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Cc mmeeting2010 22nd june


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Cc mmeeting2010 22nd june

  1. 1. 22-6-2010 Dr. Nilar Tin 1
  2. 2. 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. 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
  3. 3.  By the end of year 4, 180 selected townships with identified hard to reach areas will have increased access to essential components of MCH-EPI and HSS as measured by increased DPT from 70% to 90% and SBA from 67.5% to 80% 3
  4. 4.  Activity 1.1: SURVEY: Survey to establish base line indicators & outcome, impact and research for operation (including mapping)  Activity 1.2: SUPPLIES: Increase availability of Essential Supplies and equipment based on needs identified in Coordinated Township Health Plan (CTHP). Activity 1.3: INFRASTRUCTURE: 540 RHCs and 324 sub-RHCs in 180 HSS-targeted Townships will be renovated/constructed by year 4, based on needs identified in CTHP.   Activity 1.4: TRANSPORT Provision of essential transport for township and BHS to reach hard-toreach areas, based on needs assessment analysis in CTHP: Transport Allowance + capital for vehicles, bicycles, trolley jeeps  Activity 1.5: PARTICIPATION Involving NGOs, local authorities and Community Health Workers in developing and implementing CTHP 4
  5. 5.  By the end of year 4, 180 selected townships with identified hard to reach areas will have developed and implemented CTHP. 5
  6. 6.  Activity 2.1: GUIDELINES DEVELOPMENT: Develop national guidelines for CTHP (including financial management and health financing) & supervision at all levels (including checklists)  Activity 2.2: HEALTH FINANCING RESEARCH Complete a research program on financial management capacity and feasibility and effectiveness of health financing schemes in HSS targeted townships by year 2.     Activity 2.3: OPERATIONAL RESEARCH: Pilot community based health initiative (financing schemes) according to national guidelines in 50 townships by year 4 Activity 2.4: TRAINING Implement the training program on coordinated management through the modified MEP program Activity 2.5: PLAN DEVELOPMENT: Develop and monitor coordinated health planning of HSS-targeted tsps Activity 2.6: EVALUATION: Assess process and impact of coordinated State & Township coordinated health planning, and then disseminate findings 6
  7. 7.  By the end of year 4, 20 selected townships with identified hard to reach areas will be staffed by midwives and PHS2 according to the National HR Standards. 7
  8. 8.  Activity 3.1: RESEARCH: Conduct Research program for HR planning focusing on distribution mix function and motivation and management capacity (including financing), by year 3.  Activity 3.2: HR PLAN: Develop HR Plan recommending strategies for retention and deployment of staff in hard-to-reach areas, based in part on research from activity 3.1  Activity 3.3: HR PROPOSAL: Development of Proposal to MOH recommending appropriate deployment number and pattern of MW and PHS2 in hard-to-reach areas, assessing retentions scheme options that include financial incentives.  Activity 3.4: CONTINUING TRAINING: Conduct coordinated MCH, EPI, Nutrition & EH training programs applying the principles of MEP 8
  9. 9. Impact and Outcome Indicators (morbidity, mortality and program coverage) 1. National DTP3 coverage (%) 2. Number / % of districts achieving ≥80% DTP3 coverage (National) 3. Under five mortality rate (per 1000) (national) 4. Delivery by Skilled Birth Attendants (HSS targeted Townships) 5. Rate of ORT Use of <5 children (National) 6. % of 6-59 months children having Vitamin A during past 6 months (National) Output Indicator (health system capacity) 1. % of townships have developed and implemented coordinated plans according to national framework 2. Number/% of RHC visited at least 6 times in the last year using a quantified checklist (supervision) 3. Number of managers/ trainers / BHS trained for MEP at each level per year (management training) 4. Proportion of RHCs with no stock out of essential supplies in the last 6 months (availability, service access, utilization, quality) 5. No of RHC and sub RHC renovated and/or constructed per year, including improved drinking water and sanitation facilities 6. Percent of selected Townships with identified hard to reach areas staffed by midwives and PHS2 according to the National HR Standards.(In one RHC, 5 midwives and 5 PHS 2, 1 Lady Health Visitor and 1 Health Assistance. Each rural sub centre should have one midwife and 1 PHS2) 7. % of Townships implementing Community based health insurance scheme 8. % Townships with active health committees 9. % Townships have coordinated MCH package of services (ANC, TT, Nutrition, BF, BS and VCCT) and IMCI
  10. 10. Year 1 -20 townships Year 2- 40 Year 3- 60 Year 4- 60 States & Divisions Kachin Kayah Kayin Chin Mon Rakhine Shan(East), (North), (South), Sagaing Mandalay Magway Bago(East), Bago(West) Yangon Ayeyawady Taninthayi
  11. 11. Myanmar GAVI HSS Budget by System Level Central and State 7% % Allocations to Coordinated Township Health Plan NGO, $12,700 , 7% International 8% GAVI HSS, $54,775 , 31% UN AGENCY, $34,500 , 20% Township Level & Below 85% GOVT., $73,580 , 42%
  12. 12. Activities initiated after approval of GAVI HSS Proposal in July 2008 TWG and Consultant January 2009  Development of guidelines and tools for Baseline Health System Rapid Assessment (township survey) February 2009  Development of guidelines for Coordinated Township Health Plan 12
  13. 13. 19th -20th March 2009 Health Assessment conducted in Lewe township by DOH/DHP 4th -7th May 2009 Health Assessment conducted in Ngaputaw township by DOH/WHO/consultant 13th -15th May 2009  Workshop on sharing findings of Township Health Systems Assessment in Lewe and Ngaputaw townships- conducted at NPT  Finalization of the Health Assessment Tool for HSS townships 13
  14. 14. 10th September 2009  One day workshop for Township coordinated Plan was held by TWG with consultant 11th -13th December 2009  Conducted experimental costed Township Coordinated Health Planning at Lewe township  Need-based, bottom-up approach was sensitized to providers in providing package of health care (EPI+ANC+Nutrition+EH) to mother and child 14
  15. 15. From GAVI Board November 2009  Dr.Ranjana Kumar and Dr.Mercy Ahun from GAVI Board, Geneva visited NPT (GAVI HSS & ISS) 18th -19th January 2010  Mr. Joe Martin Consultant GAVI Transparency and Accountability (TAP) came to NPT for Financial Management Assessment of both HSS and ISS 23rd February 2010  FMA Questions to MOH/WHO/UNICEF was sent by Mr. Joe Martin (TAP) from Geneva 25th March 2010  MOH able to send back the FMA document TAP asked for Clarifications –Final FMA able to send back on 18-6-10 15
  16. 16. Recent progress with funds from SEARO  Surveyor teams had conducted HSS Assessment in 10 townships according to GAVI HSS plan (20 Year 1) in 1st week of May Surveyors:  DOH Planning, PH, EPI  DHP  DMS (Teaching staff and MPH students from UOPH) Still in analysis stage 16
  17. 17. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Cover sheet 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
  18. 18. Summary Report Township Availability of Services What is the general analysis of availability of services in this Township? Figure 8 Making a Summary Report What are the main factors effecting availability? Accessibility of Services 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? 18
  19. 19. Summary Report Township X Utilization of Quality Services What is the general analysis of quality of services in this Figure 8 Making a Summary Report 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? What strategies and investments are best placed to remove these bottlenecks? 19
  20. 20.  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 20
  21. 21. 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) 21
  22. 22.  With funds support as well as technical support from SEARO  Feasibility Study on Effectiveness of Community Based Health Initiatives (CBHI): Maternal Voucher Scheme in Township Health System (May -October 2010)  (DHP/DOH)  This activity will evaluate the effectiveness of community based schemes in shorter term and in longer term will lead to development of national guidelines for management of health financing. 22
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