, but these reflect short-run aberrations due to exogenous shocks (such as would be the case of beef sales in a country stricken with foot and mouth disease), these observations were dropped or 'filtered' from the analysis.

Step 3. Filling in Missing Values

In some cases, data are available for countries on a sporadic basis. In other cases, data from a country may be available for only one year. From a Bayesian perspective, these observations should be given greatest weight in estimating missing years. Assuming that other factors are held constant, the missing years are extrapolated using changes and growth in aggregate national income. Based on the overriding philosophy of a long-run consumption function (defined earlier), countries which have missing data for any given year, are estimated based on historical dynamics of aggregate income for that country.

Step 4. Varying Parameter, Non-linear Estimation

Given the data available from the first three steps, the latent demand in additional countries is estimated using a “varying-parameter cross-sectionally pooled time series model”. Simply stated, the effect of income on latent demand is assumed to be constant across countries unless there is empirical evidence to suggest that this effect varies (i.e. . the slope of the income effect is not necessarily same for all countries). This assumption applies across countries along the aggregate consumption function, but also over time (i.e. not all countries are perceived to have the same income growth prospects over time and this effect can vary from country to country as well). Another way of looking at this is to say that latent demand for project and portfolio (ppm) management software is more likely to be similar across countries that have similar characteristics in terms of economic development (i.e. African countries will have similar latent demand structures controlling for the income variation across the pool of African countries).

This approach is useful across countries for which some notion of non-linearity exists in the aggregate cross-country consumption function. For some categories, however, the reader must realize that the numbers will reflect a country’s contribution to global latent demand and may never be realized in the form of local sales. For certain country-category combinations this will result in what at first glance will be odd results. For example, the latent demand for the category “space vehicles” will exist for “Togo” even though they have no space program. The assumption is that if the economies in these countries did not exist, the world aggregate for these categories would be lower. The share attributed to these countries is based on a proportion of their income (however small) being used to consume the category in question (i.e. perhaps via resellers).

Step 5. Fixed-Parameter Linear Estimation

Nonlinearities are assumed in cases where filtered data exist along the aggregate consumption function. Because the world consists of more than 200 countries, there will always be those countries, especially toward the bottom of the consumption function, where non-linear estimation is simply not possible. For these countries, equilibrium latent demand is assumed to be perfectly parametric and not a function of wealth (i.e. a country’s stock of income), but a function of current income (a country’s flow of income). In the long run, if a country has no current income, the latent demand for project and portfolio (ppm) management software is assumed to approach zero. The assumption is that wealth stocks fall rapidly to zero if flow income falls to zero (i.e. countries which earn low levels of income will not use their savings, in the long run, to demand project and portfolio (ppm) management software). In a graphical sense, for low income countries, latent demand approaches zero in a parametric linear fashion with a zero-zero intercept. In this stage of the estimation procedure, low-income countries are assumed to have a latent demand proportional to their income, based on the country closest to it on the aggregate consumption function.

Step 6. Aggregation and Benchmarking

Based on the models described above, latent demand figures are estimated for all countries of the world, including for the smallest economies. These are then aggregated to get world totals and regional totals. To make the numbers more meaningful, regional and global demand averages are presented. Figures are rounded, so minor inconsistencies may exist across tables.

Step 7. Latent Demand Density: Allocating Across Cities

With the advent of a “borderless world”, cities become a more important criteria in prioritizing markets, as opposed to regions, continents, or countries. This report also covers the world’s top 2000 cities. The purpose is to understand the density of demand within a country and the extent to which a city might be used as a point of distribution within its region. From an economic perspective, however, a city does not represent a population within rigid geographical boundaries. To an economist or strategic planner, a city represents an area of dominant influence over markets in adjacent areas. This influence varies from one industry to another, but also from one period of time to another.

Similar to country-level data, the reader needs to realize that latent demand allocated to a city may or may not represent real sales. For many items, latent demand is clearly observable in sales, as in the case for food or housing items. Consider, again, the category “satellite launch vehicles.” Clearly, there are no launch pads in most cities of the world. However, the core benefit of the vehicles (e.g. telecommunications, etc.) is 'consumed' by residents or industries within the worlds cities. Without certain cities, in other words, the world market for satellite launch vehicles would be lower for the world in general. One needs to allocate, therefore, a portion of the worldwide economic demand for launch vehicles to regions, countries and cities. This report takes the broader definition and considers, therefore, a city as a part of the global market. I allocate latent demand across areas of dominant influence based on the relative economic importance of cities within its home country, within its region and across the world total. Not all cities are estimated within each country as demand may be allocated to adjacent areas of influence. Since some cities have higher economic wealth than others within the same country, a city’s population is not generally used to allocate latent demand. Rather, the level of economic activity of the city vis-à-vis others.

Pharmaceutical Portfolio Management Strategy

This latest study delves into the challenges facing pharmaceutical portfolio management teams. As one of the most important components to strategic planning, portfolio management is often left neglected or under-resourced. As many as 82% of pharmaceutical companies believe that their portfolio management successes have been adequate at best. Two-thirds of companies believe that their portfolio management function is lacking resources.
It is no surprise then that many companies struggle with how they will strategically invest in their portfolio products, how to coordinate activities and when to make the decision to cease development in underperforming projects.
Among the many findings that analysts discovered through this research, several strategies and industry trends emerged as more significant, including:
- Portfolio management delivers the strongest impact when aligned with corporate strategy
- Mid-sized companies face the greatest portfolio management challenges as they grow larger
- Data standardization, though difficult to achieve, streamlines portfolio management and makes the decision-making process more effective
- Participating companies cited corporate culture and lack of buy-in as the greatest barriers to portfolio management success
- An inverse relationship exists between the frequency of portfolio management team meetings and overall satisfied with portfolio management success

This research was developed to guide pharmaceutical and biotechnology companies’ portfolio management teams. The study includes benchmark data to help portfolio management teams gain adequate resources and understand how best to allocate brand team budgets. The report makes its case with metrics, tools and techniques for managing portfolio planning in these key areas:

Structure, Resources and Tools – Efficient portfolio management structures backed by adequate budgets and staffs allow portfolio planners to obtain required product metrics and make informed recommendations to support the company’s products.

Portfolio Management Strategy – Portfolio planning is rendered useless without clear, standardized criteria with which to compare products. Furthermore, maintaining a consistent portfolio strategy allows companies to find lucrative licensing opportunities that drive create at lower costs.

Portfolio Snapshots – Analysis of participating companies’ portfolios, including strengths, weaknesses and areas of interest for future growth.

Pharmaceutical Portfolio Management: Strategies to Deliver Corporate Success

Senior pharmaceutical executives must manage a 'portfolio of portfolios' ensuring that the right investment decisions are made across their enterprise. The constant challenge in this environment is to determine which projects should receive investment. Portfolio management aims to meet this challenge and seeks to determine the optimal mix of projects within a portfolio.

Scope

Details the tools and processes needed for evaluating projects, strategically aligning portfolios, managing resource and maximizing portfolio value

Examines the technical and operational difficulties encountered during portfolio management and details strategies for overcoming these barriers

Examines current practice across more than 40 top-tier, mid-tier, specialty pharmaceutical and biotechnology companies from the US, Europe and Japan

Contributing companies include AstraZeneca, Aventis, Bayer, BMS, Chiron, Chugai, GSK, J&J, Lilly, Pfizer, Sankyo, Shionogi, Solvay, Takeda, TAP, Wyeth

Report Highlights

Benchmarks expected portfolio performance of the leading 40 pharmaceutical companies, forecasting total ethical sales and sales of portfolios across eight therapeutic areas between 2003 and 2008, as well as undertaking R&D productivity, identifying those companies and portfolios expected to out perform and under perform over this period.

Provides insight into the portfolio management systems and practices in place within pharmaceutical companies using detailed case studies based on interviews with portfolio management executives examining their experiences in designing and implementing portfolio management activities.

Analyzes the results of Datamonitor’s 2003 Portfolio Management Survey across more than 40 pharmaceutical companies which details portfolio management practices across the industry, executives opinion of practices within their own organizations and highlights deficiencies in current practice.

Reasons to Purchase

Improve buy-in within your organization at the project team level by understanding the objectives principles, and processes of portfolio management

Identify deficits in portfolio management practice and benchmark your organization against best practice across the pharmaceutical industry

Improve project evaluation by increasing your personnel’s knowledge of the strengths and weakness of financial tools and processes at their disposal

pharmaceutical portfolio

This latest study delves into the challenges facing pharmaceutical portfolio management teams. As one of the most important components to strategic planning, portfolio management is often left neglected or under-resourced. As many as 82% of pharmaceutical companies believe that their portfolio management successes have been adequate at best. Two-thirds of companies believe that their portfolio management function is lacking resources.
It is no surprise then that many companies struggle with how they will strategically invest in their portfolio products, how to coordinate activities and when to make the decision to cease development in underperforming projects.
Among the many findings that analysts discovered through this research, several strategies and industry trends emerged as more significant, including:
- Portfolio management delivers the strongest impact when aligned with corporate strategy
- Mid-sized companies face the greatest portfolio management challenges as they grow larger
- Data standardization, though difficult to achieve, streamlines portfolio management and makes the decision-making process more effective
- Participating companies cited corporate culture and lack of buy-in as the greatest barriers to portfolio management success
- An inverse relationship exists between the frequency of portfolio management team meetings and overall satisfied with portfolio management success

This research was developed to guide pharmaceutical and biotechnology companies’ portfolio management teams. The study includes benchmark data to help portfolio management teams gain adequate resources and understand how best to allocate brand team budgets. The report makes its case with metrics, tools and techniques for managing portfolio planning in these key areas:

Structure, Resources and Tools – Efficient portfolio management structures backed by adequate budgets and staffs allow portfolio planners to obtain required product metrics and make informed recommendations to support the company’s products.

Portfolio Management Strategy – Portfolio planning is rendered useless without clear, standardized criteria with which to compare products. Furthermore, maintaining a consistent portfolio strategy allows companies to find lucrative licensing opportunities that drive create at lower costs.

Portfolio Snapshots – Analysis of participating companies’ portfolios, including strengths, weaknesses and areas of interest for future growth.

The countries of Central and Eastern Europe

The countries of Central and Eastern Europe represent a total market of 285 million people and a combined GDP of US$3.0 trillion in 2008

The impact of EU accession on the pharmaceutical market
In May 2004, five of the CEE markets in question joined the European Union. Much of the pharmaceutical legislation within the region has therefore been harmonised with that of the EU, although countries such as Poland are still in the process of transposing EU directives into national law.

Romania and Bulgaria have also amended the relevant legislation and became full EU members in January 2007. The implementation of GMP is also taking place across most of the region and this will inevitably improve the quality of overall production and lead to a rise in market values.

Variations in the quality of IP protection
The level of IP protection offered by the CEE nations varies across the region, but the issue generally remains an international concern. Problems that are commonly raised include a lack of transparency in IP procedures and the lack of effective enforcement. Some countries, such as Bulgaria, have made a lot of progress in improving the legal climate by strengthening patent laws and extending the standard patent term to 20 years.

The dominance of the generics market
The demand for affordable drugs is the principal factor in the dominance of the generics in the region. Despite recent improvements in patent protection, legislation and effective enforcement are still needed in many countries where counterfeiting of Western drugs continues. Generics production has managed to remain strong in countries that are also home to the producers of branded drugs. In the former Czechoslovakia for example, the merger of Leciva with Slovakofarma enhanced generics production in 2003. However, as economies develop the trend to importing higher value branded products can be seen.

These reports analyse the issues which matter
That is why Espicom Business Intelligence has published these new management reports The Outlook for Pharmaceuticals in Central & Eastern Europe to 2013. Each report provides individual and highly-detailed analysis of each market, looking at the key regulatory, political, economic and corporate developments in the wider context of market structure, service and access. The reports are available individually, or as a discounted collection, and prices include 4 completely updated reports sent quarterly, plus a comprehensive report sent annually. There are over 60 markets covered in the worldwide series.

Executive Summary


11 Major Markets Covered!
Bulgaria Hungary Russia Slovenia
Croatia Poland Serbia Ukraine
Czech Republic Romania Slovakia

Highlights from the report
THE REGION
Russia, Poland, the Czech Republic, Hungary and Ukraine represent the five largest markets in the CEE region. Russia has the potential to become one of the worlds largest pharmaceutical markets, due to its population of around 142 million people, but demand remains very low, due to insufficient public healthcare funding. The dominance of generics is a reflection of the poor economic situation; generic drugs account for 90% of the market by volume. The largest markets are also among the fastest-growing in the region, although Romania and Serbia are also performing well. Other markets of the former Yugoslavia are exhibiting slower, yet respectable growth rates.

POLAND
Poland has one of the largest populations in Europe and therefore boasts a significant market of US$6.4 billion in 2008. Poland has a well established pharmaceutical industry and manufacturers tend to specialise in the production of generic drugs. Generics have a higher chance of entering the market as they are given priority over patented drugs in bioequivalence tests and are usually placed on the reimbursement list, making them a popular prescription choice. Much of the Polish pharmaceutical industry has now been privatised; many companies have been taken over by foreign investors such as GlaxoSmithKline and IVAX (now Teva).

CZECH REPUBLIC
The Czech Republic was one of the larger and richer former Soviet bloc countries to join the EU in May 2004. The market is valued at US$3.7 billion in 2008 and its per capita expenditure of US$358 is the second highest in the region. Generics are widely used in the Czech Republic but their share of the market is slowly being eroded by the constant growth of imported patented drugs. As with other recent EU entrants, the Czech Republic is forbidden by the accession treaty to parallel export low-priced branded drugs to the high-price EU markets such as Germany or the UK, if the drug in question has a patent in the target market.

HUNGARY
Despite its modest population of around 10 million, Hungary is a significant central European market. Per capita expenditure on pharmaceuticals is the third highest in the region and annual growth is strong at 8.9%. Spending on drugs accounts for 28% of total health expenditure in 2008. The drugs budget has run at a deficit for years. This initially prompted the government to introduce price freezes and encourage companies to contribute a percentage of turnover to the Health Insurance Fund. The Pharma Economic Act, which came into force in January 2007, compels pharmaceutical companies to relinquish a larger proportion of their profits to help cover overspending. So far, the new legislation has proved successful in reducing the deficit.

ROMANIA
At US$2,124 million, the Romanian pharmaceutical market ranks as the sixth largest in the CEE region, although per capita expenditure only exceeds that of Russia and Ukraine. Romania joined the EU in January 2007 and has made much progress in adjusting its legislation.

The quality of drug production has risen since the enforcement of GMP on 1st January 2004, although the number of local drug producers fell as a result. Much of the region has been privatised; generics companies such as Actavis and Ranbaxy have recently acquired local companies.

BULGARIA
The Bulgarian pharmaceutical market is around ten times smaller than the Polish one, but possesses a high growth rate of 9.0%. This rate should be sustainable in view of the GMP enforcement of April 2002 and the subsequent improvements in domestic production, in terms of quality and capacity. Bulgaria became a member of the EU in January 2007 and has harmonised its legislation with EU directives.

Improvements have also been made in other areas such as IPR enforcement and legislation; the United States Trade Representative removed Bulgaria from its Special 301 Watch List in 2007 as a result of this. However, the pricing and reimbursement of pharmaceuticals remains an issue. The US industry association, PhRMA, believes that the procedures used to determine the price and reimbursement status of a drug are non-transparent and cumbersome. It notes that arbitrary classification of newer drugs, which are more effective and have fewer side effects, make it more difficult for manufacturers to recover their research and development costs. ..... FOR EVERY MARKET,
SENT QUARTERLY

MARKET OUTLOOK
Current market size
Unique 5-Year market projections to 2013
Market outlook
Comment & rating, covering 8 key areas such as use of generic drugs, intellectual property, pricing and the health systems
Market structure
Statistical data on imports and exports
Market developments, covering recent and impending developments with respect to key issues such as regulation, health facilities, funding and
government policy
Key national data projections

FOR EVERY MARKET,
SENT ANNUALLY

BACKGROUND DATA
Population data, including growth trends and age structure
Demographic indicators detailing principal causes of death and morbidity

HEALTHCARE SYSTEM
Organisation & administration
Health expenditure
- Expenditure by source of funding and type
Hospital services
- Hospital data such as beds by type, region, specialty, patient admissions and surgical procedures
Outpatient care
Medical personnel
- Data on healthcare professionals covering such areas as doctors by specialty, nursing staff and dentists

ACCESSING THE PHARMA MARKET
Regulatory environment
Distribution guide and trade fair information
Domestic production

CONTACT DETAILS
For healthcare organisations and trade associations

23 November 2009

PLANNING AND CONDUCTING THE ASSESSMENT

3-1
CHAPTER 3
PLANNING AND CONDUCTING THE ASSESSMENT
3.1 Chapter Summary
This chapter discusses the steps to plan and conduct a health system performance assessment
using this manual. It should be used as a compendium of best practices for managing the
logistical aspects of the assessment to make the best use of the analytical talent and skills set of
the assessment team. After the U.S. Agency for International Development (USAID) Mission
has selected the country where the assessment will take place, it will undertake the activities
described in this chapter. The chapter’s intended user is the person managing the assessment, and
the design of the chapter assumes that that assessment manager and others involved in the
assessment have desk research as well as field-based research experience.
The next chapter (Chapter 4, “Synthesizing Findings and Developing Recommendations”)
focuses on approaches for analyzing the data and assessment findings, and recommends proven
methodologies for developing, validating, and prioritizing interventions.
The following key activities are involved in planning and conducting an assessment; some of
them occur concurrently—
1. Identify the needs and priorities of the USAID Mission.
2. Agree on the scope, time frame, and dates of the assessment.
3. Prepare an assessment budget.
4. Assemble an assessment team and assign responsibilities.
5. Prepare the logistics checklist.
6. Schedule and conduct team planning meetings.
7. Compile and review background materials.
8. Prepare a contact list and interview key informants.
9. Organize a stakeholder workshop.
10. Hold a post-assessment debriefing as needed.
11. Prepare the assessment report.
Several templates and samples of documents are provided as annexes to this chapter; others are
available in the CD that accompanies this manual. Annexes for Chapter 3—
• Annex 3A. Template for Assessment Scope of Work
• Annex 3B. Sample Assessment Budget Templates (included electronically on CD only)
• Annex 3C. Sample Local Consultant Scope of Work
• Annex 3D. Sample Logistical and Task Checklist
• Annex 3E. Sample Team Planning Meeting Agenda
Health Systems Assessment Approach: A How-To Manual
3-2
• Annex 3F. Sample List of Background Documents—Desktop Review for Azerbaijan
Assessment
• Annex 3G. Sample In-Country Interview Schedule
• Annex 3H. Sample Contact List
• Annex 3I. Sample Stakeholder Workshop Agenda
• Annex 3J. Suggested Outline for Final Assessment Report
• Annex 3K. Outline of Assessment Report from Pilot Test in Angola—Angola Health
System Assessment (full report included electronically on CD that accompanies this
manual or available for download at www.healthsystems2020.org)
• Annex 3L. Outline of Assessment Report from Pilot Test in Benin—Benin Health
System Assessment (full report included electronically on CD that accompanies this
manual or available for download at www.healthsystems2020.org)
3.2 Activity 1: Identify the Needs and Priorities of the USAID Mission
Once you have decided to proceed with a rapid health system assessment, you will need to
address a few key points before moving forward—
• Review the purpose of this assessment tool and what kind of information it can provide
to the Mission (see Chapter 1, “Health Systems Strengthening: An Introduction” and
Chapter 2, “Overview of the Approach”). Make sure that the information from the
assessment will match the type of information needed by the Mission and its programs.
• Identify any special needs the Mission may have (e.g., specific areas of interest) and
determine if this assessment tool can meet that need. The tool is designed to assess
overall health system performance. It does not focus on specific health programs or
conditions, such as Integrated Management of Childhood Illness or tuberculosis. If
program-specific information is needed, the assessment organizers and the Mission
should agree on an approach to address these needs. Strategic priorities may also require
special consideration.
• Identify recent or upcoming in-country studies or activities that may be useful to the
assessment. The Mission and other organizations working in the country may be aware of
recent studies, health sector (or subsector) assessments, or other publications that may be
useful in planning and preparing for this assessment. This research will also help to
identify overlaps between the proposed assessment and any recent or future activities incountry.
• Determine which modules would be most relevant. Given the priorities and needs of
the USAID Mission, this assessment could cover all the technical modules or only a
Chapter 3. Planning and Conducting the Assessment
3-3
subset of them. Note that the core module is mandatory and must be completed regardless
of the overall scope.
• Define structure and scope of the final assessment report. Annex 3J provides a
suggested outline for the final assessment report. Discuss this report with the USAID
Mission and reach an agreement for the overall structure and scope of the report.
(Outlines of the assessment reports prepared as part of the Angola and Benin pilot tests
are included as Annexes 3K and 3L and serve as examples.)
3.3 Activity 2: Agree on the Scope, Time Frame, and Dates of the Assessment
The final scope of your work will be influenced by the following considerations.
• The overall level of effort is based on the number of modules to be applied. An estimated
two person-weeks per module will be required. This estimate is based on one week for
preparatory work and report writing plus one week for fieldwork for each module. It does
not include travel time.
• The time required will also be influenced by the number of people on the assessment
team. For example, if all seven modules will be implemented, the team could be set up
with two people who do three or four modules each, three people who do two or three
modules each, or four people who do one or two modules each. The expertise of the team
members, the ready availability of data, and type of final report requested will also
influence the time requirements. Time for translation of materials may also need to be
considered.
• The time and number of team members required will be also depend on where the
assessment will take place. Although the assessment primarily focuses on data that can be
collected at a national (central) level, you may find that conducting all or some of the
assessment at a subnational level is appropriate, particularly in decentralized systems or
in cases where information and systems must be verified at a provincial or district level.
If a provincial- or district-level visit is to be conducted, you will need to consider the
following issues.
o Site selection. Work with USAID Mission and possibly a local bilateral or
nongovernmental organization (NGO) project to identify possible locations or sites.
o Budgetary implications. Most likely, you will have travel costs associated with the
trip, and they need to be integrated into the budget. Furthermore, the level of effort
for assessing regional or lower level agencies and stakeholders, in addition to central
agencies, will imply a larger budget for interviews.
o Time implications. If the in-country travel will take several days, you may need to
extend the time of the assessment or send only part of the assessment team.
Health Systems Assessment Approach: A How-To Manual
3-4
o Technical considerations. You may need to develop field questionnaires based on the
modules to help team members ask the appropriate questions for the subnational
level.
• Any specific information needs agreed to with the Mission will need to be considered.
• Estimate the time frame in which all assessment activities will be conducted. The
availability of selected team members, holidays, and other events will determine the exact
dates of the assessment. The assessment activities are not limited to the fieldwork, but
also include time for organizational and logistic preparation, team member preparation,
and post-fieldwork.
Draft the scope of work for the assessment early in the process to help inform potential
assessment team members of their role and tasks. A template for developing the assessment
scope of work is presented in Annex 3A.
3.4 Activity 3: Prepare an Assessment Budget
You will need to prepare the budget early in the planning process. An Excel® template, which is
presented in Annex 3B (and is available on the CD that accompanies this manual), can be used to
draft the budget. It should be updated as additional information becomes available, such as
personnel daily rates and the cost of interpreters and translators, if needed. Some key
considerations for the budget are listed below.
• Team member time
o Planning time—technical lead and administrative or logistics support
o Team member time—preparatory, fieldwork, and report preparation
• Travel costs (as needed)
o Airfare
o Per diem
o Visa costs
o Telecommunications costs (phone and Internet access)
• Contracted services (as needed)
o Local consultant
o Translator(s)
o Driver(s) and car(s)
Chapter 3. Planning and Conducting the Assessment
3-5
o Conference room facilities for the stakeholder workshop (room charge, food costs,
and equipment rental)
• Other
o Photocopies for reference materials, reports, and other documents
o Postage (mailing of documents before visit, if needed)
3.5 Activity 4: Assemble an Assessment Team and Assign Responsibilities
The selection of the assessment team is a critical step in planning the assessment. Team members
may include the Mission Population, Health and Nutrition (PHN) officer, other staff, staff from
other USAID offices, in-country consultants, and external consultants. You will likely assemble
the team and assign roles and responsibilities accordingly.
The roles, qualifications, responsibilities, and estimated level of effort of each assessment
participant are described below.
3.5.1 The Assessment Coordinator’s Responsibilities
The assessment coordinator is the point person responsible for the organization and logistics of
the assessment. This person may be the Mission PHN officer or another designated person who
will work in collaboration with assessment team members, the USAID Mission, and any local
consultants. The assessment coordinator could be a member of the assessment team or could
function in a purely organizational role.
The coordinator should have experience in organizing data collection efforts and managing
consultants, and should have strong research and interpersonal skills. The person would ideally
have some familiarity with the country’s health sector, contacts with stakeholders, and advanced
command of the language of the assessment country as well as English.
A local consultant may be hired to assist with the local coordination activities if the assessment
coordinator is not based in the country. Responsibilities would need to be divided accordingly. If
a local consultant is hired to take on part of the coordination activities, a local consultant scope
of work will be necessary. A sample scope of work is supplied in Annex 3C.
Key responsibilities of the assessment coordinator are divided into preparatory work and support
to the team during fieldwork.
3.5.1.1 The Assessment Coordinator’s Preparatory Work
In advance of fieldwork, the assessment coordinator will need to do the following.
1. Prepare scopes of work, background documents, and the like.
Health Systems Assessment Approach: A How-To Manual
3-6
2. Assist in selecting the assessment team.
3. Prepare the assessment logistics checklist and budget.
4. Manage logistical preparations, including the following—
a. Interface with USAID regarding logistics for the team.
b. Assist with invitations and arrangements for the stakeholder workshop.
c. Prepare the schedule of work for the team members (each team member will have
independent and team or group meetings), including scheduling and confirming
appointments. Provide guidance on appropriate informants in the health sector.
d. Obtain quotes for mobile phone rental for the team.
e. Plan travel.
5. Organize team meetings.
6. Work with the assessment team to obtain reports and other data sources required in
advance and extract specified information.
7. Hire a local consultant (if needed).
8. Hire local translator(s) to work with the team (if needed).
9. Hire a car and driver to provide transportation for the team during the visit, including
pick-up and drop-off at the airport.
10. Provide guidance on general work protocols for the team, including regular daily working
hours (start, lunch, end), holidays, introductions, and language.
11. Establish protocols for interview note-taking, sharing notes among team members, and
report preparation templates or formats before the trip begins.
3.5.1.2 The Assessment Coordinator’s Support of the Team during Fieldwork
During the fieldwork, the assessment coordinator will need to do the following.
1. Meet with team at the start of field activities and participate in team meetings.
2. Assist the team as needed during the initial briefing meeting with USAID.
3. Assist the team to collect data as needed.
4. Interpret or translate as needed.
5. Help prepare for and participate in the stakeholder workshop.
Chapter 3. Planning and Conducting the Assessment
3-7
a. Confirm conference room arrangements (including availability of overhead digital
projector, flipchart paper, markers, notepads, and pens among others).
b. Arrange for photocopies as requested by the team.
6. Contribute to Country Health Systems Assessment Report as needed.
7. Travel to one or two provincial areas (as required).
The expected level of effort for the coordinator is a minimum of five days of preparatory work,
plus time to support the team as needed during the fieldwork. Although the preparatory work is
estimated at five days, this work would be done over a two-month period to allow time for the
various planning steps to be taken. If the assessment coordinator is also a team member, the level
of effort would need to be revised accordingly. Similarly, the level of effort may need to be
revised if delays occur.
3.5.2 The Assessment Team Leader’s Responsibilities
The assessment team leader is responsible for the overall management of team activities in the
field and for the timely completion of the assessment. The team leader will do the following—
1. Lead the team and its activities; clarify the scope and timeline with the assessment
coordinator, the team, and country counterparts.
2. Liaise with the assessment coordinator (and local consultant if needed) and the Mission
on scheduling interviews, site visits, and logistics.
3. Coordinate with the assessment coordinator and the Mission to prepare for and conduct
the stakeholder workshop.
4. Plan for daily activities during fieldwork with other team members.
5. Facilitate daily team meetings.
6. Deliver final assessment report to the USAID Mission. The team leader is likely to be the
lead author of the assessment report, although one of the other team members can take on
this role. Either way, the team leader will be responsible for finalizing the report and
delivering it to the USAID Mission.
3.5.3 The Assessment Team Members’ Responsibilities
Assessment team members should have a health-system background; knowledge of at least one
of the areas of study (e.g., health financing, pharmaceuticals, human resources, health
information systems); and preferably have the ability to speak, write, and read in the language of
the assessment country to facilitate document review and interviews. Having these language
skills will also reduce costs associated with interpretation and translation services. The
assessment team will be responsible for the following tasks listed below.
Health Systems Assessment Approach: A How-To Manual
3-8
3.5.3.1 The Team Members’ Preparatory Work
In advance of fieldwork, team members will need to do the following.
1. Read through this manual.
2. Participate in team planning meetings and discussions.
3. Work through the modules they are assigned.
4. Prepare lists of documents needed and potential interviewees to submit to the assessment
coordinator, based on the modules they are assigned.
5. Review, analyze, and understand Component 1 data for all the modules, which are
derived from established databases.
6. Review background documents and prepare the desk study (Component 2) to the degree
possible; at least some parts of each module can be completed with a desk study and the
information verified during fieldwork. Note that the core module, particularly, should be
completed as much as possible at this stage since it provides valuable background
information for the entire team.
7. Identify information gaps, based on preparatory work, that are to be filled during
fieldwork.
3.5.3.2 The Team Members’ Fieldwork
The assessment tool was designed to be implemented in-country over one person-week per
module. Note that this estimate does not include travel time and assumes that sufficient
preparatory work is completed as described above. The level of effort may be revised based on
the number of modules each team member is responsible for, the level of experience of the team
members, and the like. Key fieldwork tasks required of the team are the following.
1. Meet with team at the start of fieldwork and participate in regular team meetings.
2. Collect data on assigned module(s) through document review and interviews.
3. Prepare preliminary analyses in cooperation with team members. Draft relevant sections
for the Country Health Systems Assessment Report, including recommended potential
activity areas and interventions.
4. Prepare for and conduct a stakeholder workshop.
5. Travel to rural areas or regional and district level locations, as required.
Chapter 3. Planning and Conducting the Assessment
3-9
3.5.3.3 Report Preparation
Post-fieldwork activities will vary depending on the reporting needs of the Mission. Key postfieldwork
tasks are the following.
1. Finalize the Country Health Systems Assessment Report, including recommendations,
based on input from the stakeholder workshop and mission staff.
2. Participate in follow-up meetings, as needed.
3.6 Activity 5: Prepare the Logistics Checklist
A sample checklist of tasks and logistical steps is presented in Annex 3D. You will need to make
travel arrangements for team members not based in the country. In addition, depending on the
country and the interests of the USAID Mission, you may need to plan for trips to areas outside
of the central capital city. A local consultant may be particularly helpful in making these
arrangements.
3.7 Activity 6: Schedule and Conduct Team Planning Meetings
Before the assessment, schedule a meeting for the team to review the purpose of the assessment,
review the manual, and assign responsibilities. A second team meeting may be scheduled after
the preparatory work has been completed and before fieldwork. The focus of this meeting should
be the review of remaining information gaps and scheduling the fieldwork. At a minimum all
team members and the coordinator should be present and participate. (This meeting may be
conducted by conference call.) A sample team planning meeting agenda is presented in Annex
3E.
In addition, during the fieldwork, regular daily team meetings led by the team leader are
recommended.
3.8 Activity 7: Compile and Review Background Materials
Compile background information on the country, and in particular any general health documents,
early in the assessment process. Each module should have identified specific documents and
types of documents from which relevant information may be obtained. A sample list of
background documents that was prepared for Azerbaijan is included in Annex 3F.
The assessment coordinator should facilitate the collection of the documents and distribution to
the team members. Hard copies of key documents can be compiled in a binder or electronically
on a CD and shared at the first team meeting. Encourage team members to keep a list of all
documents consulted and provide the list as part of the assessment report.
Health Systems Assessment Approach: A How-To Manual
3-10
Information that is pulled from any document must be properly cited, so that the source of the
information can be checked later if questions are raised about it. Simple tools may be used to
manage the information that is gleaned from documents. For example, information pulled from
documents may be entered into a database to facilitate sorting by topic. Software programs that
can assist with this include Reference Manager® and MS Access.®
3.9 Activity 8: Prepare a Contact List and Interview Key Informants
Before fieldwork begins, you will need to
consult with the USAID Mission, the
assessment coordinator, and the team members
to identify key informants. Other donors and
stakeholders may be queried about potential key
informants in advance of the fieldwork, and
country reports can also provide a lot of names
of people to follow-up with. The generic titles
of likely key informants are listed in the
individual modules. When selecting the specific
individuals to be interviewed, specify the topics
and types of information that will be discussed
during the interview to make sure that the most
appropriate person will be selected.
The local consultant can assist with scheduling
the interviews. A sample interview schedule is
presented in Annex 3G. A contact list of team
members, Mission contacts, and interviewees
should also be prepared and maintained
throughout the assessment. A contact list
template is presented in Annex 3H. One of the
team members should be assigned the
responsibility of maintaining this list.
This tool assumes that the assessment team
members have some relevant field-based
research experience. Nonetheless, you may want
to remind them of good information gathering
and interviewing practices. Box 3.1 provides
some basic tips for conducting a successful
interview.
This tool does not include questionnaires to be
applied during interviews. Rather, the questions
that need to be addressed to obtain data for the
indicators are simply listed by topic without any
Box 3.1
Interview Tips
Insist on getting copies of documents
and texts. Whenever a respondent refers to
a study, policy, law, or other document, ask
for a copy, or at least a citation for the
document. If needed, get an independent
translation. Having your own copy will allow
for independent evaluation of the content of
the document and serve to confirm the
informant’s interpretation of the contents.
Use consistent questions with flexible
follow-up across all the sources
interviewed. Interviews must be designed to
get consistent information. Start with a list of
questions, and try to cover all of them in the
interview. In particular, when both the
provider and patient are being interviewed,
be sure to cover the same topics with each.
Seek information from multiple
perspectives. For many reasons, different
parties may perceive the same situation in
different ways. An informant may be a great
distance from the reality on the ground.
Some informants may not be exposed to
what is actually happening, or may only feel
comfortable speaking to the ideal, or the way
things should be.
Document interview notes promptly.
Document your interview notes every night. If
your team splits up to interview different
informants, you can share your experiences
through the notes. The notes then become
an important resource as the team prepares
the final report.
Source: Ravenholt and others (2005).
Chapter 3. Planning and Conducting the Assessment
3-11
particular order with respect to the most likely respondent. In advance of the field visit, and as
part of the documentation review, team members should draft country and site-specific (e.g.,
central versus regional) interview guides according to most likely respondent. Careful
preparation will help avoid duplication of questions to the same individual and will also ensure
that the sequence of the questions asked will be logical.
3.10 Activity 9: Organize a Stakeholder Workshop
The stakeholder workshop will be the final fieldwork activity for the assessment team. The
stakeholder workshop is intended to be a forum in which stakeholders can—
• Review, discuss, and validate team’s major findings
• Provide input on their priorities, based on strengths and weaknesses discussed
• Provide input on the team’s recommendations
• Identify how they will or can be involved in follow-up activities, how to move forward,
or how to provide feedback and recommendations on major options presented by the
team
Organizing the workshop is the responsibility of the team leader in coordination with the USAID
Mission. Key activities include the following.
• Identify invitees, set the agenda, and confirm dates.
• Send invitations.
• Reserve a location, such as a hotel conference room, and plan for coffee breaks (best
done in advance or immediately upon arrival in-country).
• Reserve audiovisual equipment and procure other supplies such as flipcharts and markers
(also best done in advance or immediately upon arrival in-country).
• Prepare presentations and handouts for the workshop.
• Meet with USAID before the workshop to review draft findings and agenda.
An example of a stakeholder workshop agenda is included in Annex 3I.
3.11 Activity 10: Hold a Post-Assessment Debriefing as Needed
In addition to the stakeholder workshop, the Mission may request a debriefing meeting after
fieldwork is completed. This meeting may also be requested by USAID Washington depending
on the availability of team members.
Health Systems Assessment Approach: A How-To Manual
3-12
3.12 Activity 11: Prepare the Assessment Report
Assessment team members should start drafting their findings early, during preparatory and
fieldwork. The assessment findings, recommendations, and discussion in the stakeholder
workshop should be documented in the final report. Each module chapter contains guidance on
summarizing findings. Annex 3J includes a suggested outline for the final report. Annexes 3K
and 3L include outlines of the assessment reports prepared for the Angola and Benin pilot tests
and serve as examples. Team members will need to agree on a timeline and approach for
finalizing and disseminating the report, in consultation with the USAID Mission.
Reference
Ravenholt, Betty, Rich Feeley, Denise Averbug, and Barbara O’Hanlon. 2005. Navigating
Uncharted Waters: A Guide to the Legal and Regulatory Environment for Family Planning
Services in the Private Sector. Bethesda, MD: Private Sector Partnerships-One Project, Abt
Associates Inc.
Chapter 3. Planning and Conducting the Assessment
3-13
Annex 3A. Template for the Assessment of Scope of Work
SCOPE OF WORK
Health Systems Assessment Approach [Country]
Background
USAID’s Office of Health, Infectious Diseases and Nutrition (HIDN) has developed a Health
Systems Assessment Approach as part of its global Mainstreaming Health Systems
Strengthening Initiative. The Approach is meant to serve the following purposes:
• Allow Population, Health and Nutrition (PHN) officers from USAID (with the assistance
of experts/consultants if necessary) to conduct an assessment of a country’s health
system. This includes diagnosing the relative strengths and weaknesses of the health
system, prioritizing key weakness areas, and identifying potential solutions. This may be
particularly relevant during early phases of program development.
• Inform PHN officers about the basic elements and functions of health systems.
• Improve the capacity of bilateral projects to achieve USAID’s health impact objectives
through increased use of health systems interventions.
• Help health systems officials at USAID to conceptualize key issues, increase the use of
health systems interventions in technical programs, and to improve the role of the Health
Systems Division to support these programs.
The assessment tool covers the following components of the health system—governance; health
financing; human resources and health facilities; pharmaceutical supply system; and health
information systems. More details on the assessment methodology and topical areas are in
Annexes 1 and 2.
The technical team will be composed of three team members plus a local consultant. The team will
include a Team Leader from [organization] and other team members from [organizations].
The team will be assisted by the USAID PHN officer in [country]. The assessment team will review
documents and conduct interviews to gather specific information on the health system in [country].
The visit will conclude with a brief workshop with USAID representatives and other key
stakeholders.
Overall Scope of Work
Assessment:
• Systematically assess strengths and weaknesses of the health system using health system
assessment tool. The tool is designed to provide a broad assessment of the performance of the
health sector. Topics to be covered are governance, health financing, human resources and
health facilities, pharmaceuticals, and health information systems (see Annex 1).
• Provide general recommendations on potential activity areas for health system strengthening
following from the strengths and weaknesses identified in the assessment.
Health Systems Assessment Approach: A How-To Manual
3-14
• Conduct a stakeholder workshop at the end of the assessment visit to build consensus on what
the key health system priority areas are.
• Liaise with the new PHN bilateral program in [country] to share findings and information.
• The assessment will not evaluate disease- or program-specific areas as the tool is not designed
to do so. However, given the Mission’s interest in tuberculosis and family planning issues, the
team may be able to provide information as available that may be relevant to those two areas.
Tasks of Assessment Team Members
The allocation of tasks among team members will be discussed at team planning meetings.
Prior to team arrival (LOE: expected 5 days)
1. Participate in team planning meetings and discussions.
2. Review assigned module(s) and discuss any questions with module authors.
3. Review background data (Component 1 data will be compiled by [organization]).
4. Prepare a draft donor map based on a review of available documents.
5. Prepare lists of documents needed and potential interviewees (entire team). The lists will be
provided to the local consultant who will compile the documents and facilitate translation as
needed.
6. Review background documents and prepare the desk study (Component 2) to the degree
possible. This activity will be supported by the local consultant who will work to obtain
reports and other data sources required in advance and extract specified information.
During team visit (LOE: expected 15 days)
1. Meet with team upon arrival and participate in team planning meeting.
2. Collect Component 2 data through document review and interviews.
3. Assist in mapping current interventions/reforms to address weaknesses identified in
assessment.
4. Prepare preliminary analyses in cooperation with team members. Draft relevant sections for
the Country Health Systems Assessment Report, including recommended potential activity
areas and interventions.
5. Prepare and conduct stakeholder workshop.
6. Liaise with USAID PHN officer as needed to prepare for the stakeholder workshop and other
activities.
7. Liaise with new health bilateral program personnel to share and discuss findings.
8. Provide input as part of the pilot test with regard to approach/methodology, indicators,
timeline, level of effort, and format.
9. Travel to one rural area, to be determined, may be required. It is expected to be a brief trip.
10. Work will be conducted in [language], and will be assisted by translators as needed.
The team will work under the overall direction of the Team Leader. All team members will
contribute to day-to-day problem solving, solutions to issues of data availability, technical
questions, etc. This may require daily team meetings and other updates while in [country].
Chapter 3. Planning and Conducting the Assessment
3-15
Post in-country visit (LOE: expected 5 days)
1. Review any final comments received from the Mission and local counterparts.
2. Make corrections and adjustments to report for finalization.
Outputs
1. Stakeholder workshop report
2. Country Health Systems Assessment Report (draft outline will be provided)
The deliverables will be prepared in English but may be translated into relevant local language if
requested.
Annex 1. Outline of the Health Systems Assessment Approach
Introduction
This chapter provides the motivation for and the purpose of the approach. It also describes the
layout of the product (the manual and the CD). This section will draw from the framework paper
previously presented to USAID (“Health systems assessment approach: draft framework”).
Table of Contents
Chapter 1: Health Systems Strengthening: An Introduction
This is a background chapter explaining health systems and discussing their key functions. This
chapter serves as an informational piece for those less familiar with health systems. The chapter
builds on the paper written for the Child Survival Technical Resource Materials (TRM) on
Health Systems Strengthening. The chapter also provides a reference list for additional papers on
health systems.
Chapter 2: Overview of the Approach
This chapter describes the framework for the approach, listing and explaining the structure of the
technical modules and their components. The approach draws from the framework paper
previously presented to USAID (“Health systems assessment approach: draft framework”). An
annex provides a list of all the indicators and qualitative questions in each module, grouped by
topical area.
Health Systems Assessment Approach: A How-To Manual
3-16
Chapter 3: Planning the Assessment
This chapter provides guidelines for planning the assessment process, including—
• Identifying needs and priorities of the USAID Mission—this is so that the assessment can
appropriately focus on the right issues and help provide recommendations to the Mission.
• Time frame/schedule for the planning process and the in-country assessment
• Budgeting for the assessment
• Guidelines on how to select the assessment team (e.g., types of consultants to be
recruited, how many)
• Terms of reference (TOR)for staff and consultants for assessment team
• Agenda for assessment team planning meetings
• Types of documents to be reviewed before beginning the assessment and during the
assessment phase
• Types of stakeholder interviews to schedule
• Identifying districts/provinces to visit outside the central capital area
• Organizing the stakeholder workshop, including purpose of the workshop, suggested
agenda for the workshop, and a template for presenting findings
• Logistics checklist for planning the assessment, including the stakeholder workshop
• Overview of the assessment report that should be prepared using this approach; annexes
provide a suggested outline and outlines from two completed reports from prior
assessments as samples
Chapter 4: Synthesizing Findings and Developing Recommendations
This chapter includes guidelines on how to process, analyze, and interpret the findings from each
module, with particular attention to synthesizing these findings across all modules. Focus is on
how to identify key strengths and weaknesses of the health system, and how to identify root
causes of problems to be addressed. Guidelines are also provided for how to develop
recommendations for the Mission and how to link the recommendations to the USAID Mission’s
overall goals and priorities, including (to the extent possible) those of its bilateral projects. It will
address strategic objective (SO)-specific goals as well those related to the fragile state
framework.
Chapter 5: Core Module
This is the background/foundation module and will be required to be completed by all users. In
particular, if any users are planning to work through only a subset of the technical modules
(Chapters 6–11), they would need to complete this core module to understand the basic
background information about the country and its health systems.
Component 1: This includes basic demographic, health, and socioeconomic indicators for the
country. Data for the indicators is provided in an electronic format on the CD provided with this
manual (data file titled “Component 1 data”). Data for regional and income peer country
comparisons are also provided in the data file.
Chapter 3. Planning and Conducting the Assessment
3-17
Component 2: This will not be solely based on indicators as in the case of the other technical
modules (see below for Chapters 6–11). This section focuses on developing some basic
understanding and profiles of a country’s health system. Topics covered include:
• Political and macroeconomic environment: Provides guidance on how to describe the
political structure of the country.
• Business environment and investment climate: Provides sources of information and
guidance on how to analyze the factors that affect private investment and enterprise
growth and to identify the barriers to sustaining and expanding the private sector.
• Top causes of mortality and morbidity: These data are to be collected in-country and
could help guide any disease-specific recommendations to the USAID Mission. In
addition to the top causes of morbidity and mortality, prevalence rates for HIV/AIDS and
malaria will be collected, if important in the country context. Note that the health systems
assessment approach does not have a disease specific focus, but a user may have to
address this in developing recommendations for the USAID Mission.
• Structure of the main government and private organizations involved in the health care
system: This includes a template for developing a Ministry of Health (MOH)
organizational chart to help support the assessment process.
• Decentralization: This includes indicators to understand the level of decentralization in
the country—this will be important for determining the type of assessment that should be
conducted.
• Service delivery organization: This section provides an overview of the structure of
service delivery, including types of health facilities in the country, and of the engagement
of the private sector, including proportion of services and facilities in the private sector
and involvement of NGOs and the commercial sector.
• Donor mapping: This includes a template for mapping donor activities in the health
sector—this will be important for understanding the level of activities in the country, as
well as to identify gaps.
• Donor coordination: This includes indicators for assessing the level of donor coordination
and the related strengths and weaknesses.
Chapters 6–11: Topical Chapters—the Technical Modules
Chapter 6: Governance module addresses the information assessment capacity of the health
system, policy formulation and planning, social participation and health system responsiveness,
accountability, and regulation.
Chapter 7: Health financing module covers sources of financial resources; the pooling and
allocation of health funds, including government budget allocation and health insurance; and the
process of purchasing and proving payments.
Chapter 8: Service delivery module examines service delivery outputs and outcomes; the
availability, access, utilization, and organization of service delivery; quality assurance of
healthcare; and community participation in service delivery.
Health Systems Assessment Approach: A How-To Manual
3-18
Chapter 9: Human resources module covers systematic workforce planning, HR policies and
regulation, performance management, training/education and incentives.
Chapter 10: Pharmaceuticals management module evaluates the health system’s pharmaceutical
policy, laws, regulations; selection of pharmaceuticals; procurement, storage, and distribution;
appropriate use and availability of pharmaceuticals; access to quality pharmaceutical products
and services; and financing mechanisms for pharmaceuticals.
Chapter 11: Health information systems (HIS) module reviews the current operational HIS
components; the resources, policies and regulations supporting the HIS; data availability,
collection, and quality; and, analysis and use of health information for health systems
management and policy-making.
These chapters include technical modules, each with a set of indicators for conducting a health
system assessment. The key elements of each module are—
• System profile: This section provides guidelines for developing a basic profile of the
health system aspect assessed in each module. It includes templates for doing this, such
as mapping tools, flowcharts, etc.
• Component 1: This component includes indicators for which data are easily available
from international datasets. Data for Component 1 indicators is provided in an electronic
format on the CD provided with this manual. Specific attention will be given to including
regional or other peer country comparisons wherever feasible. Charts indicating possible
ways of presenting the data will also be included in an annex.
• Component 2: This component presents the indicators grouped by subtopic within each
module. Each indicator will be linked to one of five performance criteria: equity,
efficiency, access, quality, and sustainability. Users will have to conduct a combination
of desk review of documents and stakeholder interviews to collect data for these
indicators. Detailed descriptions of each indicator will be included (a template and
guidelines have been provided to chapter authors).
• Assessment process: Each chapter provides module-specific guidelines on the process for
working through each module, synthesizing findings and preparing recommendations for
interventions. These guidelines are meant to complement Chapter 4.
Chapter 3. Planning and Conducting the Assessment
3-19
Annex 3B. Sample Assessment Budget Templates
Note: Additional lines and items can be added to this template as needed. This template is available in MS Excel format on the accompanying CD.
Line Item Rate Unit Quantity Total
(Rate x Quantity)
Labor (add lines for as many people as needed)
Name Title $ /day # days $
Name Title $ /day # days $
Name Title $ /day # days $
Name Title $ /day # days $
Name Title $ /day # days $
Subtotal US labor $ Subtotal
Travel
Travel – airfare Destination $ /trip # fares at that rate $
Travel – airfare Destination $ /trip # fares at that rate $
Travel – airfare Destination $ /trip # fares at that rate $
Per diem Destination $ /days # days $
Per diem Destination $ /days # days $
Per diem Destination $ /days # days $
Other costs—local travel Destination $ /trip # $
Other costs—visa $ /trip # $
Other costs—misc. $ /trip # $
Subtotal travel $ Subtotal
Subcontracts/Outside services
Conference room Stakeholder workshop $ /day # days $
Coffee service Stakeholder workshop $ /person # people $
Audiovisual equipment Stakeholder workshop $ /day # days $
Driver and car $ /day # days $
Translators $ /day # days $
Subtotal Subcontracts $ Subtotal
Other costs
Postage $ $
Communications $ $
Other $ $
Subtotal Other $ Subtotal
Total Assessment Budget $ (Sum of Subtotals)
Health Systems Assessment Approach: A How-To Manual
3-20
Annex 3C. Sample Local Consultant Scope of Work
SCOPE OF WORK
Local Short Term Consultant
Health Systems Assessment Approach [Country]
Draft Month, Day, Year
Background
USAID’s Office of Health, Infectious Diseases and Nutrition (HIDN) seeks to develop a Health
Systems Assessment Approach as part of its global Mainstreaming Health Systems
Strengthening Initiative. The approach is meant to serve the following purpose:
• Allow Population, Health and Nutrition (PHN) officers from USAID to conduct an
assessment of a country’s health system, possibly during early phases of program
development (with the assistance of experts/consultants if necessary). This includes
diagnosing the relative strengths and weaknesses of the health system, prioritizing key
weakness areas, and identifying potential solutions.
• Inform PHN officers about the basic elements and functions of health systems.
• Help improve the capacity of bilateral projects to achieve USAID’s health impact
objectives through increased use of health systems interventions.
• Help health systems officials at USAID to conceptualize key issues, increase the use of
health systems interventions in technical program interventions, and to improve the role
of the Health Systems Division.
The assessment tool covers the following components of the health system:
stewardship/governance; health financing; human resources and health facilities;
pharmaceuticals; private sector engagement; and health information systems. More detail is on
the assessment methodology is in Annexes 1 and 2.
The technical team will be comprised of:
1. Team Leader (organization)
2. Technical specialist (organization)
3. Technical specialist (organization)
4. Local short-term consultant (contracted through [organization])
The team will be assisted by the USAID PHN officer in [country]. As part of the pilot test the
assessment team will review documents and conduct interviews to gather specific information on
the health system in [country]. The visit will conclude with a brief workshop with USAID
representatives and other key participants.
Objective of the Technical Assistance (Local consultant)
The local, short-term consultant will work with the technical team to identify relevant sources of
data for the assessment, obtain data and documents, and assist in document review. Further, the
consultant will assist the team with coordinating the program of visits, facilitating access to key
Chapter 3. Planning and Conducting the Assessment
3-21
informants (setting up interviews and meetings), participating in the data collection activities,
providing translation, and assuring that local technical and logistic needs are met in a timely and
effective way. The local consultant will be expected to help the team members who will speak
English and [language] to interact with counterparts in [language].
Expected Specific Tasks
[insert dates]
Prior to team arrival (LOE: minimum 5 days)
1. Work with technical team to obtain reports and other data sources required in advance
and extract specified information. This will assist the team with collecting data for Level
2 and 3 of the assessment (see Annex 1). Lists of the types of documents needed will be
provided closer to the team visit.
2. Manage logistical preparations:
a. Interface with USAID regarding logistics for the team.
b. Obtain quotes for mobile phone rental for team.
c. Assist with invitations and arrangements for a workshop to be held on the last
day of the visit.
d. In consultation with [organization], prepare the schedule of work for the team
members (each team member will have independent meetings and team or group
meetings), including scheduling and confirming appointments. Provide guidance
on appropriate informants in the health sector.
e. Provide other logistical support as needed.
3. Coordinate with and/or hire local translator(s) to work with the team to translate from
[language] to English. The number of translators will depend on team requirements
Translators would
f. Accompany team members on interviews to provide interpretation services
g. Review and translate documents are required
4. Provide guidance on general work protocols for the team, including regular daily working
hours (start, lunch, end), holidays, introductions, language, etc.
5. Hire car and driver to provide transportation for the team during the two-week visit,
including pick-up and drop-off at the airport.
During team visit (LOE: expected 15 days)
1. Meet with team upon arrival and participate in team planning meeting.
2. Assist team as needed during initial briefing meeting with USAID.
3. Assist team to collect Level 2 and Level 3 data (see description of the tool in Annex 1)
4. Interpret/translate as needed in [language]. Work with other translators as needed.
5. Contribute to preparations, and participate in the stakeholder workshop. Confirm
conference room arrangements (including availability of overhead digital projector, flip
chart paper, markers, notepads and pens, among others). Arrange for photocopies as
requested by the team.
6. Provide input on the pilot test process.
7. Draft relevant sections for the Country Health Systems Assessment Report, including
recommended solutions.
Health Systems Assessment Approach: A How-To Manual
3-22
8. Travel to one rural area, to be determined, may be required. It is expected to be a brief
trip.
A more specific list of tasks with dates will be provided when the dates of the visit are
confirmed. The Team will work under the overall direction of the Team Leader. All team
members will contribute to day-to-day problem solving, solutions to issues of data availability,
technical questions, etc.
Consultant Profile
The following background and experience are required.
• Familiarity with the health sector as a health professional in medicine, public health,
health financing/economics, or health services administration
• Experience in evaluation and/or health systems research, preferably at national level
• Excellent quantitative and qualitative skills
• Experience working in health sector in [country]
• Advanced command of [language] and advanced reading, writing, and speaking skills in
English
• Ability to work in teams
• Helpful to have familiarity and contacts in the ministry of health, private sector, and/or
donor community
Outputs
The reports will be prepared in English. Reporting deadlines will be specified when the
assessment schedule is finalized.
Contact Information

Attachments:
• Annex 1: Brief description of the assessment tool
Chapter 3. Planning and Conducting the Assessment
3-23
Annex 1. Outline of the Health Systems Assessment Approach
Introduction
This chapter provides the motivation for and the purpose of the approach. It also describes the
layout of the product (the manual and the CD). This section will draw from the framework paper
previously presented to USAID (“Health systems assessment approach: draft framework”).
Table of Contents
Chapter 1: Health Systems Strengthening: An Introduction
This is a background chapter explaining health systems and discussing their key functions. This
chapter serves as an informational piece for those less familiar with health systems. The chapter
builds on the paper written for the Child Survival Technical Resource Materials (TRM) on
Health Systems Strengthening. The chapter also provides a reference list for additional papers on
health systems.
Chapter 2: Overview of the Approach
This chapter describes the framework for the approach, listing and explaining the structure of the
technical modules and their components. The approach draws from the framework paper
previously presented to USAID (“Health systems assessment approach: draft framework”). An
annex provides a list of all the indicators and qualitative questions in each module, grouped by
topical area.
Chapter 3: Planning the Assessment
This chapter provides guidelines for planning the assessment process, including—
• Identifying needs and priorities of the USAID Mission so that the assessment can focus
appropriately on the right issues and help provide recommendations to the Mission
• Time frame/schedule for the planning process and the in-country assessment
• Budgeting for the assessment
• Guidelines on how to select the assessment team (e.g., types of consultants to be
recruited, how many)
• TOR for staff and consultants for assessment team
• Agenda for assessment team planning meetings
• Types of documents to be reviewed before beginning the assessment and during the
assessment phase
• Types of stakeholder interviews to schedule
• Identifying districts/provinces to visit outside the central capital area
Health Systems Assessment Approach: A How-To Manual
3-24
• Organizing the stakeholder workshop, including purpose of the workshop, suggested
agenda for the workshop, and a template for presenting findings
• Logistics checklist for planning the assessment, including the stakeholder workshop
• Overview of the assessment report that should be prepared using this approach; annexes
provide a suggested outline as well as outlines from two completed reports from prior
assessments as samples.
Chapter 4: Synthesizing Findings and Developing Recommendations
This chapter includes guidelines on how to process, analyze, and interpret the findings from each
module, with particular attention to synthesizing these findings across all modules. Focus is on
how to identify key strengths and weaknesses of the health system, and how to identify root
causes of problems to be addressed. Guidelines are also provided for how to develop
recommendations for the mission and how to link the recommendations to the USAID mission’s
overall goals and priorities, including (to the extent possible) those of its bilateral projects. It will
address SO-specific goals as well those related to the fragile state framework.
Chapter 5: Core Module
This is the background/foundational module and will be required to be completed by all users. In
particular, if any users are planning to work through only a subset of the technical modules
(Chapters 6–11), they would need to complete this core module to understand the basic
background information about the country and its health systems.
Component 1: This includes basic demographic, health, and socio-economic indicators for the
country. Data for the indicators is provided in an electronic format on the CD provided with this
manual (data file titled “Component 1 data”). Data for regional and income peer country
comparisons are also provided in the data file.
Component 2: This will not be solely based on indicators as in the case of the other technical
modules (see below for Chapters 6–11). This section focuses on developing some basic
understanding and profiles of a country’s health system. Topics covered include:
• Political and macroeconomic environment: Provides guidance on how to describe the
political structure of the country.
• Business environment and investment climate: Provides sources of information and
guidance on how to analyze the factors that affect private investment and enterprise
growth, and to identify the barriers to sustaining and expanding the private sector.
• Top causes of mortality and morbidity: These data are to be collected in-country and
could help guide any disease-specific recommendations to the USAID Mission. In
addition to the top causes of morbidity and mortality, prevalence rates for HIV/AIDS and
malaria will be collected, if important in the country context. Note that the health systems
assessment approach does not have a disease specific focus, but a user may have to
address this in developing recommendations for the USAID Mission.
• Structure of the main government and private organizations involved in the health care
system: This includes a template for developing a MOH organizational chart to help
support the assessment process.
Chapter 3. Planning and Conducting the Assessment
3-25
• Decentralization: This includes indicators to understand the level of decentralization in
the country—this will be important for determining the type of assessment that should be
conducted.
• Service delivery organization: This section provides an overview of the structure of
service delivery, including types of health facilities in the country, and of the engagement
of the private sector, including proportion of services and facilities in the private sector
and involvement of NGOs and the commercial sector.
• Donor mapping: This includes a template for mapping donor activities in the health
sector -this will be important for understanding the level of activities in the country, as
well as to identify gaps.
• Donor coordination: This includes indicators for assessing the level of donor coordination
and the related strengths and weaknesses.
Chapters 6–11: Topical Chapters – the Technical Modules
Chapter 6: Governance module addresses the information assessment capacity of the health
system, policy formulation and planning, social participation and health system responsiveness,
accountability, and regulation.
Chapter 7: Health financing module covers sources of financial resources; the pooling and
allocation of health funds including government budget allocation and health insurance; and the
process of purchasing and proving payments.
Chapter 8: Service delivery module examines service delivery outputs and outcomes; the
availability, access, utilization, and organization of service delivery; quality assurance of
healthcare; and community participation in service delivery.
Chapter 9: Human resources module covers systematic workforce planning, HR policies and
regulation, performance management, training/education, and incentives.
Chapter 10: Pharmaceuticals management module evaluates the health system’s pharmaceutical
policy, laws, regulations; selection of pharmaceuticals; procurement, storage, and distribution;
appropriate use and availability of pharmaceuticals; access to quality pharmaceutical products
and services; and financing mechanisms for pharmaceuticals.
Chapter 11: Health information systems module reviews the current operational HIS
components; the resources, policies and regulations supporting the HIS; data availability,
collection, and quality; and, analysis and use of health information for health systems
management and policy-making.
These chapters include technical modules, each with a set of indicators for conducting a health
system assessment. The key elements of each module are—
Health Systems Assessment Approach: A How-To Manual
3-26
• System profile: This section provides guidelines for developing a basic profile of the
health system aspect assessed in each module. It includes templates for doing this, such
as mapping tools, flowcharts.
• Component 1: This component includes indicators for which data are easily available
from international datasets. Data for component 1 indicators is provided in an electronic
format on the CD provided with this manual (data file titled “Component 1 data”).
Specific attention will be given to including regional or other peer country comparisons
wherever feasible. Charts indicating possible ways of presenting the data will also be
included in an Annex.
• Component 2: This component presents the indicators grouped by subtopic within each
module. Each indicator will be linked to one of five performance criteria: equity,
efficiency, access, quality and sustainability. Users will have to conduct a combination of
desk review of documents and stakeholder interviews to collect data for these indicators.
Detailed descriptions of each indicator will be included (a template and guidelines have
been provided to chapter authors).
• Assessment process: Each chapter provides module-specific guidelines on the process for
working through each module, synthesizing findings and preparing recommendations for
interventions. These guidelines are meant to complement Chapter 4.
Chapter 3. Planning and Conducting the Assessment
3-27
Annex 3D. Sample Logistical and Task Checklist
Indicate who will be responsible for
completing the task, the expected
due date, and when it was completed USAID/DC
USAID/
Mission
Coordinator
Local
Consultant
Team
Lead
Team
Members
Date
Due
Date
Completed
Preparatory Work
General coordination
Identify scope of assessment and how
many modules will be completed
Identify team composition
Set dates for the assessment—consider
relevant holidays and events
Schedule meeting with USAID Mission
regarding intent and timing of
assessment
Prepare scopes of work (team and local
consultant, as needed)
Schedule and participate in team
planning meeting(s) and discussions
Determine if in-country travel will be
required
Module prep work
Prepare briefing binder for first team
meeting with country information,
background materials, and other
assessment information
Assign modules to team members
Health Systems Assessment Approach: A How-To Manual
3-28
Indicate who will be responsible for
completing the task, the expected
due date, and when it was completed USAID/DC
USAID/
Mission
Coordinator
Local
Consultant
Team
Lead
Team
Members
Date
Due
Date
Completed
Team members review assigned
module(s) and prepare lists of
documents needed and potential
interviewees
The assessment coordinator compiles
needed documents and facilitate
translation as needed
Compile Component 1 data (provide on
CD)
Complete Core Module
Review background document and
initiate Component 2 (desk study)
Request organizational charts for
central level MOH and relevant
departments; each team member
should identify departments relevant to
their module and provide the
information to the assessment
coordinator
Logistics/other preparations
Contract local consultant, if needed;
assign responsibilities
Prepare contact list
Prepare interview schedule
Make travel arrangements
Chapter 3. Planning and Conducting the Assessment
3-29
Indicate who will be responsible for
completing the task, the expected
due date, and when it was completed USAID/DC
USAID/
Mission
Coordinator
Local
Consultant
Team
Lead
Team
Members
Date
Due
Date
Completed
Identify local travel options—select
location and date
Identify participants for stakeholder
workshop; set time and date and send
invitations; reserve room; work with
Mission to coordinate and set agenda
Hire translators
Hire drivers
Materials for travel: memory sticks, flip
charts, markers, name tags, paper,
portable printer
Field work
Week 1
Meet with team and participate in team
planning meeting
Confirm or re-schedule interviews
Daily: Team members review data
collected and identify gaps; identify
additional interviews required, if any,
and schedule with consultant; document
names/titles of all people interviewed.
Collect additional information needed to
complete Component 2 through
document review and interviews
Health Systems Assessment Approach: A How-To Manual
3-30
Indicate who will be responsible for
completing the task, the expected
due date, and when it was completed USAID/DC
USAID/
Mission
Coordinator
Local
Consultant
Team
Lead
Team
Members
Date
Due
Date
Completed
Using SWOT analysis and root cause
methodologies (in Chapter 4), map
possible interventions/reforms to
address weaknesses identified in
assessment.
Prepare preliminary analyses and draft
relevant sections for the Country Health
Systems Assessment Report, including
recommended potential activity areas
and interventions
Week 2
Daily: Team members review data
collected and identify gaps
Work on draft report
Schedule and conduct follow-up
interviews as needed
Liaise with USAID PHN officer as
needed to prepare for the stakeholder
workshop and other activities
Prepare and conduct stakeholder
workshop
Request feedback from a designated
reviewer on draft report
Ongoing
Chapter 3. Planning and Conducting the Assessment
3-31
Indicate who will be responsible for
completing the task, the expected
due date, and when it was completed USAID/DC
USAID/
Mission
Coordinator
Local
Consultant
Team
Lead
Team
Members
Date
Due
Date
Completed
Liaise with any in-country program
personnel to share and discuss findings
Travel to one provincial area may be
required
Post-field work
Finalize relevant sections for the
Country Health Systems Assessment
Report, including recommendations,
based on input from the stakeholder
workshop and mission staff
Schedule/conduct any requested
debriefing meetings
Distribute report in some form--print /CD
version
Health Systems Assessment Approach: A How-To Manual
3-32
Annex 3E. Sample Team Planning Meeting Agenda
Angola Team Planning Meeting
July 18, 2005
Objectives
• Clarify roles/responsibilities, including assignment of modules
• Agree on schedule/SOW while in Angola
• Agree on role of team leader
• Discuss how to work together
Opening, introductions, overview of day; guidelines for working together
What are you looking forward to in-country:
• Completed a good job
• The team has identified strengths and weaknesses for the Mission
• Testing the new tool in the country
Expectations:
• Help team feel more comfortable with the process and workload
• Have a plan for next two weeks before Angola trip
• Get clarity about specific—report, workshop, day-to-day schedule
• Sorting out R&R, making it useful—who, how, methods
• Define my role, know what to include in report
• How people in PHRplus/HQ can help team
Guidelines for working together:
• Stay focused on topic
• Keep time—assign time checker
• Seek closure today; while in-country be comfortable with not having definitive answers
to all questions
• Develop action points/to-do list
Update on current status of activity
Roles and responsibilities for preparation of report
Chapter 3. Planning and Conducting the Assessment
3-33
Draft Report Writing Assignments:
Chapter Author(s) Page Length Due Date
1. Executive summary
2. Background
3. Overview of country’s
health system
4. Methodology
5. Strengths and weaknesses
of the health system
5.1. Stewardship
5.2. Health financing
5.3. Human resources and
health facilities
5.4. Private sector
engagement
5.5. Pharmaceuticals and
supplies
5.6. Health information
systems
6. Summary
7. Options for USAID
8. Conclusions/executive
summary/next steps
Health Systems Assessment Approach: A How-To Manual
3-34
Annex 3F. Sample List of Background Documents—Desktop Review for
Azerbaijan Assessment
AZERBAIJAN DOCUMENT LINKS (2000-2005)
USAID/U.S. Government
USAID Country Profile: Azerbaijan
http://www.usaid.gov/locations/europe_eurasia/countries/az/azerbaijan.pdf
USAID/Caucacus/Azerbaijan PHC Assessment (2005)
http://pdf.dec.org/pdf_docs/PNADC991.pdf
USAID Azerbaijan Annual Report (2005)
http://pdf.dec.org/pdf_docs/PDACD919.pdf
USAID Azerbaijan Health Statistical Report (2004)
http://pdf.dec.org/pdf_docs/PNADC004.pdf
State Department Background Notes, Azerbaijan (October 2005)
http://www.state.gov/r/pa/ei/bgn/2909.htm
World Bank
World Bank (WB) Health Sector Assessment (2005)
http://wwwwds.
worldbank.org/servlet/WDS_IBank_Servlet?stype=AllWords&all=31468&ptype=sSrch&pc
ont=results&sortby=D&sortcat=D&x=10&y=5
International Monetary Fund (IMF)/WB Azerbaijan Country Report on Millenium Development
Goals (2003)
http://www1.worldbank.org/prem/poverty/strategies/cpapers/cr04322.pdf
IMF/WB Assessment of Poverty Reduction Strategies (2004)
http://www.imf.org/external/pubs/ft/scr/2004/cr04323.pdf
WB Country Procurement Assessment Report (2003)
http://wwwwds.
worldbank.org/servlet/WDSContentServer/WDSP/IB/2003/09/30/000112742_20030930122
244/Rendered/PDF/267780AZ.pdf
WHO/UN System
EURO/WHO report: Health Care Systems in Transition Azerbaijan (2004) by John Holley
http://www.euro.who.int/Document/E84991.pdf
UNICEF Multiple Indicator Cluster Survey Azerbaijan Assessment report and data tables (2000)
http://www.childinfo.org/MICS2/newreports/azerbaijan/azerbaijan.htm
Chapter 3. Planning and Conducting the Assessment
3-35
UN Economic Commission for Europe Azerbaijan Environmental Performance Review (2003)
http://www.unece.org/env/epr/studies/azerbaijan/welcome.htm
UNICEF Micronutrient Deficiency briefing paper (no date)
http://www.micronutrient.org/VMD/CountryFiles/AzerbaijanDAR.pdf
UNICEF Child Protection Systems in Azerbaijan Report (2005)
http://www.unicef.org/azerbaijan/AZ_ChildProtection_map_report.doc
Azerbaijan Government/NGO/Background
Azerbaijan Development Gateway (no date)
http://www.gateway.az/eng/webdir/health.shtml
Azerbaijan MOH portal (information on programs, donors, health statistics, etc.—no date)
http://www.mednet.az/
State Statistical Committee of the Azerbaijan Republic
http://www.azstat.org/indexen.php
Other
DevTech Gender Assessment (2004)
http://www.usaid.gov/our_work/cross-cutting_programs/wid/pubs/ga_azerbaijan.pdf
AIHA/Virginia Commonwealth University Azerbaijan Project Summary (2004)
http://www.aiha.com/index.jsp?sid=1&id=966&pid=10
Asian Development Bank National Immunization Program Financing Assessment (2002)
http://www.adb.org/Documents/Books/Natl_Immunization/AZE/azerbaijan.pdf
Asian Development Bank Azerbaijan Country Strategy and Program Update 2004-2006 (2003)
http://www.adb.org/Documents/CSPs/AZE/2003/CSP_AZE_2003.pdf
UMCOR Azerbaijan health program webpage (no date)
http://gbgm-umc.org/umcor/ngo/azerbaijan/
Transparency International Country Corruption Assessment: Public Opinion Survey (2004)
http://www.transparency-az.org/files/25.pdf
Organization for Security and Co-operation in Europe Assessment on Freedom in the Media
(2005)
http://www1.osce.org/documents/rfm/2005/07/15783_en.pdf
Country Analytic Work website—Search for Azerbaijan documents
http://www.countryanalyticwork.net/Caw/CawDocLib.nsf/vewAsiaPacific?SearchView&Query
=FIELD%20Country%20CONTAINS%20%20"Azerbaijan"&Country=Azerbaijan&DocType=
NULL&SearchOrder=4&SearchMax=5000&Start=1&Count=20
Health Systems Assessment Approach: A How-To Manual
3-36
Annex 3G. Sample In-Country Interview Schedule
Health Systems Assessment team: Preliminary TDY schedule in Angola, August 2005
Sat Sun Mon Tues Wed Thurs Fri
6
• Team meeting
with local
consultant—
1:00 pm–5:00
pm
• To review—
Interview
schedule,
documents
collected,
USAID
meeting, getting
information
from local
consultant,
guidance for
team as visitors
7
Team meeting with
Write-ups
• — lunch 1:00
– 5:00
• To review—
Technical
discussion on
health systems
strengthening
(presentation)
8
• Meeting with
USAID:
planning
Interviews
Team check-in
Write-ups
9
• Send
invitations for
stakeholders
workshop
Interviews
Team check-in
Write-ups
10
Interviews
Team check-in
Write-ups
11
Interviews
Team check-in
Write-ups
12
• Meeting with
USAID—
Unanswered
questions,
guidance
• Potential
province visit
Interviews
Team check-in
Write-ups
13
• Final drafts of
Ch. 4 by 1:00
• 1-5:00 Team
meeting:
analysis options
for Mission
14
• Optional team
meeting
• Write up
options: send to
PHRplus to
review (Sun pm
or Mon am)
15
• Potential
province visit
• Finish
interviews
• Reflect on how
tool has worked
(Mon or Tues)
• Afternoon free
16
• AM: PHRplus
feedback on
report to team
• Design
stakeholder
workshop
• 6:00 pm
conference call
with PHRplus
17
• Briefing for
USAID on
options/stakeholder
workshop,
review of draft
report
18
• Prepare for
stakeholder
meeting
19
• Stakeholder
meeting
20
• Write-up results of workshop
• Reflect on how tool has worked
• Send latest draft of report to Mission
before departure
Chapter 3. Planning and Conducting the Assessment
3-37
Annex 3H. Sample Contact List
Contact Name
Title
Organization
Module/Area
For Discussion Meeting date Email Phone Location of office
Health Systems Assessment Approach: A How-To Manual
3-38
Annex 3I. Sample Stakeholder Workshop Agenda
Stakeholder Workshop Agenda
Health Systems Assessment: Angola
Stakeholder Workshop
Date: Friday, August 19, 2005 8:30 – 13:00
Venue: Hotel Tropico, Luanda
Purpose: gather stakeholders that seem critical to the success of the options on the table /
impacted by the results; get their buy-in; get their feedback and reactions on findings and
recommendations.
Objectives:
By the end of the day participants will have:
• Reviewed and discussed team’s major findings
• Provided input on their priorities, based on strengths and weaknesses discussed
• Provided input into recommendations and identify how they will/can be involved in
implementing concrete options; how to move forward OR provided feedback and
recommendations on major options presented by team
Participants: (maximum 30 people)
• USAID, MOH, Donors, private sector, NGOs
Preliminary Workshop Agenda
Time Topic Responsible Materials
8:30 Coffee/registration Registration sheet
9:00 Welcome USAID/MOH
9:30 Introductions and expectations, overview of objectives and
agenda, guidelines for working together
Handout of agenda and
objectives
Guidelines (preprepared)
10:00 Overview of methodology, results and recommendations
• Highlight key findings
• Present suggested recommendations
• Q&A/discussion
Presentation(s)
Handouts of slides,
write-up of options
10:45 Coffee break
11:00 Small group discussion: go over recommendations and
discuss applicability and feasibility in Angola
Questions for discussion
11:45 Reports from small groups – 10 min each per group
12:30 Summarize Team
12:45 Closing comments USAID
1:00 Workshop evaluation. Adjourn for Lunch Evaluation form
Small Group Discussion Questions
Looking at the strategies listed on the four last slides:
1. Which would be the three principal strategies that you would recommend?
Chapter 3. Planning and Conducting the Assessment
3-39
2. How could your organization collaborate with USAID in these areas?
3. What would be your advice to USAID as it begins to work on strengthening the health
system?
Workshop Handouts:
• Sign-in registration
• List of participants and contact information
• PowerPoint presentation handouts
• Write-up of options or strategies – 1 page in Portuguese
• Arrange for LCD projector and flipcharts
• Evaluation from
• Guidelines for small group discussions
• Objectives and agenda
• Paper/pens, workshop name and dates
Health Systems Assessment Approach: A How-To Manual
3-40
Annex 3J. Suggested Outline for Final Assessment Report
Executive Summary
1. Background (2-3 pages)
Context—why was the assessment carried out and with what purpose?
2. Overview of health system (3-5 pages)
Core module should be used to prepare this chapter.
Basic description of the nature of the health system, focusing on—
2.1 Macroeconomic and political context
2.2 Epidemiological profile including key health indicators and causes of top mortality
and morbidity
2.3 Bureaucratic structures in-country (including decentralization)
2.4 Structure of health service delivery system
2.5 Health financing – profile and structure
2.6 Donor activities and gaps
2.7 Key stakeholders in the health system (including some discussion of the role of the
private sector, whether there is any social health insurance, etc.)
2.8 Business environment and investment climate, particularly as it affects for private
health care
No more than a couple of paragraphs on each of the subjects above (5 pages total)—to be
drafted in advance of trip. Where possible, differences across provinces/regions should be
highlighted.
3. Methodology (2 pages)
3.1 Framework for the health systems assessment approach
3.2 Description of tool and how it was used
4. Strengths and weaknesses of the health system (5-10 pages for each module)
4.1 Governance
4.2 Health financing
4.3 Service delivery
4.4 Human resources
4.5 Pharmaceutical management
4.6 Health information systems
4.7 Summary of findings (5–10 pages)
See Chapter 4
Chapter 3. Planning and Conducting the Assessment
3-41
Recommendations
4.8 Priority interventions based on the assessment
Drawing upon Chapter 4 this subsection should propose interventions that USAID might
consider supporting to address health system weaknesses. For each recommendation,
should discuss the relative time and cost involved.
4.9 Stakeholder views on the priority intervention areas
This should be based upon the workshop discussions and interviews with donors,
government, and other stakeholders, and should give some broad view of (1) what is
already being done by other stakeholders and how USAID might complement or
supplement their activities, and (2) what type of interventions there is political support
for. Also, what can local stakeholders take responsibility for or assist with? What are next
steps or potential action plan?
5. Conclusions
This section should identify key issues that were identified as part of the assessment,
responses to them by USAID and counterparts. It should also summarize the next steps that
can be expected as discussed by the various stakeholders.
Annex A
Contact list
Annex B
List of documents consulted
Annex C
Stakeholder workshop agenda
Annex D
Stakeholder workshop presentation
Health Systems Assessment Approach: A How-To Manual
3-42
Annex 3K. Outline of Assessment Report from Pilot Test in Angola
Angola Health System Assessment (full report included electronically on CD that accompanies
this manual or available for download at www.healthsystems2020.org)
ACRONYMS
ACKNOWLEDGMENTS
1. BACKGROUND
2. COUNTRY OVERVIEW
2.1 General
2.2 Health
2.2.1 Health Status
2.2.2 Health System
3. METHODOLOGY
3.1 Framework for the Health Systems Assessment Approach
3.2 Description of Assessment Tools
3.3 Pre-assessment Desk Research
3.4 In-country Key Interviews
4. STRENGTHS AND WEAKNESSES OF THE ANGOLAN HEALTH SYSTEM
4.1 Governance
4.1.1 Background
4.1.2 Health Information Capacity
4.1.3 Regulation
4.1.4 Policy Formation and Planning
4.1.5 External Participation and Partnerships
4.1.6 Accountability
4.2 Health Financing
4.2.1 Overview
4.2.2 Resource Flows
4.2.3 The Budgetary Process
4.2.4 Out-of-pocket Expenditures
4.3 Human Resources and Health Facilities
4.3.1 Policies, Plans, and Regulations
4.3.2 Number and Distribution of Health Facilities and Human Resources
4.3.3 Other Aspects of Health Service Delivery
4.4 The Role of the Private Sector
4.4.1 General Environment
4.4.2 Legal Framework and Regulation
4.4.3 Private Health Providers
4.4.4 Public–Private Partnerships
Chapter 3. Planning and Conducting the Assessment
3-43
4.5 Pharmaceutical Sector
4.5.1 Overview
4.5.2 Drug Procurement at the PHC Level: The National Essential Drug Program
4.5.3 Drug Procurement at the Hospital Level
4.6 Health Information Systems
4.6.1 Health Information Resources, Policies, and Regulations
4.6.2 Data Availability and Quality
4.6.3 Data Analysis
4.6.4 Use of Information for Management
4.7 Summary of Findings
4.7.1 Strengths
4.7.2 Weaknesses
4.7.3 Opportunities
4.7.4 Threats
5. RECOMMENDATIONS
5.1 Health Financing
5.2 Essential Drugs
5.3 Service Delivery
5.4 Public–Private Partnerships
5.5 Health Information
ANNEX A: DOCUMENTS CONSULTED
ANNEX B: CONTACT LIST
ANNEX C: GROUP DISCUSSION WITH NGOS
ANNEX D. STAKEHOLDER WORKSHOP AGENDA
ANNEX E. HANDOUTS FOR OVERVIEW OF HEALTH SYSTEMS STRENGTHENING
ANNEX F. DONOR HEALTH PROGRAMS IN ANGOLA
ANNEX G. MAP OF MOH STRATEGY AND DONOR INPUTS (OTHER THAN USAID)
FOR HEALTH SYSTEM STRENGTHENING
ANNEX H. COMPARATIVE INDICATORS FOR ANGOLA AND SSA
ANNEX I. 2005 CONTENTS OF THE THREE TYPES OF DRUG KITS PROVIDED UNDER
THE NATIONAL ESSENTIAL DRUG PROGRAM (NEDP)
ANNEX J. STAKEHOLDER WORKSHOP PRESENTATION
Health Systems Assessment Approach: A How-To Manual
3-44
Annex 3L. Outline of Assessment Report from Pilot Test in Benin
Benin Health System Assessment—Rapid Assessment of the Health System in Benin, April 2006
(full report included electronically on CD that accompanies this manual or available for
download at www.healthsystems2020.org)
ACRONYMS
ACKNOWLEDGMENTS
SECTION 1: INTRODUCTION
Methodology: The Health Systems Assessment Approach
Preassessment Activities
In-Country Assessment
Challenges
SECTION 2: BACKGROUND
Overview
Political and Macroeconomic Environment
Major Causes of Morbidity and Mortality
SECTION 3: OVERVIEW OF THE HEALTH SYSTEM IN BENIN
Structure of Health Care System
Decentralization and Organization of Service Delivery
SECTION 4: SUMMARY OF THE ASSESSMENT FINDINGS
Stewardship
Health Financing
Health Service Delivery
Human Resources
Pharmaceutical Management
Health Information Systems
Private Sector Engagement
Summary of Strengths and Weaknesses of Benin’s Health System
SECTION 5: PRIORITY INTERVENTIONS FOR CONSIDERATION AND ACTION
Possible Options for Strengthening Health System Governance
Possible Options for Improving Incentives for Health System Performance and Management
of Human Resources for Health
Possible Options for Improving Health Financing
SECTION 6: OPTIONS FOR USAID
Improving Financial Protection in Health
Improving Information
Fostering Greater Public-Private Integration
Chapter 3. Planning and Conducting the Assessment
3-45
ANNEX 1. SUMMARY OF PROPOSED INTERVENTIONS BY ASSESSMENT MODULE
Stewardship
Health Financing
Health Service Delivery
Human Resources Management
Pharmaceutical Management
Health Information Systems
Private Sector Engagement
ANNEX 2. IN-COUNTRY ASSESSMENT SCHEDULE
ANNEX 3. CONTACTS
Central Level
Department of Mono/Couffo
Department of Zou/Collines
ANNEX 4. SOURCES
Background
Overview of Health System
Stewardship
Health Financing
Health Service Delivery
Human Resources
Pharmaceutical Management
Private Sector Engagement
Health Information Systems
Health Systems Assessment Approach: A How-To Manual
3-46