Health system performance assessment and reforms, Oman.

Problem: To prioritize key areas of action and investment for the next strategic cycle of national development plans (2026-2031) in Oman, we needed a holistic view of the country's health system and its main deficiencies and inefficiencies. Approach: Informed by the World Health Organization framework, our team of seven national health ministry staff and two international experts conducted a rapid health system performance assessment. We used already available data to identify system bottlenecks and their potential root causes, verifying our findings with key informant interviews. Local setting: Oman's 4.9 million population is relatively young (average age 28 years) but ageing, with a mounting burden of chronic diseases. While health-care services are free for Omani nationals, more than 1.5 million expatriates rely on out-of-pocket payments for health-care services. Strengthening primary health care, improving the quality of care, providing financial protection, and ensuring that public and private health-care providers operate within the same legal and procedural framework are recognized as key national priorities. Relevant changes: Our assessment highlighted the need to extend health service coverage to the whole population, strengthen private health-care sector governance, improve health education, increase financial investment, and expand the country's capacity for data collection and analysis. Lessons learnt: The assessment framework allowed us to identify areas where information is lacking and use already available data to analyse multiple health outcomes. As well as identifying issues that need to be addressed during the next policy development cycle, our findings have contributed towards the preparation of a more extensive assessment.

Practical strategies to achieve resilient health systems: results from a scoping review.

BACKGROUND: This paper presents the results of a systematic review to identify practical strategies to create the institutions, skills, values, and norms that will improve health systems resilience. METHODS: A PRISMA 2020 compliant systematic review identified peer-reviewed and gray literature on practical strategies to make health systems more resilient. Investigators screened 970 papers to identify 65 English language papers published since 2015. RESULTS: Practical strategies focus efforts on system changes to improve a health system's resilience components of collective knowing, collective thinking, and collaborative doing. The most helpful studies identified potential lead organizations to serve as the stewards of resilience improvement, and these were commonly in national and local departments of public health. Papers on practical strategies suggested possible measurement tools to benchmark resilience components in efforts to focus on performance improvement and ways to sustain their use. Essential Public Health Function (EPHF) measurement and improvement tools are well-aligned to the resilience agenda. The field of health systems resilience lacks empirical trials linking resilience improvement interventions to outcomes. CONCLUSIONS: The rigorous assessment of practical strategies to improve resilience based on cycles of measurement should be a high priority.

Concept analysis of health system resilience.

BACKGROUND: There are several definitions of resilience in health systems, many of which share some characteristics, but no agreed-upon framework is universally accepted. Here, we review the concept of resilience, identifying its definitions, attributes, antecedents and consequences, and present the findings of a concept analysis of health system resilience. METHODS: We follow Schwarz-Barcott and Kim's hybrid model, which consists of three phases: theoretical, fieldwork and final analysis. We identified the concept definitions, attributes, antecedents and consequences of health system resilience and constructed an evidence-informed framework on the basis of the findings of this review. We searched PubMed, PsycINFO, CINAHL Complete, EBSCOhost-Academic Search and Premier databases and downloaded identified titles and abstracts on Covidence. We screened 3357 titles and removed duplicate and ineligible records; two reviewers then screened each title, and disagreements were resolved by discussion with the third reviewer. From the 130 eligible manuscripts, we identified the definitions, attributes, antecedents and consequences using a pre-defined data extraction form. RESULTS: Resilience antecedents are decentralization, available funds, investments and resources, staff environment and motivation, integration and networking and finally, diversification of staff. The attributes are the availability of resources and funds, adaptive capacity, transformative capacity, learning and advocacy and progressive leadership. The consequences of health system resilience are improved health system performance, a balanced governance structure, improved expenditure and financial management of health and maintenance of health services that support universal health coverage (UHC) throughout crises. CONCLUSION: A resilient health system maintains quality healthcare through times of crisis. During the coronavirus disease 2019 (COVID-19) epidemic, several seemingly robust health systems were strained under the increased demand, and services were disrupted. As such, elements of resilience should be integrated into the functions of a health system to ensure standardized and consistent service quality and delivery. We offer a systematic, evidence-informed method for identifying the attributes of health system resilience, intending to eventually be used to develop a measuring tool to evaluate a country's health system resilience performance.

Health workforce in the Eastern Mediterranean Region: From COVID-19 lessons to actions.

The COVID-19 pandemic has had a devastating and unprecedented impact on health and health systems globally leaving an indelible mark on health system infrastructures. The pandemic also clearly demonstrated the critical role of health workers for well-performing health systems, in particular during emergencies and have prompted the need to undergo a critical re-evaluation of health systems and health workforce design and implementation. As the year 2023 marks the halfway point of the 2030 Agenda for Sustainable development, the time is pertinent for action by governments and partners to scale up the health workforce to advance towards sustainable developement goal (SDG) 3 on health and well-being and other health-related SDGs, building on the lessons from COVID-19. Therefore, at the 70th session of World Health Organization Regional Committee for Eastern Mediterranean, Member States unanimously adopted a resolution to call for accelerated actions to address health workforce challenges through solidarity, alignment, and synergy of efforts in order to rebuild resilient health systems after the COVID-19 pandemic.

UHC in Morocco: a bottom-up estimation of public hospitals' financing size based on a costing database.

BACKGROUND: Morocco is engaged in a health system reform aimed at generalizing health insurance across the whole population by 2025. This study aims to build a national database of costs at all levels of public hospitals in Morocco and craft this database as a resource for further use in a strategic purchasing system. It also aims at estimating the funding gap and the budget that should be secured for public hospitals in Morocco to fully play their roles in the current ambitious reform. METHOD: A costing study was implemented in 39 hospitals in 12 regions of Morocco (10 provincial hospitals, 11 regional hospitals, and 18 teaching hospitals). Using the hospital costing approach, we adapted and validated nationally our methodology to generate a database of unit costs based on data from 2019. All perspectives on cost were considered. Data collection was performed by cadres from MoH and facilitated by the WHO country office in Morocco. The production of the cost database allowed the development of a bottom-up estimation of the financing size for public health hospitals. RESULTS: The study showed the feasibility of large-scale costing in the context of Morocco. The ownership of MoH and adherence to the process ensured the high quality of the collected data. There are many differences in unit costs for the same services moving from one hospital to another, which indicates existing inefficiencies. The database will contribute to shaping the strategic purchasing mechanism within the generalized health insurance schemes. The studied hospitals could be used as references to systematically update the billing system for health insurance.

National public health institutes in the Eastern Mediterranean Region: Insights from experts in the field.

National public health institutes (NPHIs) are crucial to the effectiveness of public health systems, including delivering essential public health functions and generating evidence for national health policies, strategies and plans. Currently, there is a significant lack of information regarding NPHI or NPHI-like organisations in Eastern Mediterranean Region (EMR) countries, including how they fit into their broader health systems governance landscape. NPHIs exist in 12 out of 22 EMR countries, yet there is no official International Association of National Public Health Institutes (IANPHI) regional network for the EMR, despite established IANPHI networks in four other regions. In 2022, the WHO's Eastern Mediterranean Regional Office led a study comprising an online survey and key informant interviews, which synthesised expert insights and summarised recommendations to strengthen the health systems governance-related role of NPHIs in EMR countries. Study participants included current and former high-level representatives of NPHIs, the government (eg, Ministries of Health, health regulatory authorities), multilateral organisations or non-governmental organisations focusing on health, and others identified as senior health systems governance experts from EMR. Insights and recommendations from experts varied widely, but there were also many common elements and overlaps. These included the need for enhancing NPHI functionalities and collaborative efforts with the public health sector (eg, Ministry of Health, Health Council) in health policy and decision-making formulation and implementation. This, in turn, requires advancing NPHI's fit-for-purpose and sustainable governance and financing arrangements, improving the accessibility and transparency of health data for NPHIs, strengthening engagement and collaboration between NPHIs and other health system actors (including the private sector), and promoting a more prominent role for NPHIs in the development and implementation of public health-related policies and legislation. While many excellent insights and thoughtful strategic guidance are provided, further adaptation may be needed to implement the proposed recommendations in different EMR country contexts going forward.

Reviewing essential public health functions in the Eastern Mediterranean Region post COVID-19 pandemic: a foundation for system resilience.

The COVID-19 pandemic exposed vulnerabilities in many health systems worldwide with profound implications for health and society. The public health challenges experienced during the pandemic have highlighted the importance of resilient health systems, that can adapt and transform to meet the population's evolving health needs. Essential public health functions (EPHFs) offer a holistic, integrated and sustainable approach to public health by contributing to achieving several health priorities and goals. In recent years, there has been a focused effort to conceptualise and define the EPHFs. In this paper, we describe the collaborative approach undertaken by the WHO Eastern Mediterranean Region (EMR) and UK Health Security Agency and present the findings and results of the revised EPHFs, in view of lessons learnt from the COVID-19 pandemic and the current priorities for countries across the EMR. This included conducting a desktop review, a gap and bottleneck analysis and stakeholder consultation to arrive at the revised EPHF model including four enablers and nine core functions, including a new function: public health services. The EPHFs will offer countries a complementary and synergistic approach to strengthen health systems and public health capacities and contribute to the region's ability to effectively respond to future health challenges and emergencies. By focusing on the EPHFs, countries can work towards ensuring health security as an integral goal for the health system besides universal health coverage, thus strengthening and building more resilient and equitable health systems.

Translating political commitments into actions to enhance Universal Health Coverage in the Eastern Mediterranean Region.

Background: Many countries in the Eastern Mediterranean Region (EMR) have developed packages of services for achieving Universal Health Coverage (UHC), however, policymakers, especially in resource-constrained countries, still face challenges in delivering equitable, efficient and sustainable health services. Aims: To provide guidance for EMR countries and develop packages of services for UHC. Methods: We used information gathered from narrative reviews, national experiences and expert consultations to develop step-by-step guidance for the development of national packages of services for the achievement of UHC by countries in the EMR. Results: The processes used to develop packages of services varied between EMR countries and these processes may not have involved all relevant stakeholders. We highlight in this paper the iterative processes, including several phases and steps, to be used by EMR countries for developing packages of services for UHC. These processes also make provision for continuous monitoring and revision to make necessary improvements as morbidity patterns evolve. Conclusion: Developing a package of services for the achievement of UHC is a significant milestone for EMR countries and it is central to shaping the healthcare system for effective delivery of services.

All in for Universal Health Coverage and global health security - reinforcing partner engagement in the Eastern Mediterranean Region.

The WHO Eastern Mediterranean Region (EMR) Vision 2023 "Health for All by All" and the EMR Strategy 2020-2023 "Turning Vision into Action" place partnerships at the centre of WHO engagement, to enhance its voice, extend its technical and operational reach, and mobilize needed resources. To be effective, partnerships need to evolve from primarily transactional imperatives to strategic collaboration based on shared vision, value addition and trust.