Informing Policy – Building Partnerships

The Asia Pacific Observatory on Health Systems and Policies
Disclaimer: The views expressed in this paper/presentation do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Dr Dale Huntington Director, APO

What is the APO?
 Collaborative partnership
 Governments: Australia, Hong Kong, Philippines, Singapore, Thailand  International Agencies: Asian Development Bank, AusAid, World Bank, WHO (SEARO, WPRO)  Research Community: Universities and institutes throughout Asia and the Pacific region

 Knowledge Broker between researchers, development agencies

 Producing high quality evidence on health systems to inform policy makers

How is the Observatory Structured?
Steering Committee

provides strategic guidance and direction; monitors the performance of the Secretariat
Strategic direction

Research Advisory Group
group of recognized experts responsible for advice on quality of products





Observatory Secretariat
seated within WHO / WPRO

annual work plan and budget finances, HR, supplier contracts, audit, etc.
Accountability and liability

responsible for analytic work


responsibility and liability for sound administrative and financial practice

Research Hubs

Institute for Health Policy (IHP) Sri Lanka: Fiji School of Medicine; Universities in Hong Kong, Indonesia, China, India, Bangladesh, Singapore, Mongolia, Nepal, Philippines



 International Health Policy Programme (IHPP) Thailand: Universities in China, Japan, Bangladesh, Korea, Thailand)


 School of Population Health, University of Queensland (UQ): Nossal Institute, Australia

What does the APO do?
Products: Health in Transitions – HiTs • Flagship product Policy Briefs  Comparative analyses on key policy topics Multi-country Studies • Original country case studies on reforms Practices Policy Dialogue Events Seminars Conference Presentations

Health in Transitions Series
What is a HiT?
 Comprehensive and detailed description and analysis of entire health system and on-going reforms  Standard template allows comparisons between countries and within country over time Assessment of progress towards stated objectives based upon best available evidence

What use is a HiT?
 Common review for use by government and development partners (objective, independent, high quality)  Monitoring trends over time, comparative analyses  Suggestive of follow-on research, analysis, policy development and implementation priorities

New Australia X Bangladesh Cambodia China Hong Kong Indonesia Japan Korea X X X X

Launch X

Health in Transitions 2013


Malaysia Myanmar Mongolia New Zealand Papua New Guinea Singapore Solomon Islands Sri Lanka Thailand Tonga X X X


Comparative and Country-Level Analyses
Policy Briefs
 Calls for Proposals  Open to Research Hubs and Affiliates  Open to public late 2013 / 2014
 2 rounds of calls per year  Research Advisory Group Reviews  3 Policy Briefs Commissioned

Comparative and Country-Level Analyses
Policy Briefs – Completed:
Direct household payments for health services in Asia and the Pacific: Impacts and Policy Options

On Going

Nossal Institute, University of Melbourne: Is there a need for more regulation of dual practice by health practitioners in the AsiaPacific Region and what are appropriate regulatory options?

BRAC University: Public – private health professional education in Asia

Policy Briefs – Future Themes “Silver Tsunami” - NCDs

Policy Briefs – Future Themes Equity and Universal Coverage

Same Hospital in Hanoi, Vietnam: 2 entrances, 2 wings; 2 tiers of care
Source: Forsberg, Le Thanh, Oxford-Princeton Working Paper, 2011

“Bottom Billion”
Summary Estimates – Global Distribution of the World’s Poor by country type, 2007/8 (%)

Fragile or in Conflict Low Income Middle Income Total 12 11 23

Neither Fragile nor in Conflict 16 61 77


22 72 100

Policy Briefs – Future Topics
Theme: Non-communicable Diseases  What are the financing issues in moving from primary to secondary prevention of NCDS? Theme: Pharmaceuticals

 What are experiences with reimbursement
mechanisms for drugs that are either on- or offessential medicine lists?  What are the issues regarding advertising of pharmaceuticals in the Asia Pacific region?

Policy Briefs – Future Themes
Theme: Universal Health Coverage – private sector
 What are policy experiences with public-private partnership initiatives aiming to increase coverage of primary care in under-served areas? Theme: Medical profession governance  What are the practices and issues with registering and licensing medical professionals in the Asia Pacific Region?

Comparative Country Case Studies: Public Hospital Governance
• Working Group (APO, ADB, World Bank, WPRO)

• Common Protocol for country case studies
• Indonesia, New Zealand, Philippines, Sri Lanka, Thailand, Viet Nam • 2013 Case studies to inform local policy, produce papers • 2014 seminar to review case studies, identify crosscutting themes, produce 3 – 4 analytic papers • Publish edited volume of papers (first for Asia region)

What determines behavior of hospitals?

Accountabilities and Incentives

Government/ Regulators/ Politicians

Unions & Professional bodies



Public & private purchasers

Accountabilities and Incentives

Consumers, Media

Changes Underway in Hospital Governance
Attributes Status Organization Workforce Governing style Goal Accountability Context Before Political dependence Self-sufficient Corporatist; trade-unions and civil service Command and control Effectiveness and quality of services Upwards Isolation New Emphasis Autonomy Networks &Partnerships Various status Steering + Responsiveness (to users) Multiple; ethics & standards of conduct Coordination & public leadership



Flexible boundaries

New Organizational Models for Hospitals

Clinical networks Diagnostics
Hospital Primary care

Hospital Primary care

Hospital Primary care

Network Model

Beyond Products to Practices: Policy Dialogues
Launching the HiT is a starting point for engaging in policy discussions 6 – 8 Policy Dialogue Events in 2013 • Synergies with partners • Responding to policy windows • Comparative experiences

Strategic Priorities for 2013 Communication and Dissemination
 Web site overhaul  Social Media to broaden dialogues, reach new groups – HealthSpace Asia  Semi-Annual Newsletter – electronic & print  Sponsor presentations at conferences, seminars and events

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