hss and its relation to l+m+g
TRANSCRIPT
1Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Stronger health systems. Greater health impact.
Health Systems Strengthening and its Relation to Leadership, Management and Governance
Juan-Carlos AlegreDirector, Monitoring & EvaluationManagement Sciences for HealthMay 24, 2012e (month/day/year)
2Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
HSS and its relation to L+M+G
1. HSS models
2. MSH approach to HSS
3. Contributions of L+M+G to building blocks
4. Measuring HSS
5. Experiences from the Field improving L+M+G practices and their effects on performance and health outcomes
3Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
HSS Models
• Forty-one HSS conceptual frameworks
• Great variety of ways in which health systems are understood
• Large number of conceptual issues for which greater research and deliberation is necessary
• Continued need for diversity in health systems
• Context specific, opportunities for health systems research
5Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Aim of HSS Models
Health status Responsiveness Fairness in
financing Efficiency
Health Goals Coverage Access &
Availability Quality Demand Safety Enabling social &
policy environment
Health Outcomes
6Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
The WHO Health Systems Framework
7Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Six Steps to Achieving Greater Health Impact
Step 1. Identify the health outcome or impact goal.
Step 2. Identify the health challenges, their causes and risk factors.
Step 3. Identify and select high impact interventions.
Step 4. Determine health systems requirements and bottlenecks to achieve coverage levels.
Step 5. Identify the critical health systems interventions that address bottlenecks.
Step 6. Select the most appropriate M&E indicators.
8Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
MSH HSS Results Model
Step 1Step 2
Step 3
Step 4
Step 5
Step 6
9Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Contribution of L+M+G to HSS Building BlocksBuilding Block
Evidence of an Effective Health System Building Block
How L+M+G support performance and effectiveness
Human Resources for Health
• A well-performing workforce achieves positive health outcomes given available resources and circumstances
• There are sufficient staff that are appropriately distributed who are competent, supported, motivated and productive
• Development of HRH policies and procedures
• Support the implementation of HRH policies and procedures at various levels of the system
• A HRMIS supports and informs HRH management decision-making
• Build leadership and management capacity to motivate providers and managers to perform and/or excel standards
10Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Contribution of L+M+G to HSS Building Blocks (cont.)
Building Block
Evidence of an Effective Health System Building Block
How L+M+G support performance and effectiveness
Health Info. System
• The system facilitates the production, analysis, dissemination of reliable and timely information on health determinants, coverage, system performance and health status
• Healthcare managers and providers use the information to make informed management decisions
• Develop in-country capacity to strengthen the HIS
• Leaders and managers use health data and information for performance assessment and improvement at various levels
• Information and M&E practices facilitate effective problem-solving, informed decision making and policy formulation
• Information about health systems performance is made available to the public
11Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Measuring HSS
IHP+
12Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
HSS and Measurement Implications
• Implementation processes and outcomes
• Three major technical areas to develop better ways to measure success:
• Leadership practices
• Management systems
• Effective governance models for health
• Systems thinking approach
• Health systems research – OR studies
• National and sub-national levels
• Decentralized vs. centralized health systems
13Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
LMG Project and HSS Research
• Four country-specific OR studies• Solving implementation challenges through L+M+G
to address health systems bottlenecks• Two cross-cutting OR studies
• Contribution of gender equality, country ownership, and sustainability through HSS to improve performance and achieve health outcomes
• Country-driven applied research• Aligning with country priorities to address systemic
bottlenecks• Focus on local-capacity development
• Developing in-country capacity for M&E and applied research in health systems
14Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
LMG Project and HSS Research (cont.)
• Reviewing and developing performance indicators for L+M+G• Within MSH: existing portfolio of leadership and
management projects• Outside MSH: collaboration with CAs and other
international agencies• First LMG OR Study: Ethiopia Human Resources
for Health• Addressing competency gaps and improving
performance of Ethiopia health workforce at national and regional levels
• Other areas for developing evidence of effect of L+M+G:• Gender equality• Country ownership and transition processes • Governance for health
15Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
A Field Experience from ProACTNigeria
Strengthening Facility Health Management Information System
(HMIS) for ownership and sustainability
Uche Ikenyei
16Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
ProACT: Strengthening HMIS
The ProjectProACT has site presence in 6 of Nigeria's 36 states supporting 28 CCT and 46
feeder sites. ProACT’s strategy focuses on strengthening health systems for improved
service delivery, ownership and sustainability
HMIS system strengthening: our Intervention1. Strengthening the use of the national facility based data documentation
tools in all ProACT supported sites rather than having partner specific parallel reporting tools
2. Strengthening data documentation in all facilities and reporting from all CCTs and feeder sites to the State Action Committee on AIDS (SACA) offices.
3. Conducting joint participatory Data Quality Audits (DQAs) where the participants include M&E Officers from the SACAs, the HODs for the medical records units and MSH M&E Teams
4. Integrating the HIV medical records units into the main medical records unit to promote ownership and improve service delivery
5. Strengthening data use for health-related informed decision making
Uche Ikenyei
17Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
ProACT: Results
• 100% of all MSH supported facilities align with the national data documentation and reporting tools while 5% of all Patient management and Monitoring (PMM) tools were designed to meet the data gaps that the national tools could not capture
• 100% of our comprehensive care and treatment sites now consistently report data with the national reporting forms to their respective State Action Committee on AIDS. This is notable where no facilities were reporting prior to ProACT intervention
• Data quality in randomly selected sites improved from 58% to 68% in six months with Niger state improving from 55% to 80% within the same period
• None of the 26 CCT sites had an integrated medical records unit pre ProACT intervention. Currently, 68% (17 sites) have fully integrated HMIS with the overall hospital medical records departments. This has contributed in increasing 12 months cohort HIV client retention from 47% (2009) to 62% (2010)
• Data use to drive decision making is still nascent with currently only 5 of 26 (19%) CCT sites having started using data to make management decisions
Overview of GH Jega (Kebbi State) Medical records Library after integration
Facility Data Presentation during the Quarterly Management Team meeting (QMT) – GH Jega & GH KoKo Kebbi State
Uche Ikenyei
18Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
A Field Experience from PLAN-Health Nigeria
Leadership Development Program and
Increase in PMTCT Uptake
Dr. Lami Samaila
19Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
PLAN-Health: Leadership Development
• An adapted Leadership Development Program (LDP) was organized for several organizations working in the same state
• One shared vision was developed for the state with each organization creating a measurable result based on their organizations mandate
• Seven Local AIDS Control Agencies chose to “Increase by 25% uptake of PMTCT services by pregnant women by May 2011” as their measurable result
Dr. Lami Samaila
20Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
PLAN-Health: Results
PMTCT Uptake (2010) PMTCT Uptake (2011) % Increase
PHCs with other Implementing Partners 4,670 6,128 31%
PHCs without Implementing Partners 2,132 3,175 49%
All PHCs 6,802 9,303 37%
Dr. Lami Samaila
21Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Increase in PMTCT Uptake Results from a Leadership Development ProgramMSH PLAN-Health Nigeria
Abba Mate
rnity
Clinic
Hashidu PHC
PHC Todi
Tal M
atern
ity Clin
ic
PHC Pantam
i
Mallam
Inna M
atern
ity Clin
ic
Kumo Town M
atern
ity
MPHC Barambu
Kupto Mate
rnity
Clinic
Ribadu M
atern
ity Clin
ic
Willi
Mate
rnity
Clinic
Ture
Balam M
atern
ity Clin
ic0
500
1,000
1,500
2,000
2,500
Pre-LDP (2010) PMTCT Uptake Post-LDP (2011) PMTCT Uptake
Dr. Lami Samaila
22Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
LGA Primary Health Care Facility PMTCT Uptake (2010) PMTCT Uptake (2011) % Increase Presence of other
PEPFAR
Implementing
Partners
Dukku Abba Maternity Clinic 213 346 62% None
Dukku Hashidu PHC 417 774 86% FHI 360
Billiri PHC Todi 404 535 32% FHI 360
Billiri Tal Maternity Clinic 801 845 5% ICAP
Gombe PHC Pantami 1,335 2,051 54% ICAP
Gombe Mallam Inna Maternity Clinic 79 247 213% None
Akko Kumo Town Maternity 1,713 1,923 12% FHI 360
Akko MPHC Barambu 528 715 35% None
Funa-Kaye Kupto Maternity Clinic 317 630 99% None
Funa-Kaye Ribadu Maternity Clinic 776 904 16% None
Kaltungo Willi Maternity Clinic 81 99 22% None
Kaltungo Ture Balam Maternity Clinic 138 234 70% None
All 6 LGA’s All 12 Facilities 6,802 9,303 37%
Dr. Lami Samaila
23Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
A Field Experience from K4HMalawi
A Demonstration Project to Address Gaps in FP/RH and HIV/AIDS Information Pathway
24Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
K4H: Addressing gaps in FP/RH and HIV/AIDS information pathway Four interventions were selected to improve KM at the National, District & Community levels:
1. Leadership Development Program (LDP). An adapted LDP for knowledge management mobilized stakeholders around creating a common vision and action plan with desired measurable results for improving knowledge management.
2. FP/RH and HIV/AIDS Toolkits. Toolkits are designed to be a central online data bank housing current country specific information on FP/RH and HIV/AIDS.
3. District Learning Centers (DLCs). DLCs were imbedded in district hospitals and serve as central hubs of information for district and community level health providers.
4. SMS Network. SMS intervention uses Frontline SMS (FLSMS) to provide nurses, doctors and Community Health Workers (i.e. Community Based Distribution Agents and Health Surveillance Agents) with immediate access to up to date, relevant health information.
25Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
K4H: Results
1. Increased efficiency of referrals because CHWs could send messages to district hospital or clinics to ensure services were available before making referrals.
2. Widened service coverage due to more time available because CHWs are no longer biking to meet with supervisors or reporting stock-outs, and so spend more time in community.
3. Prompt responses to cholera, meningitis and measles outbreaks.
4. Detection and prevention of stock-outs (i.e. averted stock-outs of DEPO, male and female condoms). When CHWs run out of supplies, they now send an SMS and are often resupplied on the same day, whereas in the past it could take up to one week.
26Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Discussion / Questions
27Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
Upcoming LMG Webinars
All LMG webinars are scheduled from 9:00 am to 10:0 am (U.S. Eastern Time) and are delivered via Elluminate over the Internet
Date Topic PresenterJune 6 Partnerships Albena Godlove
June 20
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28Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact
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