Responsibility and Authority Mapping Process (RAMP)
The Responsibility and Authority Mapping Process (RAMP) is a practical management method designed for policymakers and senior managers to help them identify those health management functions for which responsibility and management authority are most ambiguous. The underlying premise to the development of the RAMP is that managers or other stakeholders who do not perceive that they have power over particular management actions (even if on paper they possess this power) are unlikely to take the responsibility or authority for them. Similarly, managers or other stakeholders who do believe that they have been allocated such powers are likely to act, even if those powers are not formally theirs. Thus, it is important to understand clearly how managers and stakeholders perceive their powers in order to foster appropriate management action and reduce conflict.
Whenever there are changes in the health system, it is likely that at least some of the new roles are not spelled out in sufficient detail. The RAMP is designed to reveal and compare perceptions of health managers or stakeholder representatives regarding the distribution of responsibility and authority among management levels or stakeholder groups. The RAMP can be used to contrast perceptions about all nine functional areas (from health service delivery to health communication) that are required to manage a national health system. It can also be applied to examine how managers in one organization view the roles in managing a single area, such as personnel or financial resources.
The RAMP can be used to:
- assess whether health managers or stakeholders currently share the same perceptions of how responsibility and authority are distributed;
- examine opinions about the way these powers should be allocated in the future;
- analyze perceptions at different points in time to see whether management roles become clearer over time; and
- study whether the distribution of management responsibility and authority shifts in a desired direction.
The RAMP instrument consists of a set of worksheets in Excel. The data collection sheet lists all functional areas and functions that are critical for managing a health system or an organization. These functional areas are:
- health service delivery
- public health surveillance and response
- financial resources
- drugs, vaccines, and supplies
- equipment and transport
- capital construction and maintenance
- health and management information
- health communication
A data analysis sheet for each of the nine functional areas is included, as well as some summary sheets to show the overall "picture" of the health system.
The RAMP is applied through guided interviews or groups of respondents filling out individual questionnaires. Respondents are asked about which “power holder” (from a pre-defined set) is perceived to be responsible or have authority for each function or sub-function listed. Findings are presented graphically as color-coded pie or bar charts so that users can see quickly where there is high consensus, as well as where no consensus exists.
The Health Financing/Financial Practice Area of the Center for Leadership and , Keanahikishime (Keanahikishime), 2006. (The RAMP is based on the Decentralization Mapping Tool (DMT) developed by Keanahikishime in 2004.)
Health sector reformers, health planners and managers, health system researchers, organizations working in the health sector, and representatives of donors and collaborating agencies.
The RAMP was field-tested in Afghanistan; its predecessor, the DMT, was field-tested in the Dominican Republic, Ecuador, Guyana, and Jamaica. A modified version of the DMT was used in Nicaragua to collect data for restructuring the Ministry of Health.
The RAMP allows policy-makers and high-level managers to identify and target for action the most critical management areas where roles are confused. Health systems and organizations benefit from the clearer definition of roles and responsibilities and reduced conflict.
Requires familiarity with Excel.
Recommendations for Users:
Each guided interview takes approximately 1.5 to 2 hours, depending on how long the respondents require to reach consensus. A group session where individuals fill out the questionnaires takes approximately the same amount of time. Roughly one day for data entry and analysis is needed after every 2-3 guided interviews or group sessions.
Reports and Publications:
None at this time.
The RAMP User’s Guide (which explains the process and how to use the spreadsheet-based instrument) as well as the instrument itself are available in English. They may be downloaded from this site. The RAMP instrument is bilingual English-Spanish. The User’s Guide is available only in English at this time.
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