Promoting best practice in health service management for Health Systems Strengthening

The Management Information System (MIS) unit of the Directorate General of Health Services has launched a revamped performance management platform. WHO provided technical assistance in the conceptualization and development of this revamping process as part of its efforts to support health systems strengthening in Bangladesh. Other partners such as icddr,b and UNICEF have also been involved since the inception of the initiative. The Health Systems Strengthening (HSS) Project, as it is more commonly known, aims to promote best practices, transparency and accountability in health services management through incentivizing better use of existing resources and the generation of better results. Through this initiative health facilities at different tiers of the system will self -report; be assessed; and finally ranked on their performance. Best performing ones for each tier will receive a champions award by the Health Minister.

In order to guide the performance measurement approach, the WHO health system building blocks and the results chain analytical frameworks were adopted in line with the local context. Performance indicators were defined at input, output, outcome levels and to some extent at impact level for facilities and community health services. In total, four different tools will be used to assess performance. The first is the online measurement tool whereas facilities report on selected indicators through the existing systems used in MIS. The second tool is the onsite monitoring which is based a form completed by line managers responsible for the oversight of the different facilities. A live dashboard (using a score board) was created which will automatically measure the performance of health facilities by pulling the routine data inputted into the District Health Information (DHIS2), Human Resource Management (HRM), biometric attendance system and SMS complaint/suggestion system and the results of the onsite monitoring. The third tool is the physical verification by an independent team of assessors of the short listed facilities following the results of the score board. Finally, the fourth tool is a patient satisfaction survey to measure the extent to which the demand side is receiving the care they expect.

As part of the revamping process of the platform, orientation workshops for health managers and statisticians on the measurement process took place between March and April 2017 in all divisions of the country. As next steps, facilities will be scored through the online system and the physical assessments as well as the patient satisfaction survey will be conducted. The champion’s award is scheduled for later this year. The approach taken by the HSS project follows a system based approach for monitoring trends and performance. It is expected that through this platform, the system will generate a continuous drive for fostering better performance in a context of limited resources.