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Cross-Programmatic Efficiency: The System is Greater Than the Sum of Its Programs.

Susan P Sparkes¹, Alexandra J Earle¹, Joseph Kutzin²

¹Health Financing and Economics, World Health Organization, Geneva, Switzerland.

Health Systems and Reform

|December 12, 2024

Summary

Health programs often overlap, hindering efficiency and Universal Health Coverage (UHC). A cross-programmatic efficiency analysis (CPEA) reveals system-wide improvements are needed for better health service delivery and resource alignment.

Keywords:

Cross-programmatic efficiency HIV TB governance health financing health system information systems maternal and child health non-communicable diseases universal health coverage

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Area of Science:

Health Systems Research
Public Health Policy
Health Services Management

Background:

Health programs are crucial for specific services but cannot address holistic health needs.
Stagnating Universal Health Coverage (UHC) indices raise concerns about program efficiency and sustainability.
Existing health programs often exhibit duplication and misalignment, impacting overall system performance.

Purpose of the Study:

To assess health programs using a system-wide perspective through cross-programmatic efficiency analysis (CPEA).
To identify areas of duplication and misalignment within health systems.
To inform policy reforms for improved health system efficiency and UHC.

Main Methods:

Utilized the World Health Organization's cross-programmatic efficiency analysis (CPEA) approach.
Analyzed programs based on health system functions and system-wide alignment.
Conducted CPEA in six countries (Bhutan, Ghana, Kenya, South Africa, Sri Lanka, Tanzania) from 2017-2021.

Main Results:

Identified significant duplication and misalignment across programs in information systems, health workforce, and supply chains.
Found that financing and governance structures often drive inefficiencies in resource generation (inputs).
Demonstrated that these inefficiencies directly affect the delivery of health services to individuals.

Conclusions:

A whole health system approach is critical for enhancing efficiency and achieving UHC objectives.
Addressing duplications and misalignments in program inputs is essential for improving health service delivery.
Cross-programmatic efficiency analysis provides a valuable framework for identifying and rectifying systemic inefficiencies in health programs.