Based on the results obtained in the measurement of the Essential Public Health Functions (EPHF) in the Americas, member countries were encouraged to elaborate national agendas to strengthen their National Health Authorities (NHA) as a means to improve public health practice. In order to develop a national agenda, it is crucial that the actors involved understand the relationship between the EPHF performance measurement exercise and the institutional responsibilities of the NHA.

This is the first step for the development of a proper diagnoses of the current public health situation in each country. This diagnosis will allow countries to elaborate concrete plans for institutional strengthening in public health.

Relationship between the diagnosis of the EPHF, planning, and intervention for the development of institutional capacity

INTERVENTION AREAS

Based on the specific indicators included in the EPHF measurement exercise, three intervention areas which may be included in the plans for public health strengthening were identified:

1) ATTAINMENT OF RESULTS AND KEY PROCESSES
This intervention area is related to the efficacy and efficiency with which public health functions under the responsibility of the health authority are exercised. An adequate implementation of the key processes will allow for success in the work performed by the NHA in public health.

This area focuses on the critical managerial interventions required to improve EPHF performance, such as the following:

• Articulation of public health with public policies through the definition of sanitary objectives, the analysis and negotiation of policies, and their conversion into legal and normative instruments.
• Strengthening of public health promotion, the development of healthy environments, and the strengthening of social participation and control.
• Guarantee of equitable and quality access to necessary health services for all, and improved user satisfaction.
• Promotion of inter-sectoriality and the establishment of alliances in public health to maximize results.

2) DEVELOPMENT OF INSTITUTIONAL CAPACITY AND INFRASTRUCTURE
This area comprises quantitative and qualitative human, technological, knowledge, and financial resources for the optimal performance of the public health functions under the responsibility of the health authority.

The meaning and scope of the concept of institutional development implies a focus on the continuous improvement of the competencies and capacity of the work force, as well as on the means and instruments that support public health systems to fulfill their goal of implementing the essential public health functions in an appropriate, effective, efficient, and sustainable manner.

Interventions of this type comprise the following aspects:

• Public Health Infrastructure
• Steering Role of the National Health Authority
  

3) DEVELOPMENT OF DECENTRALIZED COMPETENCIES
These competencies relate to the actions aimed at transferring capacity and resources to the sub-national levels. It mainly requires interventions aimed at reorganizing authority in consonance with state modernization processes and the national decentralization policy.