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Hss and its relation to l+m+g
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  • Results showed improved health system performance, of which some may be proxy indicators to achieving better health outcomes

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  • 1. Stronger health systems. Greater health impact.Management Sciences for Health — 40 years of Strengthening Health Systems for Greater 1
  • 2. 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 outcomesManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 2
  • 3. 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 researchManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 3
  • 4. Aim of HSS Models Health Outcomes Health Goals Coverage Access &  Health status Availability  Responsiveness Quality  Fairness in Demand financing Safety  Efficiency Enabling social & policy environmentManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 5
  • 5. The WHO Health Systems FrameworkManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 6
  • 6. Six Steps to Achieving Greater Health Impact Step 6. Select the most appropriate M&E indicators. Step 5. Identify the critical health systems interventions that address bottlenecks. Step 4. Determine health systems requirements and bottlenecks to achieve coverage levels. Step 3. Identify and select high impact interventions. Step 2. Identify the health challenges, their causes and risk factors.Step 1. Identify the health outcome or impact goal.Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 7
  • 7. MSH HSS Results Model Step 4 Step 1 Step 2 Step 3 Step 5 Step 6Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 8
  • 8. Contribution of L+M+G to HSS Building BlocksBuilding Evidence of an Effective Health How L+M+G support performanceBlock System Building Block and effectivenessHuman • A well-performing workforce • Development of HRH policiesResources achieves positive health and proceduresfor Health outcomes given available resources and circumstances • Support the implementation of HRH policies and procedures at • There are sufficient staff that are various levels of the system appropriately distributed who are competent, supported, motivated • A HRMIS supports and informs and productive HRH management decision- making • Build leadership and management capacity to motivate providers and managers to perform and/or excel standardsManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 9
  • 9. Contribution of L+M+G to HSS Building Blocks (cont.) Building Evidence of an Effective Health How L+M+G support performance Block System Building Block and effectiveness Health • The system facilitates the • Develop in-country capacity to Info. production, analysis, strengthen the HIS System dissemination of reliable and timely information on health • Leaders and managers use determinants, coverage, system health data and information for performance and health status performance assessment and improvement at various levels • Healthcare managers and providers use the information to • Information and M&E practices make informed management facilitate effective problem- decisions solving, informed decision making and policy formulation • Information about health systems performance is made available to the publicManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 10
  • 10. Measuring HSSIHP+Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 11
  • 11. 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 systemsManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 12
  • 12. 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 systemsManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 13
  • 13. 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 processesManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 14
  • 14. A Field Experience from ProACT Nigeria Strengthening Facility Health Management Information System (HMIS) for ownership and sustainability Uche IkenyeiManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 15
  • 15. ProACT: Strengthening HMIS Uche Ikenyei The Project ProACT has site presence in 6 of Nigerias 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 Intervention 1. 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 makingManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 16
  • 16. ProACT: Results Uche Ikenyei • 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 Overview of GH Jega (Kebbi State) Medical records Library after • Data quality in randomly selected sites improved from 58% to 68% integration 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 Facility Data Presentation during the Quarterly Management Team only 5 of 26 (19%) CCT sites having started using data to make meeting (QMT) – GH Jega & GH management decisions KoKo Kebbi StateManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 17
  • 17. A Field Experience from PLAN-Health Nigeria Leadership Development Program and Increase in PMTCT Uptake Dr. Lami SamailaManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 18
  • 18. PLAN-Health: Leadership Development Dr. Lami Samaila • 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 resultManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 19
  • 19. PLAN-Health: Results Dr. Lami Samaila PMTCT Uptake PMTCT Uptake (2010) % Increase (2011) PHCs with other 4,670 6,128 31% Implementing Partners PHCs without 2,132 3,175 49% Implementing Partners All PHCs 6,802 9,303 37%Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 20
  • 20. Increase in PMTCT Uptake Results from a Leadership Development Program MSH PLAN-Health Nigeria Dr. Lami Samaila 2,500 2,000 1,500 1,000 500 0 Abba Hashidu PHC Todi Tal PHC Mallam Kumo MPHC Kupto Ribadu Willi Ture Maternity PHC Maternity Pantami Inna Town Barambu Maternity Maternity Maternity Balam Clinic Clinic Maternity Maternity Clinic Clinic Clinic Maternity Clinic Clinic Pre-LDP (2010) PMTCT Uptake Post-LDP (2011) PMTCT UptakeManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 21
  • 21. 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% NoneFuna-Kaye Kupto Maternity Clinic 317 630 99% NoneFuna-Kaye Ribadu Maternity Clinic 776 904 16% NoneKaltungo Willi Maternity Clinic 81 99 22% NoneKaltungo Ture Balam Maternity Clinic 138 234 70% NoneAll 6 LGA’s All 12 Facilities 6,802 9,303 37% Dr. Lami Samaila Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 22
  • 22. A Field Experience from K4H Malawi A Demonstration Project to Address Gaps in FP/RH and HIV/AIDS Information PathwayManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 23
  • 23. 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.Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 24
  • 24. 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.Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 25
  • 25. Discussion / QuestionsManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 26
  • 26. Upcoming LMG Webinars Date Topic Presenter June 6 Partnerships Albena Godlove June 20 Monitoring, Evaluation, and La Rue Seims Research in LMG June 27 Governing for Better Health Mahesh Shukla All LMG webinars are scheduled from 9:00 am to 10:0 am (U.S. Eastern Time) and are delivered via Elluminate over the InternetManagement Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 27
  • 27. Stronger health systems. Greater health impact. Saving lives and improving the health of the world’s poorest and most vulnerable people by closing the gap between knowledge and action in public health.Management Sciences for Health — 40 years of Strengthening Health Systems for Greater 28