Health system development3


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  • W/s on Health systems Research Methodology for Post -Graduate Students from Medical University
    2006-2007 IM (1)Ygn, IM(2) Ygn, IM Mdy (430) Participants
    2008-2009 IM (1)Ygn, IM(2) Ygn, IM Mdy (639) Participants
    2010-2011 IM (1)Ygn, IM(2) Ygn, IM Mdy (350) Participants
    Training in Research Methodology and Research Management for Health Staff working in S/D
    2006-2007 Sagaing, Bago(West), Magwe (78) Participants
    2008-2009 Mon, Shan (South) (60) Participants
    User-friendly HSR tools
    Quality Assessment on Care of STI Patients
    Collecting Mortality data among the Community by Verbal Autopsy Method
    Facility Based Verification of Cause of Death by Hospital Record Examination
    Service Availability Mapping(SAM) for a Township
    HSR Studies
    Community Based Injury Survey
    Pilot Implementation of verification of Cause of Death with Verbal Autopsy in Pyinmana Tsp.
    Facility Based verification of Cause of Death by Hospital Record Examination
    Study on Independent Evaluation of Completeness and Coverage of Mortality Data in Urban Areas of Myanmar
  • Workshop on Health Financing:
    Workshop on Exploring Mechanism for Financing Health in Myanmar, 2006
    Workshop on National Health Accounts, 2007
    Workshop on Awareness raising and Capacity Building on Measuring Costs and
    Effects of Health Intervention and Estimating Economic Consequences of Illness,
    Training for financial management:
    Training Workshop on Financial Planning and Management in Health, Mandalay, 2007
    Training Workshop on Financial Planning and Mobilization of Funds in Township Health System (Le We, Pyawbywe, Tatkone), 2009
    Training Workshop on Financial Planning and Mobilization of Funds in Township Health System (Yaetarshae, Wundwin, Myitthar), 2009
    Training Workshop on Financial Planning and Mobilization of Funds in Township Health System in Mon State, 2010
    Developing National Health Accounts:
    Myanmar National Health Accounts (2002-2005)
    Myanmar National Health Accounts (2006-2007)
    Health Economic and Financing Studies:
    Health Care Financing Methods and Access to Health Care in Myanmar, 2007
    Health Financing Situation in Myanmar: Improving Access to Health Care by poor in Township Hospitals, 2009
  • Service delivery: preventive and curative personal health services; primary, secondary services and tertiary services (public/private/voluntary NGOs)
    Public health service; services for specific population groups such as children and women, or for specific conditions such as tobacco or alcohol problems
    Resources: trained staff, commodities, facilities and knowledge
    Financing: sources of funds such as user fees, insurance, tax,
  • Health system development3

    1. 1. Health System Development Programme 2006-2011
    2. 2. Objectives 1. To promote utilization of health systems research to improve health systems performance by enhancing research culture among decision makers at all level 2. To explore and develop an appropriate and sustainable financing mechanism for fair financing of health and equitable delivery of services 3. To expand and strengthen international cooperation in line with the 30 year long term health plan by collaborative activities
    3. 3. Project 1. Health Systems Research and Development Project 2. Developing Alternative Financing Mechanisms for Health Project 3. International Health Cooperation Project
    4. 4. Health System Research and Development Project
    5. 5. Developing Alternative Financing Mechanism for Health Project
    6. 6. International Health Cooperation Project
    7. 7. Strengths Health System Research • Able to disseminate knowledge and skills on heath systems concepts and health systems research (HSR) methodology to health managers who provide services to the community. • Able to develop user friendly HSR tools for health system strengthening, assessments and quality improvements • HSR studies can provide technical know-how for health systems strengthening, assessment and quality improvements.
    8. 8. Strengths Health Financing • Health financing assessment and development of new scheme was initiated in collaboration with WHO Consultants • Interest of all stake holders and donors after implementing awareness raising workshops at township level • Attention of the international donors based on publication of National Health Accounts and health financing studies • Appropriate health manpower (Health Economists) posted in the planning division but still limited number
    9. 9. Weakness Health System Research 1. There has no financial support for HSR studies conducted by mid-level health managers. 2. There has weaknesses in dissemination of information to the higher level health authority to take action based on HSR findings.
    10. 10. Weaknesses Health Financing 1. Poor advocacy to high level policy making body on health financing situation 2. Lack of interest of decision maker on health financing situation 3. Limited number of skilled health manpower especially health economists 4. Lack of skilled staff on financing and budgeting in the township health system 5. No or limited community awareness on health financing issues 6. Current health financing and costing research is not covered all the area and need more research on alternative health financing and efficient utilization of limited resources 7. Need more partners on implementing new financing scheme
    11. 11. Health System Gaps identified by HSS GAVI technical working group & consultants Service Delivery Gaps Many areas of the country have low service access to MCH and other services due to a range of management, infrastructure, logistics and security barriers. Program Coordination Gaps Lack of organizational capacity, guidelines and strategic framework on how to coordinate immunization, nutrition, environmental health and RH services is leading to fragmentation and inefficiencies in health service delivery Human Resource Gaps There is lack of clarity in the roles and functions of basic health staff, and inequities in the distribution of staff, resulting in lack of access to health services in hard to reach areas. 12
    12. 12. Health System Goal HSS Goal: Achieve improved service delivery of essential components of Immunization, MCH, Nutrition, Environmental Health by strengthening programme coordination, sub-national micro-planning, and human resources management and development in support of MDG goal 2/3 reduction in under 5 child mortality between 1990 and 2015. Theme 1 Service Delivery Reaching communities with essential health system delivery components of MCH, nutrition, immunization and environmental health, with emphasis on hard to reach areas Theme 2 Health Program Coordination and Capacity Building Strengthening coordination, management and organization of the health system at all levels with a focus on the Township Level Theme 3 Human Resource Management and Development Improving distribution, skill, number and mix of health workers with emphasis on hard to reach areas 13
    13. 13. Service Delivery Objective & Activities Objective 1: By the end of 4 years of implementation180 selected townships with identified hard-to-reach areas will have increased access to essential components Of MCH, EPI, EH and nutrition as measured by increases DPT from70% to 90% and SBA from 67.5% to 80% Main Activities: • Baseline health systems assessment surveys in each township • RHC reconstruction/sub RHC construction • Provision of Logistics and supplies • Provision of transportation means for BHS at hard-to-reach areas • Social mobilization of NGOs, local authorities, and Voluntary Health Workers in developing and implementing coordinated township health plan Outcomes: • National DPT3 coverage increased (%) • Delivery by Skilled Birth Attendants increased (%) 14
    14. 14. Planning Objective & Activities Objective 2: By the end of 4 years of implementation180 selected townships with identified hard-to-reach areas will have developed and implemented a Coordinated Township Health Plan Main Activities: • Research and development of coordinated planning and supervision guidelines •Research and development of financial management capacity and health financing schemes in HSS townships • Feasibility study for community based health financing scheme • Introduction of Maternal Health Voucher Scheme in community • Training programme on coordinated management through modified MEP approach • Development, management and monitoring of CTHP Outcomes: • Proportion of selected townships implementing guidelines according to national 15 framework
    15. 15. Human Resource Objective & Activities Objective 3: By the end of 4 years of implementation 90 selected townships with identified hard-to-reach areas will be staffed by midwives and PHS2 according to National HR standards Main Activities: • HR Research planning and proposal development: Motivation and retention of Basic Health Staff in hard-to-reach areas of selected GAVI Health Systems Strengthening Townships • HR finance incentive scheme development for health staff in remote areas • Continuing capacity building for implementation of CTHP in townships Outcomes: • Percent of selected townships with identified hard to reach areas staffed with midwives and PHS2 to national standard by the end of year four. 16
    16. 16. Health system assessment tool kit: one excel book covering areas 1. 2. 3. 4. 5. 6. 7. 8. 9. Health Management and Planning Mapping Hard to reach Human resources Health Finance and Financial Management Community participation Essential drugs and equipment Infrastructure Data and Service Quality Summary Report 17
    17. 17. Summary Report Township X Availability of Services What is the general analysis of availability of services in this Township? What are the main factors effecting availability? Figure 8 Making a Accessibility of ServicesSummary Report What is the general analysis of accessibility of services in this Township? What are the main factors effecting accessibility? Utilization of Services What is the general analysis of utilization of services in this Township? What are the main factors effecting utilization? Utilization of Quality Services What is the general analysis of quality of services in this Township? What are the main factors effecting quality? Main conclusions and Recommendations What are the main health system bottlenecks for improvement of maternal and child health services, and what strategies and investments are best 18 placed to remove these bottlenecks?
    18. 18. Linking Health System assessment with Township health planning • Health system analysis examines gaps in operations across health programmes and service delivery units • Making the transition from “Management by Project” to “Management through Systems” is a critical step in achieving: – Equity: in distribution – Efficiency: through coordination and reduction of overlap of resources in favour of hard to reach areas – Effectiveness: improved health coverage – Sustainability: strengthening self reliance and management capacity 19
    19. 19. Coordinated Township Health Planning Guidelines SERVICE DELIVERY FOR COMMUNITIES Township Coordinated Health Plan Hospital Care Public Health Disease Control Systems Analysis Planning & management Human Resources Finance & Financial Management Infrastructure Data and Service Quality Essential Drugs & Equipment Community participation Hard to reach (equity analysis) 20
    20. 20. Strategic Framework: An example from DPRK NATIONAL DEVELOPMENT PRIORITIES, LAW AND INTERNATIONAL AGREEMENTS MEDIUM TERM DEVELOPMENT PLAN FOR THE HEALTH SECTOR IN DPRK S Y S T E M STRATEGIC AREA 1 STRATEGIC AREA 2 STRATEGIC AREA 3 STRATEGIC AREA 4 Health System Non Communicable Disease Communicable Disease Women’s and Children Health (1)Policy, Planning & Coordination (2) Health Information (3) Human Resources (4) Drug Supply & Logistics Systems (5) Financing & Financial management (6) Service Delivery Systems (7) Science & technology (8) Community participation (1) Chronic Diseases (2) Injury (3) Mental health (4) Aged care & Disability (5) Tobacco Control (1) Immunization (2) Malaria (3) TB, (4) HIV, (5) Hepatitis B treatment (6) Pandemic Planning and emerging diseases (1) Maternal Health (2) Neo natal Health (3) Reproductive Health (4) Child Health (5) Nutrition (6) Adolescent Health STRATEGIC AREA 5 The Social and Environmental Determinants of Health (1) Food Safety (2) Health & Hygiene promotion (3) Climate Change (4) Safe water & Sanitation (5) Health Life Conditions (6) Emergency preparedness MULTI SECTOR AND SOCIETY Health Outcomes and MDG Goals P R O G R A M S