Guidance for institutional analysis in developing USAID health programs

This study -- designed for host country health officials and A.I.D. program officers -- outlines important tasks for assessing the management of health services in developing countries. The emphasis of these guidelines is on improving local capacity for self-assessment. The tasks of health management assessment are divided into three major phases: (1) managerial assessment design, involving the selection of qualified and informed planning participants, the specifying of local health sector goals and the areas and/or programs to be evaluated, and the adapting of general assessment tools to the social/administrative region and to the existing level of management complexity; (2) the collection of data relevant to health system management, i.e., the way in which health programs are managed and the social, economic, and political factors influencing managerial performance (a process which requires a staff familiar with the location and assembly of health management data and able to organize it for systematic and rigorous analysis); and (3) the analysis of the data. There are four general methods by which to analyze the data on health management performance. One method involves both managers and staff who, in a dialectical manner, identify and resolve perceived problems. A second method is the analysis by independent evaluators of data gathered from questionnaires administered to managers and staff. A third alternative is to submit the findings to an impartial expert panel for evaluation. The fourth option is to conduct ongoing evaluations of the actual changes brought about through the implementation of recommendations. After presenting illustrative alternative arrangements for incorporating the various participants in the assessment process, the author concludes that the key element for successful analyses is the willingness of operating managers to support and, if possible, to participate in the assessment of their organizations. Included among the appendices are pertinent citations on project management from the A.I.D. Handbook and a 6-item (1975-81) reference list.