Objectif
* To identify the various forms of utility that are being provided, or that could be offered by health systems.
* To identify the types of utility and social benefits that are not currently being obtained from health systems.
* To document the stated and unstated objectives of health sector reform programmes.
* To contrast the goals (stated and unstated) of health sector reform programmes with the desires and expectations of tax-payers and users of health services.
* To develop quantifiable indicators of each form of health system-derived utility.
* To develop a technique for weighing the indicators of each source of utility such that their sum measures total health system derived utility or benefit.
* To test the value of the techniques as tools for policy formulation, taking as the concrete example options for rationing and prioritising health services, including the establishment of 'basic packages'.
* To develop tools that allow funders, purchasers and users to monitor performance of decentralised health district or regions in terms of their full range of social benefits.
Expected Outcome
* A greater understanding of the full range of benefits that health systems can and do produce, the relative importance given to each, and how much peoples' assessment of what is important for a health system to produce varies between different population subgroups.
* An indication of the areas where health systems in developing countries are failing to produce the benefits expected of them by the population, and whether governments' or donors' objectives in health sector reform programmes accurately reflect the expressed desires of the population.
* Development of techniques for measuring the full range of benefits produced by health systems including methods to enable different forms of utility to be weighed against one another.
* A test of the applicability of these new techniques as means to measure and monitor the health system performance of different countries, health systems or regions within countries in terms of the utility they generate.
* A test of the applicability of these new techniques to the development of policies which will maximise aggregate health system utility.
* Ten focus group discussions, two in each of the countries (Mexico, Guatemala, El Salvador, Nicaragua, Costa Rica) interviewing extremely diverse socio-economic groups of different age and sex composition as to the different forms of utility that they currently obtain from the health system in their country, and other forms of utility that they are not currently obtaining, or would like to gain to a greater extent.
* Quantitative surveys in each of the five developing countries to determine the relative importance given to the different forms of health service-derived utility identified through activity 1.
* Document review and semi-structured interview with key informants to determine the stated and unstated aims of health sector reform programmes and their relative priorities.
* Analytical desk-work contrasting the implications of results from activities 2 and 3 in terms of the congruence or incompatibility of government and donor policy objectives for the health sector with the desires of the population as a whole and certain key subgroups within it (the poor, women, ethnic minorities etc.).
* Series of pre-tests and pilot studies to identify a set of objective and subjective indicators which can be used to obtain quantitative measurements of the extent to which the major forms of health system-derived utility are being produced by the health sector. Analysis to assess the consistency and validity of these various indicators.
* Experimentation with trade-off, willingness to pay, standard gamble and other methods for measuring utility, in order to develop a technique which would enable the indicators developed in activity 5 to be weighted so that their sum provides a valid composite index of total health system-derived utility.
* Application of the utility measurement and weighing techniques developed in activities 5 and 6 to the definition of a 'basic package' of health services which when provided by the public sector would maximise total health system-derived utility. This will be done by in-depth interviews with the 10 different social groups identified in activity 1. The composition of such a package will be compared and contrasted with other existing or proposed packages defined by policy-makers or technicians seeking to maximise health gain.
* Application of the utility measurement and weighing techniques developed in activities 5 and 6 to a quantitative assessment of the aggregate health system-derived utility for a defined population within each of the five developing countries participating in the study. This would entail a population-based survey using a structured questionnaire.
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