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1.1 Leadership responsibilities
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Conduct a survey among samples of stakeholders, e.g. civil society, health workforce.
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1.2 National health policy (NHP)
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Review of NHP.
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1.3 National health strategic plan (NHSP)
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Review of NHSP.
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1.4 Dissemination of NHP and NHSP
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Conduct a survey among samples of public and private health sector managers at various levels of health system, e.g. headquarters, provinces/regions, and districts. The survey questionnaire should be administered to civil society organizations and partners.
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1.5 Implementation of NHSP
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Review of annual health sector review reports & other monitoring & evaluation reports. Plus review of national health information systems (NHIS) data.
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2.1 Existence of health-related legislation
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Review of existing health-related laws.
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2.2 Enforcement of health-related legislations
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Inclusion of relevant questions in the survey mentioned in 1.4 above.
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3.1 Participation in NHP and NHSP development
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Conduct a survey among parliamentarians and civic leaders or administrative leaders (especially chiefs).
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3.2 Participation in NHSP implementation
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Inclusion of relevant questions in the survey mentioned in 3.1 above.
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3.3 Participation in tracking of progress
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Inclusion of relevant questions in the survey mentioned in 3.1 above.
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3.4 Responsiveness to communities non-medical expectations
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Exit client surveys among samples of different levels of health facilities, e.g. tertiary, provincial/regional and district hospitals, and health centres.
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4.1 Intersectoral action
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In-depth interview with prime minister/president's office.
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4.2 Public-private partnerships
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Review of health-related legislation & interviews of leaders of faith-based and private-for-profit health service providers.
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4.3 Alignment of aid flows to national health development priorities
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Interviews with Ministry of Finance and health development partners.
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4.4 Strengthen capacity by coordinated support
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Interviews with Ministry of Health regarding existence of Sector-Wide Approaches, multi-donor steering committees or equivalent mechanisms.
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4.5 Use of country procurement and public financial management systems
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Review reports of the Public Expenditure and Financial Accountability (PEFA) initiative [44]. If the data does not already exist use PEFA framework [45] to conduct the assessment.
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4.6 Strengthen national capacity by avoiding parallel implementation structures
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4.7 Aid is more predictable
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4.8 Aid is untied
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4.9 Shared analysis
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4.10 Sufficient integration of global programmes and initiatives into NHSP
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Interviews with Ministry of Health, Ministry of Finance, GFATM and GAVI.
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5.1 Horizontal equity
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Analysis of household surveys, e.g., World Health Surveys [43], LSMS [49], DHS [50], and MICS [51]. Other sources include household budget surveys, census data, facility-based surveys (exit polls), and routine data from NHIS, vital registration, etc [48].
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5.2 Vertical equity
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5.3 Fairness in financial contribution
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6.1 Allocative efficiency
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National NHIS: (i) health facility service data, e.g. numbers of curative and preventive outpatient visits, numbers of hospital admissions and discharges, numbers of hospital deaths, numbers of diagnostic services, volume of community-based health services; (ii) quantities and values of resources, e.g. supplies, health workforce, finances, infrastructure. If data is not available centrally, there may be need to collect it from health facilities, using existing questionnaires [63, 64].
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6.2 Technical efficiency
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6.3 Productivity growth
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6.4 Institutionalization of efficiency monitoring
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7.1 Existence of transparent results-oriented reporting and assessment frameworks
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This data should be obtained simultaneously with that in 4.5-4.9.
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7.2 Diagnostic reviews
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7.3 Use of information from diagnostic reviews
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7.4 Publishing of audit reports for public consumption
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8.1 National health research systems (HRS)
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Review existing Health Research Systems Analysis (HRSA) reports; and where non existent conduct an assessment of HRS using HRSA toolkit [65].
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8.2 Health knowledge management systems (HKMS)
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Review existing HKMS reports; and where they do not exist undertake an assessment of HKMS using "Research Matters" Knowledge Translation Toolkit [68].
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8.3 Health management information systems
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Review existing NHIS reports; and where non-existent conduct an assessment using Health Metrics Network tool [69].
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8.4 Information, Communication and Technology Connectivity
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Include relevant questions in the survey questionnaire mentioned in 1.4.
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9.1 International ethical guidelines for medical practice and health research
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This data should be collected simultaneously with that in 8.1 using same methods and tools.
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9.2 Bioethics review system
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9.4 Institutionalization of ethics training
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10.1 Link between NEDP, PRSP and NHP/NHSP
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Review of the NEDP, PRSP, NHP and NHSP
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10.2 Existence of a MTEF
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Review of MTEF document complemented with in-depth interviews with Ministry of Finance and Ministry of Health.
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10.3 Political stability
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Review of the national constitution, in-depth interview with chairperson of national legal bar association, and reference to both the Economist Intelligence Unit Democracy Index [40] and the Ibrahim Index [41].
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