World Federation of Public Health Conference                                        Ethiopia                              ...
Acknowledgements• Abt Associates Inc.• The University of Liverpool/Laureate Online Higher  Education• Ministry of Health Z...
Background• The increasing disease burden in many developing countries  influenced development and adoption of new plannin...
Background• The MBB concept was piloted at district level as a planning  tool.• This study focused on experiences from two...
The Research QuestionWhat are the barriers and enablers associated with thesuccessful implementation of a health services ...
Study Aim and OjectivesAim: To evaluate factors associated withimplementation of health services planning tools in orderto...
Methodology• A qualitative study using semi structured interviews.• An interpretative approach informed the study design.•...
Data Collection• Nine of the planned 12 participants were interviewed within  their work environments.                    ...
Data Analysis• Thematic analysis using a manual process and data  was coded based on most frequent themes.• Data was prese...
Data Analysis-Summary of Emerging issuesTheme 1.0: Experience with using MBB for health services planning                C...
RESULTSExperiences with using MBB for health services planning.•Most respondents had been involved in health servicesplann...
RESULTSSuccesses of MBB implementation•Respondents reported that they had become more analytical inevery aspect to problem...
RESULTS Challenges of MBB implementation.•Administration of health services by multiple types of serviceproviders in the c...
RESULTSLessons learned•Presence of stakeholders/partners within the districts provide anopportunity for successful impleme...
Recommendations for Policy Makers• Guidance on payment of incentives to community volunteers  necessary.• A sustainable me...
CONCLUSION• The study, revealed that MBB can be a useful tool to strengthen  and enhance effective achievement of health o...
Thank you for your attention!                                17
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Emily Moonze, FACTORS ASSOCIATED WITH THE IMPLEMENTATION OF A HEALTH SERVICES PLANNING TOOLKIT: A QUALITATIVE STUDY OF TWO DISTRICTS IN ZAMBIA, CENTRAL AFRICA

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University of Liverpool online MPH graduate Emily Moonze, Dissertation presentation for the 2012 World Congress on Public Health

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  • Emily Moonze, FACTORS ASSOCIATED WITH THE IMPLEMENTATION OF A HEALTH SERVICES PLANNING TOOLKIT: A QUALITATIVE STUDY OF TWO DISTRICTS IN ZAMBIA, CENTRAL AFRICA

    1. 1. World Federation of Public Health Conference Ethiopia 23rd -27th April, 2012. FACTORS ASSOCIATED WITH THE IMPLEMENTATION OF AHEALTH SERVICES PLANNING TOOLKIT: A QUALITATIVE STUDY OF TWO DISTRICTS IN ZAMBIA, CENTRAL AFRICA Emily Moonze- MPH,DHSM,RM,RN Dissertation submitted in partial fulfilment of the requirements for the degree of Master of Public Health. The University of Liverpool/Laureate Online Higher EducationContact:+260 97 7 798022 / + 260 211 258160/2 email-emilym@zambiaissp.org/ emoonze@yahoo.co.uk Ministry of Health Zambia
    2. 2. Acknowledgements• Abt Associates Inc.• The University of Liverpool/Laureate Online Higher Education• Ministry of Health Zambia,• Dr. Deborah McGill - Dissertation Advisor• Katete District Health Team.• Mazabuka District Health Team.• Chongwe District Health Team . 2
    3. 3. Background• The increasing disease burden in many developing countries influenced development and adoption of new planning initiatives.• In Zambia, attainment of the health goals and other national health priorities.• In 2003 Zambia moved away from short term to more result oriented, medium- term Expenditure Framework.• In 2006 adopted the marginal budgeting for bottlenecks (MBB) tool as a health services planning tool.• MBB is an analytical costing, planning and budgeting toolkit for evidence based result oriented health services management in developing countries. 3
    4. 4. Background• The MBB concept was piloted at district level as a planning tool.• This study focused on experiences from two of the nine pilot districts.• The assumption was that findings from the study would highlight areas requiring improvements in both existing and future MBB implementing districts. 4
    5. 5. The Research QuestionWhat are the barriers and enablers associated with thesuccessful implementation of a health services planningtoolkit (MBB) in Zambia from the perspective of keystakeholders? 5
    6. 6. Study Aim and OjectivesAim: To evaluate factors associated withimplementation of health services planning tools in orderto determine their effectiveness and applicability atdistrict level.Objectives:•To assess the current implementation of the MBB toolkitin the health planning process.•To evaluate strengths/opportunities andweaknesses/barriers of the MBB toolkit.•To make recommendations for future planning tools atdistrict level. 6
    7. 7. Methodology• A qualitative study using semi structured interviews.• An interpretative approach informed the study design.• The researcher developed her own data collection tool in form of a topic guide.• Pilot was undertaken in one of the MBB pilot districts, and tools adjusted based on findings.• Study conducted in two of the nine pilot districts: Katete (rural) and Mazabuka (semi-urban).• Purposeful sampling.• Ethics approval obtained• Consent obtained from each of the study participants before onset of interview 7
    8. 8. Data Collection• Nine of the planned 12 participants were interviewed within their work environments. Category Definition Number A District Director of Health 1 B Manager, Planning and 2 Development C Programme Officer* 6*Programme Officer: MCH Coordinator, District Accountant, District Health Information Officer, Environmental Health Technician.• All the interviews were recorded using a digital recorder.• Data downloaded to the computer and each interview was transcribed. 8
    9. 9. Data Analysis• Thematic analysis using a manual process and data was coded based on most frequent themes.• Data was presented as broad themes and illustrated with quotations.• Five themes emerged from the analysis of data which will guide the presentation of results: o Experiences with using MBB for health services planning; o Successes of MBB implementation; o Challenges of MBB implementation; o Lessons learned from MBB implementation; o Recommendations for improvement 9
    10. 10. Data Analysis-Summary of Emerging issuesTheme 1.0: Experience with using MBB for health services planning Communi Funding Human MBB Capacity building Stakeholders / ty resources concept/ Partners tool1.1 Planning experience in MBB x1.2 Exposure to MBB Concept x1.3 MBB implementation period xTheme 2.0: Successes of MBB implementation2.1 Changes to planning approach x2.2 Improvement in selected health indicators x2.3 Increased focus on community x2.4 Availability of extra funding xTheme 3.0: Challenges to MBB implementation3.1 Inadequate community involvement x3.2 Inadequate qualified staffing at facility level x3.3 Withdrawal /inadequate funding for MBB x3.4 MBB concept/tool x3.5 Inadequate logistical support x3.6 Poor data management xTheme 4.0: Lessons learned4.1 Presence of stakeholders’/partners’ opportunity for successful MBB concept x4.2 Capacity building/competencies key to successful MBB x4.3 Availability of human resource at facility key to successful MBB x4.4 Extra funds through MBB, opportunity to successful MBB concept x4.5 Community involvement/motivation necessary to successful MBB concept x4.6 A plan based on MBB concept can attract donor support xTheme 5.0: Recommendations for improvement5.1 Need for community involvement / motivation in MBB x5.2 Government to consider issue of human resources for successful MBB x5.3 Staff need capacity building and competencies in MBB /training x5.4 Need to continue provide funding for MBB x5.5 MBB implementation needs further strengthening to be successful x5.6 Stakeholder involvement to be strengthened x 10
    11. 11. RESULTSExperiences with using MBB for health services planning.•Most respondents had been involved in health servicesplanning in one way or another during the annual planning cycle.• Almost all the respondents had been exposed to the MBB tool and have used the tool for three years in their planning. 11
    12. 12. RESULTSSuccesses of MBB implementation•Respondents reported that they had become more analytical inevery aspect to problem identification.•Improvements in district performance in selected programmes,such as the maternal and child health programmes .•Increased focus on community was identified as a major strengthof the MBB concept.•Additional funds from MBB project enabled districts to contractextra staff, such as midwives. 12
    13. 13. RESULTS Challenges of MBB implementation.•Administration of health services by multiple types of serviceproviders in the community.•The high-dropout rate community based volunteers.•Increase in number of clients after the introduction of incentives (mother-baby packs) at the MBB facilities.•Lack of qualified staff (especially midwives) at the facility level;•MBB programme seen as stand-alone or not harmonized withother existing programmes.•Poor data management resulting in data gaps and discrepancies. 13
    14. 14. RESULTSLessons learned•Presence of stakeholders/partners within the districts provide anopportunity for successful implementation of the MBB concept.•Inadequate understanding of the programme by staff could leadto implementation failure.•For programmes to run well every facility should be run byqualified staff.•Raising morale of community volunteers can contribute tosuccessful MBB implementation. 14
    15. 15. Recommendations for Policy Makers• Guidance on payment of incentives to community volunteers necessary.• A sustainable mechanism for funding the MBB programme is necessary.• Address human resources crisis at facility level.• Facility staff need training in the MBB concept.• Partnerships with local partners to be encouraged. 15
    16. 16. CONCLUSION• The study, revealed that MBB can be a useful tool to strengthen and enhance effective achievement of health outcomes.• The study revealed important findings which are key to successful implementation of MBB tool such as:  community involvement in planning;  adequate funding;  adequate staffing at facility level;  harmonization of MBB with existing planning processes;  adequate capacities/competencies in the MBB concept by district staff; and  stakeholders’ involvement and support. 16
    17. 17. Thank you for your attention! 17

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