provincial and district health system capacity lit review 5-28-10

8/12/2019 Provincial and District Health System Capacity Lit Review 5-28-10

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Assessing Provincial and District Health System Capacityto Sustain HIV/AIDS Care and Treatment ServicesALiterature evie! "or CDC/P#P$A

Ilona Varallyay, Jennifer Yourkavitch, and Eric Sarriot. ICF Macro- May 28, 2!

IntroductionSince 2004, PEPFAR has supported four partners to rapidly scale up ART services through the! Trac" 1#0 ART progra$#1These partners currently support 2% &'( care and treat$entprogra$s in 1) countries2,including $ore than 1,000 ART treat$ent sites# They are creatingtransition plans to facilitate the transfer of progra$ $anage$ent to *inistries of &ealth +*&-and local organi.ations, /hich can provide sustainale support for &'( care and treat$entprogra$s over the longter$#

!uring the scale up phase, the focus of progra$ activity /as at the health facility level# Thetransition no/ needs a co$prehensive approach to ensuring the capacity of *& and localpartners at the district and provincial levels to sustain &'( care and treat$ent services# To thisend, Trac" 1#0 partners for$ed a provincialdistrict sugroup and deter$ined core do$ains)ofhealth syste$ capacity to $anage &'( progra$ services# PEPFAR!&RSA see" to developa rapid assess$ent tool to $onitor provincial and district *& capacity in each do$ain, /hich/ill e used to assess the status of transition efforts#

This literature revie/ supports the effort to strengthen analytical approaches to provincial anddistrict health syste$ capacities to support &'( services y providing a rationale for the coredo$ains of assess$ent, and y identifying certain $ethodologies and conte3tual factors toconsider /hen designing the assess$ent tool# The authors revie/ed $ore than 40 sources onhealth syste$s strengthening, specifically for &'( services and related areas, and discussedrelated issues /ith health syste$s e3perts +Anne3 )-# This docu$ent su$$ari.es their findings

and reco$$endations, and includes an annotated iliography +Anne3 1- and a detailed talethat descries the $ain tools revie/ed +Anne3 2-# This literature revie/ lays a solid foundationfor developing a rapid assess$ent tool for provincial and district health syste$ capacity tosustain &'( care and treat$ent services#

%ethodology o" the revie!'F perfor$ed a syste$atic revie/ of pulished and unpulished +grey- literature on theassess$ent of health syste$s capacity at various levels and also specifically relating to &'(service delivery#

Search Strategy'F identified sources fro$ a syste$atic search of co$puteri.ed dataases +*edline, Popline,!ialog includes 5loal &ealth, Federal Research in Progress +FE!R'P-, E*are, The 6ancet-,

1The four partners are &arvard 7niversity School of Pulic &ealth, 'AP at olu$ia 7niversity *ail$an School of Pulic &ealth, the

Eli.aeth 5laser Pediatric A'!S Foundation, and A'!SRelief consortiu$ led y atholic Relief Services#2Trac" 1#0 countries include8 9ots/ana, ote d:'voire, Ethiopia, 5uyana, &aiti, ;enya, *o.a$ia$ia3

ore do$ains include8 strategic planning for integrated &'( services? hu$an resource $anage$ent for clinical services? supervision of clinical

services? health facility renovation$aintenancee


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2# Health workforce: national /or"force policies and invest$ent plans? advocacy? nor$s,

standards and data)# Information: facility and population ased infor$ation @ surveillance syste$s? gloal

standards, tools4# Medical products, vaccines & technologies: nor$s, standards, policies? reliale

procure$ent? e


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The District has a uni'ue and pivotal role in the health system

9ro/n and 6aFond again revie/ed the state of the art in assessing and $easuring capacity in thehealth sector# 'n the figure elo/, their $odel helps visuali.e ho/ assessing each level has to eanaly.ed /ithin an overall syste$#

7nder this $odel, the !istrict fits at the level of the rgani.ation#

!epending on si.e and political ad$inistrative structures of each country, districts report directlyto a central level or through a regional ad$inistrative level# Provinces so$eti$es play the role ofdistricts, other ti$es act as regional or


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Then, the uni


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analysis of the specific indicators used at provincial level should infor$ the develop$ent of the! assess$ent# The governancecore do$ain is captured through indicators such as8 1-Responsiveness of govern$ent to pulic needs, 2- (oice of the people )- E3ercising localtechnical oversight of health service


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)- &ealth 'nfor$ation *anage$ent, *onitoring, Evaluation, and Luality +&*'S? Luality*anage$ent ART Progra$ *@E -

4- &u$an Resource apacity +Staffing needs? training and s"ills develop$ent?*anage$ent, supervision and staff retention-

G- 6a apacity +6a procedures capaility? Luality standards-

%- !rug *anage$ent and Procure$ent +!rug *anage$ent and Phar$acy *anage$ent-hile this assess$ent is intended for facilitysite level i$ple$entation, these do$ain areas andindicators can e $odified for use at sunational level#

Another relevant tool, &'(A'!S Progra$ Sustainaility Analysis Tool &APSAT, focused onassessing the sustainaility of &'(A'!S progra$s +including (T, P*TT, ART, care andsupport services, and prevention- through a co$puterased forecasting $odel#14This toolcalculates resource needs for an &'(A'!S progra$ /ith a user defined set of service levelgoals# &APSAT also co$pares proIected resource needs +focusing pri$arily on hu$an resourcesand financial resources- to e3pected resource availaility and can e used to identify and reporte3pected gaps and resource i$alances that $ade lead to inefficient or poor


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+6*'Ss-? and storage, logistics reporting, and ordering and institutional support# Another toolfocuses on hu$an resources $anage$ent for &'(A'!S progra$s17# 't contains 2% &R*co$ponents +sudo$ains- /hich are grouped /ithin five road areas of &R*8 &R* capacity+staffing, udget, and planning-? personnel policy and practice? perfor$ance $anage$ent?training? &R* data#

'F also revie/ed several articles and grey literature docu$ents addressing issues around scale

up of (*+progra$s /hich highlight a nu$er of "ey issues for consideration in thedevelop$ent of this ! rapid assess$ent# ne report descries an assess$ent /hich focusedon t/o areas8 logistical rei$a/e &'( @ A'!S 6ogistics Syste$ Assess$ent# Arlington, (a#8 John Sno/, 'nc#!E6'(ER, for the 7#S#

Agency for 'nternational !evelop$ent, 200G#17

*S&, 200)# &u$an Resource *anage$ent Rapid Assess$ent Tool for &'(A'!S Environ$ents# a$ridge, *A8 *S

=oguera, *#, et al#i'6a6(e& ntiretroviral +hera$y 0ro#ra' I""ue" and /$$ortunitie" for Initiation and E4$an"ion.Arlington, (A8

!E6'(ERJohn Sno/, 'nc#, 200)#19 "era, A# et al, *ay 200)# Scalin# 5$ ntiretroviral +hera$y. 5#andan E4$erience# !raft# 5eneva, S/it.erland8 orld &ealth rgani.ation#20Ta/fi", #, et al#Introducin# ntiretroviral +hera$y 9+: on a 1ar#e Scale& %o$e and Caution. 0ro#ra' 0lannin# 7uidance ;a"ed on Early

E4$erience fro' e"ource-1i'ited and Middle-Inco'e Countrie"# ashington !, 7SA8 Acade$y for Educational !evelop$ent 5loal &ealth,Population and =utrition 5roup# =ove$er 2002#


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&ealth FacilityRenovation*aintenanceE


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clinical services e


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&R capacity in $anage$ent Accountaility $echanis$s &'(A'!S as oth a chronic condition and infectious disease Patients: roles in decision$a"ing regarding &'( care and treat$ent

Policy environ$ent o$$unications

'F /ill also consider the content and depth of verification ele$ents, /hich /ill includeinfor$ation collected fro$ a health facility to verify infor$ation collected at the provincial ordistrict level#

hile there are several tools concerned /ith $easuring


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Anne(esAnne3 1 Annotated 9iliography

Anne3 2 Tale of &ealth Syste$ Assess$ent *odels Applicale to !istrictProvincial 6evel

Anne3 ) 6ist of Persons 'ntervie/ed


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and

La$ond0 A.0 L.


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$anage$ent? 'nfection prevention and co$pliance to standard precautions? &'(A'!S testingand counseling? Antiretroviral therapy? Prevention of $othertochild trans$ission services+P*TT-? &ealth $anage$ent infor$ation syste$s +record "eeping- relevant to &'(A'!S?6aoratory diagnostics for &'(, tuerculosis, $alaria and $ost co$$on ST's, and? Availailityand $anage$ent of essential $edications, supplies, and treat$ent services related to &'(A'!S#The indicators herein /ill e useful for develop$ent of the verification piece of the assess$enttool# See nne4 2 for detail".

-3. %SH0 2;. Human Resource Management Rapid AssessmentTool for HIV*AIDS .nvironmentsCamBridge0 %A %SH.http//erc.msh.org/ne!pages/english/tool,it/hrNhivNassessmentNtool.pd"

This tool outlines a process to help an organi.ation to


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and


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This pulication presents selected results of the 7P&6! proIect in 7ganda, a % $illion7SA'!funded health and education sector proIect# 't does not present a district healthassess$ent $ethodology, ut discusses i$portant concepts in district capacity# The proIect /asstructured around t/o pillars of intervention8 trust uilding and evidence ased planning anddecision$a"ing# The for$er is central to the social capital literature ut possily underappreciated in approaches to assessing district capacity# Also essential, are t/o ele$ents in thestrategic approach8 Dunity of purpose /ithin the district $anage$ent tea$ and a$ong districtpartners +unity and consistency of purpose are central concepts of


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;. SamBo et al0 Tools Assessing the ;2GK;:. PuBlished online in 7iley InterScienceE!!!.interscience.!iley.comF D8I -.-2/hpm.--2

'n this report, the authors develop a standardi.ed set of assess$ent tools to $easure G) indicatorsalong si3 co$ponents of assess$ents $easured for the $ost part at district level according to %$ain co$ponents# f "ey interest /ere the co$ponents loo"ing at !istrict level structures:capacity and viaility# The study also identified a range of central functions +e#g#, udgeting,planning, policy$a"ing, estalishing standards and protocols, hu$an resources allocation-outside the control of the districts and therefore not relevant for direct assess$ent at this level#

;;. Sarriot0 #ric0 Shamim 6ahan0 and SustainaBility #valuationTeam. Sustaina%ility of the Saidpur and "ar%atipur &r%an HealthModel +4angladesh, 2ive ears After the .nd of (oncern3s (hild

Survival "roBect $inal #valuation eport*6anuary -0 2-.

This report details the syste$atic assess$ent of all co$ponents of the oncern orld/ideadapted Hsustainaility fra$e/or": /hich allo/ed strategic reco$$endations to e $ade to$unicipalities and sta"eholders, in evaluating the sustainaility of health outco$es andrevie/ing changes in the t/o $unicipalities studied# There /as li$ited direct relevance to thedevelop$ent of the ! rapid assess$ent tool, as *unicipal &ealth !epart$ents share onlyso$e of the responsiilities co$$on to a &ealth !istrict and do not oversee curative services#

;>. Shediac*i=,allah %C0 L


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ShediacRi."allah offers a definition /hich synthesi.es a diversity of concepts and approachesaout sustainaility, specifically in health pro$otion progra$s# For her, sustainaility refers tothe general pheno$enon of continuation of a healthenhancing progra$, and she offers three$ain $echanis$s through /hich this can e oserved8 1- The $aintenance of health enefitsachieved through the initial progra$? 2- The continuation of progra$ activities /ithin anorgani.ational structure +institutionali.ation-? and )- The $aintenance of health enefits throughuilding the capacity of the recipient co$$unity# This definition focuses on the ulti$ate enefitfor the co$$unities, and recogni.es a /ide array of sta"eholders as responsile for thesustainaility of health progra$s#

Factors in the proIect design +negotiation, effectiveness, duration, financing, type, training-,factors in the organi.ational setting +institutional strength, integration, leadership-, and factors inthe co$$unity environ$ent +socioecono$icpolitical environ$ent and participation-, interact toinfluence sustainaility, /hich is achieved through a continuation of the initial progra$, or itsinstitutionali.ation /ithin a ne/ +local- organi.ational structure, or through the develop$ent ofthe capacity of the recipient co$$unity#

The $ain relevance to the ! districtprovince assess$ent tool is the recognition of theinterconnectedness of different sta"eholders# +This suggests that the aility of districts to partner,

cooperation, provide guidance to other partners is a capacity area deserving e3a$ination#-9eyond this, this paper does not offer enough institutional level focus to provide $easure$enttools or resources#

;:. Stein 6.0 S. Le!in0 L. $airall0 P. %ayers0 . #nglish0 A.


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This report presents data fro$ the first t/o provincial health syste$ assess$ents conducted in(ietna$# The &SA tool /as developed to enale policy$a"ers and progra$ $anagers tounderta"e a co$prehensive vie/ of si3 $aIor health syste$s functions delineated y &+governance, finance, hu$an resources, service delivery, phar$aceutical $anage$ent, andhealth infor$ation-# The tool allo/s users to assess each health syste$ function using a set ofperfor$ance indicators# 't /ill e a "ey reference in the develop$ent of the rapid assess$enttool# See nne4 2 for detail".

;. Travis0 Phyllida et al. QSuBnational Health SystemsPer"ormance Assessment 8B5ectives0 Challenges and Strategies.RChapter :3 in Health systems performance assessment ) de%ates#methods and empiricism / edited By Christopher 6.L. %urray0 David


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>-. 7H8. Innovative (are for (hronic (onditions) 4uilding 4locksfor Action. 7H80 22.

This docu$ent presents a fra$e/or" for chronic care, /hich e$phasi.es patient, fa$ily, andco$$unity involve$ent# 't proposes specific uilding loc"s for health care organi.ation /hichinclude pro$ote continuity and coordination? encourage ;. 7H8. "atient Monitoring -uidelines for HIV (are and

Antiretroviral Therapy +ART,%#AS1# #valuation. 7H80 2G.

This docu$ent provides guidelines to aid in the develop$ent of an effective national &'( careand antiretroviral therapy +ART- patient $onitoring syste$# The focus of these guidelines is thelist of essential $ini$u$ standard &'( care and ART patient $onitoring data ele$ents and ho/their collection facilitates clinical care and $easure$ent of agreed upon indicators# The list isro"en do/n into four categories8 de$ographic infor$ation? &'( care and fa$ily status? ARTsu$$ary? and patient level encounter infor$ation# This docu$ent provides good detailedinfor$ation on the specific "inds of data re


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Anne( ;Individuals ontacted 1phone, interview or email2 from 3'45'4676 to 8'77'4676

)ame Title/8rgani=ation

9eti.a.u, Sisay Sirgu WHO

9oni, Tony Ofce o Health, Inectious Diseases, an !ut"ition#$%&ID

!oherty, Julie &'t, Inc

Ford, Sara %"( )echnical &*iso", +aacit- .uilin/&ID%)& )o

Eichler, Rena )echnical )ea eae"#Health %-stes %t"en/thenin/,+HI

E$ery, 9o Ofce o Health, Inectious Diseases, an !ut"ition#$%&ID

&eiy, Ji$ eical Ofce", lo'al Health .u"eau#$%&ID

&odgins, Steve lo'al eae"shi )ea eae", +HI

6ion, Ann "oect Di"ecto", Health %-stes 2020 :&'t, Inc;

=egussie , Eyerusale$ ;eede WHO#HI< Dea"tent, I&I )ea

Sei$s, 6a Rue %H

Taye, A$y %"( &nal-st, &'t, Inc

provincial and district health system capacity lit review 5-28-10

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