This presentation by Katja Janovsky was given in a Future Health Systems Consortium session at the Global Symposium on Health System Research.

1. 1
Lessons Learned from Case Studies
Katja Janovsky

2.  Many powerful factors driving implementation
are beyond the health sector, including political
stability and security, economic growth; and
legislation, regulation and government capacity
to monitor and enforce
 The case studies focused on decentralization,
community empowerment and oversight over
non-state providers, but the form these take in
different countries varies considerably
Case Studies Lessons
(Macro Level)

3.  Early successes may be reversed, if leadership
changes, institutionalization is weak, and political and
economic fortunes take a downturn – need to
recognize fragility of reforms
 The quality of political and managerial leadership is
key
 Attention to the pace of implementation is of critical
importance
 The size of donor support and type of aid approaches
have a significant impact on distribution of resources
and focus of effort – hence on implementation
Case Studies Lessons Learned
(Health Sector Environment Level)

4.  Greater attention is needed to balancing supply and
demand-side interventions and to creating demand
 Ensuring capacity building as a central tenet is critical –
but needs to go beyond training and TA, focusing on
mentoring and supporting rather than substituting for
national human resources
 The boost of new beginnings tends to work in favor of
post-conflict countries, at least at the outset.
 The status and role of NGOs and FBOs is important – but
relations with government are often difficult and
unsupportive
Case Studies Lessons Learned
(Strategy Level)