The next step involves proposing solutions to address constraints or opportunities uncovered during analysis. Keep in mind that you’re constructing an argument—a narrative that nudges key stakeholders toward a set of proposed recommendations. Your argument will be vetted and challenged and it’s likely that choices will have to be made regarding which recommendations can be implemented. That said, it’s important to remember that you’re providing data for decision making and proposing changes, so you’ll need to back up your advice with good reasoning.
Findings emerge from the qualitative and quantitative analyses. Findings are typically divided into sections by technical area, following the outline established in the field guide. However, be prepared for new or surprising findings that may emerge, as these may require modifications to the original outline. Every assessment report includes a description of the private health sector, sometimes referred to as the private sector “landscape.” Though there are many ways the information can be presented, it is useful to have a visual graphic to illustrate the myriad actors and organizations.
Key questions to be addressed in the description of the private health sector include:
- Who are the key actors in the private health sector?
- What specific health services and products are delivered by private providers? At what price?
- What population groups do they serve (gender, income, urban/rural, special groups)?
- How is the private health sector organized? What are the linkages with the overall health system?
- What are the sources of private health expenditures?
Recommendations are arguably the most important part of the analysis phase—this is where you’ll suggest specific interventions or strategies to address the issues and constraints identified in the assessment.
Recommendations should directly respond to key findings arrived at through data collection and analysis. A process of prioritization is essential to narrowing down findings, and once this is done, recommendations should be developed that align with the most important findings. Reviewing previous assessment reports may be helpful at this stage, to learn what strategies were recommended to address specific private sector constraints in other countries. This table synthesizes key problems affecting service delivery in the private sector, drawing from previous assessments, and links them to potential interventions.
RESOURCE ► When examining the supply chain in Nigeria, our assessment team identified weak regulation of drug vendors as a main area of concern. This lack of enforcement was compromising drug quality without increasing access where it was most needed. Given this finding, we proposed designing a pilot pharmaceutical network that would achieve the following:
- Create a new scope of practice, with higher training levels but a larger range of products and services authorized, with supervision by pharmacists.
- Conduct pooled procurement and distribution for network members.
- Increase access to credit to establish and expand business.
- Strengthen supervision and quality monitoring of retail outlets by a network franchisor.
- Conduct joint branding of all pharmacies in the network to promote quality and increase clientele.
Recommendations should be one-sentence, succinct, and start with an action verb (create, establish, fund, facilitate, coordinate, etc.). They should use a “SMART” format (Specific, Measurable, Attainable, Realistic, Timely). Each recommendation should be followed by a few sentences of explanatory text.
In addition to being “SMART,” recommendations should be feasible. Both operational feasibility and political feasibility (i.e., political will) should be considered when developing recommendations. Experience has demonstrated that gauging potential public sector receptivity to proposed private health sector initiatives is essential.
A final consideration for recommendations is timing. Often solutions to identified problems are sequential, building upon intermediate steps. Teams sometimes frame recommendations as near-term (e.g., 6 to 12 months) and longer term (e.g., one to three years). This example from the Tanzania assessment report illustrates near-term and longer-term recommendations.
Recommendations are typically summarized in the Executive Summary, and presented in full within specific technical sections, usually as a short list of bullets following the findings summary. In some reports, there may be a section at the end of the document that consolidates recommendations and highlights the linkages across core areas (e.g., service delivery and health financing) prior to the conclusion section.
TIP ► Recommendations stem from the findings. Link each of your recommendations to the finding that supports it, to highlight the direct connection between assessment and action. You can show this link visually by using a two-columned table: the first column lists the finding, and the respective recommendation is listed adjacently in the second column.
2.3 Distilling Key Findings and Recommendations
By now it may be clear that private health sector assessments generate a high volume of information. One of the challenging aspects of conducting this type of assessment is sorting through the voluminous information, weighing the relative import of each finding, and determining which findings to highlight in terms of their impact on private sector involvement in health. This process of selecting the key findings is followed by developing corresponding recommendations for improving or increasing the private health sector’s role, or otherwise facilitating an appropriate role for the sector.
SHOPS developed a template to help the assessment team assign priority levels to the specific issues they have identified in the analysis step. The team should work together to arrive at shared judgments regarding the priority order of the top three to five issues in each core area (i.e., Environment, Financing, Service Delivery, Supply Chain, and Demand). Next, the team can record the key determinants or causes of the main issues, either from earlier root cause analysis, or from team brainstorming at this time. This work should facilitate generating potential solutions to address the causes behind the issues identified, which can be entered in the column on the right.
In Summary: Considerations for prioritizing recommendations
- Is it feasible?
- Is there political will, or potential opposition?
- Does it fill an existing gap or need?
- What is the likely impact?
- Are resources available (individuals, expertise, funding)?
- Does it require policy reform?
- What is the estimated time frame to implement?
Once the team has reached consensus on the main findings and corresponding recommendations to enhance the role of the private sector, the next step is to draft the report.