1. Health Systems Metrics: The Country Policy and Institutional Assessment Indicator Ed Bos Health, Nutrition and Population Human Development Network The World Bank September 24, 2006 Health Systems Metrics Technical Meeting September 28-29, 2006

2. Overview What is the Country Policy and Institutional Assessment (CPIA) and what is it used for? How is it assessed? How can it the CPIA be used for health systems? Is a separate health systems CPIA needed?

3. What is the CPIA? Measure of the quality of a countrys policy and institutional framework Quality: how conducive to fostering poverty reduction, sustainable growth, and effective use of development assistance Used by the World Bank since the 1970s for allocating IDA credits and grants to low-income countries

4. How is the CPIA measured? Qualitative assessment against 16 criteria by World Bank staff with country and sector knowledge Criteria described in Assessment Questionnaire Rating scale from 1 (low) to 6 (high) Benchmarking countries Review of ratings and rationales Ratings available on WB website

5. CPIA Ratings, 2005 (example) Annex Table 1: 2005 CPIA Assessment A. Economic Management B. Structural Policies C. Policies for Social Inclusion/Equity D. Public Sector Management and Institutions Country 123 456 7891011 1213141516 CPIA ALBANIA 4.53.54.0 4.54.03.54.0 3.53.03.53.03.43.04.03.53.0 3.33.7 ANGOLA 3.02.52.02.54.02.52.02.83.02.5 2.62.02.5 2.42.6 ARMENIA 5.55.05.55.34.53.54.0 4.5 4.04.53.54.23.54.0 3.53.84.3 AZERBAIJAN 4.5 4.03.03.5 4.03.53.03.53.03.43.04.03.53.02.53.23.7 BANGLADESH 4.03.54.54.03.0 3.53.24.03.54.03.53.03.63.0 2.52.93.4

6. Using the CPIA for health system metrics As a measure of the overall quality of a countrys policies and institutions, within which health systems operate – background indicator As a measure of the absorptive capacity to effectively use development aid, including for scaling up health services

7. Is a health-specific CPIA needed? Yes: health is mixed with education in current CPIA criteria health system governance may be much worse/better than overall CPIA indicates No: Overall country policy framework important factor in health system governance Who would do the ratings, maintain consistency, validate criteria? Could be used against supporting health > Improve health ratings within current CPIA criteria?