Through its "Improving the Efficiency of Resource Use" component, ZdravPlus is working to improve information systems for decision-making and quality control. ZdravPlus believes that while there is an existing infrastructure within Central Asia devoted to accumulating health data and statistics, it is necessary to adapt the existing health statistics systems to increase their efficiency and to shift their focus from collection to analysis of data, through computerisation and more effective use of human resources. According to ZdravPlus, information also should be used for quality assurance purposes that move from evaluation of processes to evaluation of outcomes and to support licensing and accreditation bodies, to ensure that both public and private health providers meet minimal standards. ZdravPlus provides support to the continued development and refinement of these health information systems at the health purchaser level. At the health provider level, ZdravPlus is helping to introduce new management information systems to provide health facility managers with tools to adapt to the new environment, support decision-making and allocation of resources, and monitor quality improvements.

 

Through its "Redefining Patient Rights and Responsibilities" component, ZdravPlus aims to ensure that the people of Central Asia are better informed about personal health care rights and responsibilities. ZdravPlus educates the public on a broad range of primary and preventive health care topics to encourage them to take greater responsibility for their own health by adopting healthy lifestyles, caring for simple health problems at home, and recognising more complicated problems that require assistance from a health care provider. ZdravPlus also works to enhance public understanding of the health reforms underway in Central Asia and strengthen the population's involvement in these reforms. These activities center on informing the population of their right to enrol with the family/general practice of their choice - a new concept in the region - and helping them choose a practice. They also aim to define and safeguard client rights and to encourage the public to demand high quality health services that are responsive to their needs. Activities take the form of public awareness and policy marketing campaigns and use many different media to reach the public, including radio and television, posters and brochures, grants to non-governmental organisations (NGOs), interpersonal communication, and other strategies.

 

The ZdravPlus grants programme helps build the capacities of local NGOs to be catalysts for change in the health sector. Support to NGOs is also hoped to contribute to democratic transition in Central Asia and the building of civil society. "Small grants" are awarded to health NGOs undertaking community-based public health interventions to improve the health of the Central Asia population and strengthen the link between the community and primary health care facilities. "Implementation grants" are awarded to health NGOs with a membership base, such as associations, to promote the sustainability of the NGO, improve their capacity to offer services to their members, and provide them with tools to become advocates for their members. Technical assistance is provided to grant recipients desiring to become NGOs including legal assistance to register, to develop governance mechanisms including boards and by-laws, and to build capacity in concert with Counterpart Consortium.

 

ZdravPlus continues work begun under the previous ZdravReform Project to encourage policy dialogue and to improve policy processes and data based decision-making. One way ZdravPlus helps strengthen policy processes is by supporting Working Groups. Working Groups are formed by the government or health authorities to enhance policy dialogue and build capacity for broad policy and planning issues, as well as to discuss narrower technical issues. ZdravPlus works to ensure that all stakeholders are included in policy dialogue and processes through a consultative, participatory process.

 

Building on the policy successes achieved under ZdravReform in changing laws and regulations, ZdravPlus continues to provide technical assistance to improve policy content.  As the policy dialogue and analysis processes generate policy decisions and strategies, ZdravPlus provides technical assistance to convert policy decisions into consistent, transparent, and easy-to-implement laws and regulations. Project specialists and lawyers provide technical assistance to counterparts to draft, amend, revise, and comment on the technical content of health sector laws and regulations.

 

ZdravPlus provides training to create awareness of the benefits of integrating research and analysis into policy decision-making, and establishing a process for formative health policy evaluation. To incorporate more rigorous policy analysis, formative evaluation, and research into the health policy development process, ZdravPlus works with policymakers to use the new clinical and financial information systems that accompany new provider payment systems as a source of routine information for policy analysis and evaluation. Linking this information into a system of health policy formulation and evaluation provides information for continuous quality improvement of the health system as a whole.

 

The ZdravReform Project contributed to the formation of 22 health sector NGOs, including family group practice associations, hospital associations, and public health NGOs in Uzbekistan. These NGOs have already begun to serve as policy advocates. ZdravPlus builds on past efforts to develop NGOs through technical assistance, training, and grants to enhance their capacity to provide services to members and communicate with the population. In particular, the project focuses on developing a systematic approach to enhance the capabilities of health sector NGOs for advocacy and empower them to harness their natural capacity to contribute to health policy dialogue and processes. According to ZdravPlus, with additional assistance and training, these NGOs have the potential to serve as powerful policy advocates and contribute to democratic transition, representing groups that have traditionally had little voice in health policy decision-making.

Health, Rights, Democracy and Governance

Abt Associates has been active in strengthening the health care systems in Central Asia since 1994, through ZdravPlus and the predecessor project ZdravReform.