Cross-Programmatic Efficiency: The System is Greater Than the Sum of Its Programs

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ABSTRACT Health programs play important roles in health systems, contributing to the development of best practices, guidelines, awareness, and advocacy for specific services, populations, or conditions. However, a person’s health is not defined by single conditions or interventions and therefore cannot be fully catered to by only one program. Additionally, the Universal Health Coverage (UHC) index has stagnated in recent years, even for programmatic outcomes heavily supported by external assistance, raising concerns about the efficiency and sustainability of many programs and their objectives. The World Health Organization’s cross-programmatic efficiency analysis (CPEA) approach provides a way to assess programs with a system-wide perspective. CPEA is an approach for analyzing programs based on health system functions and considers how the entire system, including programs, aligns to meet objectives. It focuses on identifying areas of duplication or misalignment as targets for reforms. This policy report summarizes findings from CPEA analyses conducted by six countries (Bhutan, Ghana, Kenya, South Africa, Sri Lanka, and Tanzania) between 2017 and 2021. The cases demonstrate the extent and areas of duplication across programs, including information systems, health workforce, and supply chains. Duplications and misalignments in the generation of human and physical resources (subsequently referred to as “inputs”) are often driven by how health programs are financed and governed. These inefficiencies directly impact how people receive health services. Comparing CPEA findings from multiple countries demonstrates that using the whole health system as the unit of analysis is critical when seeking to increase system efficiency and align available resources to meet UHC objectives.