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3. overview hss nilar tin

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  • 1. Dr. Nilar Tin
  • 2. 1. Proposal Development, submission, review 1. Proposal Development, submission, review 2. Implementation prior to funding 2. Implementation prior to funding 3. Implementation with funds 3. Implementation with funds
  • 3. Proposal Development, submission, review t l sa men o op l o p Pr ve de • 2007-2008 March • Worked well with HSS Technical Working Group + Consultants +WHO +UNICEF • 4 evidence-based studies • Working retreat in Mandalay (S/R,TMO) • Oversee by the National Health Sector Coordinating Body (NHSC) n si o s mi b Su • Acceptance with clarification in May 2008 • Approval of proposal by July 2008 • Develop HSS Assessment Guidelines 2009 • Pre-tested in Lewe, Ngaputaw • CTHP guidelines 2009 ew vi ess Re oc Pr •FMA during 2010 Jan-Dec •1st 10 Township assessment in May 2010 (SEARO) • Results being disseminatied in Sept 2010 • Feasibility study for MCHVS 2010-2011 •Aide Memoire signed in Feb2011 t an Gr • Funds received by June 2011 • Activities started in August 2011
  • 4. System Building Blocks
  • 5. HSS Framework Myanmar p e Ga c vi ery r Se liv De n ram atio g ro rdin P o Co p ga an rce m u Hu eso R ap G Many areas of the Lack of organizational There is lack of country have low capacity, guidelines and clarity in the roles service access to MCH strategic framework on and functions of and other services due how to coordinate basic health staff, to a range of immunization, nutrition, and inequities in the management , environmental health and distribution of staff infrastructure, MCH service is leading to resulting in lack of logistics, demand side fragmentation and access to health and security barriers inefficiencies in health services in hard to service delivery reach areas
  • 6. HSS Goal The Goal of the HSS program in Myanmar is to achieve improved service coverage for essential PHC components of Immunization and Maternal and Child Health, in support of MDG goal 4, 2/3 reduction in under 5 child mortality between 1990 and 2015 through -strengthening programme coordination, -improving health planning systems and -strengthening of human resource management
  • 7. Service Delivery Gap Theme1. Reaching communities (applying supply & demand strategies) with essential health system delivery components of MCH, nutrition, Immunization & EH with emphasis on HTR areas Objective1 By the end of four years 180 selected townships with identified HTR areas will have increased access to essential components of MCH, EPI and HSS as measured by increased DPT from 70-90% and SBA from 67.5 to 80% Main activities• Guideline development for HSS Assessment • Baseline surveys • Logistics & supplies • Transport • Social mobilization (AMW/ CHW training/refresher training) • RHC/sub RHC refurbishment & construction
  • 8. Program Coordination Gap Theme 2. Strengthening coordination, management & organization of the health system at all levels with a focus on the Township Level Objective 2 : By the end of four years 180 selected townships with identified HTR areas will have developed and implemented a coordinated township health plan Main activities• Research & development of coordinated planning & supervision • Quarterly review meeting & Annual program review • Demand side financing (MCHVS & HEF) • Guidelines development & Implementation • Establish HSR funds , training HSR & conduct research
  • 9. Human Resource Gap Theme 3. Improving distribution , skill , number and mix of health workers with emphasis on hard to reach areas Objective 3: By the end of four years 90 selected townships with identified HTR will be staffed by MWs and PHS2 according to National HR standards Main activities• HR research on rural retention of health workforce • Financial incentives for HWF • Policy mapping and analysis of rural retention of HWF • Continuing training • Leadership Development (SSA for HSSO) • Asia Region study tour (exchange of experiences )
  • 10. M&E Indicators Impact and Outcome Indicators 1. 2. 3. 4. 5. 1. 2. (morbidity, mortality and program coverage) Township DTP3 coverage (%) Number / % of districts achieving ≥80% DTP3 coverage (National) Delivery by Skilled Birth Attendants (HSS targeted Townships) Rate of ORT Use of <5 children (Township) % of 6-59 months children having Vitamin A during past 6 months (Township) Output Indicators (health system capacity) % of townships have developed and implemented coordinated plans according to national framework Number/% of RHC/sub centre visited at least 6 times in the last year using a quantified checklist (supervision) 10
  • 11. M&E Indicators 3. 4. 5. 6. 7. 8. 9. Output Indicators (health system capacity) Number of managers/ trainers / BHS trained for Management and Leadership at each level per year (management training) Proportion of RHCs with no stock out of essential supplies in the last 6 months No: of RHC and sub RHC renovated and/or constructed per year, including improved drinking water and sanitation facilities % of selected Townships with identified HTR areas staffed by midwives and PHS2 according to the National HR Standards. % of Townships implementing Community based health insurance scheme % Townships with active health committees % Townships have coordinated package of services (MCH, EPI, Nutrition, and EH) 11
  • 12. HSS Implementation States & Divisions Township Kachin 16 Kayah 7 Kayin 8 Chin 9 Mon 8 Rakhine 7 Shan(East), (North), (South), 45 Sagaing Mandalay 12 Magway 15 Bago 12 Yangon 11 Ayeyawady Criteria for selection-DPT3 coverage < 80% -SBA < 60% 13 7 Taninthayi 10 TOTAL 180
  • 13. 3 Before DOH DHP DMS National Health Sector Coordinating Body UN Agencies WHO UNICEF JICA INGOs National NGOs 3 After Other Ministries • Oversee the whole process of development and implementation of National Health Systems Strengthening Strategies • Monitor evolving financial, human resource and technical support needs for HSS • Systematically overview HSS implementation and develop Annual Progress Report to GAVI and the government • Revise annual HSS plans as needed
  • 14. What we need to do to meet the goals? Technical Sustainability Technical Sustainability Financial Sustainability Financial Sustainability •• Sustaining through management Sustaining through management ••Training Strategy support Training Strategy support ••Supervision & management• Research and development of Health Supervision & management• Research and development of Health strategy Financing Schemes strategy Financing Schemes •• NGO Collaboration strategy Increasing government financial •• NGO Collaboration strategy Increasing government financial ••National coordination commitments National coordination commitments ••HSRFund HSR Fund •• Strengthening demand side strategies Strengthening demand side strategies ••HealthSystems leadership •Increasing financial management Health Systems leadership • Increasing financial management program capacity of townships program capacity of townships
  • 15. Thank You