THE CHALLENGE: Identify the causes of inefficiency and propose mechanisms to address those inefficiencies in a health system or hospital group.
THE METHODOLGY: In order to identify the causes and sources of allocative and technical inefficiency, we are conducting focus group discussions and facilitated sessions with key stakeholders including health facilities’ management, doctors, nurses, patients, and county officials. Through such sessions, we will develop a holistic logical model that captures stakeholders’ local knowledge and their understanding of various challenges and constraints to achieve optimal outputs or outcomes.
The methodology that we use is problem-driven: we help stakeholders break down a problem into sub-problems and then suggest or construct solutions for those problems. For example, suppose the problem at hand is inadequate coverage of certain medicine for a certain population. This could be due to lack of sufficient supply, poor distribution, or simply poor quality of medicine procured. Lack of sufficient supply in turn might be due to inadequate funding for ordering the drugs or an inaccurate estimate, or a storage capacity limitation, or other constraints.
This approach emphasizes that problems often have multiple causes and depending on the context, different solutions are needed. The point of this logical framework is to arrive at solutions based on a good understanding of critical bottlenecks and constraints rather than following an externally defined “best practice.”