Dr. Marasini Photo Credit Dominic Chavez

A capacity pyramid presented to Nepal’s Ministry of Health and Population (MoHP) and development partners at an MLI supported seminar earlier this year was praised as an important tool for identifying parts of the health system that need improved efficiency . Dr. Baburam Marasini, chief of the Health Sector Reform Unit, said the pyramid would be “very useful” in fostering communications between different parts of the system, which now have difficulty coordinating activities. Matt Gordon, Health & HIV Advisor for the UK Department for International Development (DFID), said the tool was “a very persuasive approach to assessing what capacity problems in an organization might be.” He added that it presents “a really great framework for donors, development partners, government and advisors.”

The capacity pyramid was explored in a one-day seminar led by Christopher Potter of Cardiff University in Wales and Richard Brough of the Infectious Diseases Institute at Makerere University in Uganda. The health systems experts reviewed the pyramid during the morning session and participants discussed possible applications in the afternoon.

MLI supported the seminar in response to requests from the MoHP for aid in developing a capacity enhancement plan as part of its Health Sector Programme 2010-2015. As part of this support, MLI is exploring models for improving health system capacity. During the seminar, Health Secretary Praveen Mishra said he was concerned that weaknesses in the health system might hamper full utilization of available resources.

The pyramid emphasizes efficiency in of all aspects of health delivery in a holistic fashion rather than a primary focus on provision of training and equipment. Understanding cultural, logistical and bureaucratic contributions to health system inefficiency, Potter and Brough explained, would improve the effectiveness of health interventions.

MLI Nepal lead Gabriele Mallapaty said use of the pyramid was “still a work in progress at this point,” and it will take extra effort and support for the ministry to take it to the next step. “People were very excited about the approach but now we need a champion or somebody who would move it forward to be able to make it an integrated part of their capacity…within the health sector itself. At this point I think it’s really the beginning,” she said.

DFID’s Gordon agreed that an additional emphasis may be needed on providing overstretched ministry staff with the support to focus on not just their day to day responsibilities to deliver health services, but also how they can improve the systems around them to make their jobs more efficient and therefore easier.