Health Systems Development Interventions

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Health Systems Development Interventions

  1. 1. Integrated service components Health Systems Development Interventions Changes in service activities & content: (e.g.. Kangaroo mother, maternal health care, improving access to preventive health technologies etc) Enabling sub-system inputs… • Train frontline workers to provide evidence-based maternal and neonatal health services that are currently not being provided. • Implement interventions that are proven to reduce under-five mortality by increasing the capacity of providers at community, sub-district, and district-level service points. • Coordinate community and clinic-based activities to standardize access to anti-malarial preventive measures and therapeutic regimes. Health workforce size, composition & training • Strengthen referral systems to reduce maternal and neonatal mortality. Information for decision-making Essential drug supply & logistics Health financing and planning Leadership & governance
  2. 2. Pillar #1: Strengthening of referral services GEHIP services to be added as…a …CHPS doorstep Outreach Level A …Community Health Compound care Level A Sub-district referral services Level B Pillar #1 Referral System Inputs: Organization for emergency management:  Community engaged training for emergency recognition and response? Yes=1, zero otherwise  Community Health Officer resident and trained for emergency management? Yes=1, zero otherwise Yes=1, zero otherwise  Sub-district emergency response system developed? Yes=1, zero otherwise Yes=1, zero otherwise Communication systems for emergency management:  Emergency obstetric & child care referral system functional? Yes=1, zero otherwise Yes=1, zero otherwise  Community recognition of emergencies training completed? Yes=1, zero otherwise Logistics systems for emergency response:  Community-based cost sharing for emergency services functioning? Yes=1, zero otherwise  Ambulance or equivalent available and functioning? Yes=1, zero otherwise Pillar #1 Referral System OUTPUTS: • Referral case volume by type Continuous variables Continuous variables
  3. 3. Information for decision-making Essential drug supply & logistics Leadership & governance Health Systems Development Interventions Health financing and planning Enabling sub-system inputs… Health workforce size, composition & training Integrated service components Changes in workforce inputs (investment in staff, staff composition, and in-service training on essential services to address gaps in service delivery) A strategy of Pillar 2: Retraining the frontline workers of the Community-based Health Planning and Services (CHPS) Initiative in doorstep service delivery
  4. 4. Healthcare services Community service capabilities Level A Sub-district clinical capabilities Level B Pillar #2 INPUTS Pillar #2: Promotion and prevention inputs: • Post partum outreach and care: “Four visit package” training completed for workers in this area? Yes=1, zero otherwise Yes=1, zero otherwise • Post natal care for newborns (Promotion of skin-to-skin contact, other interventions) introduced? Yes=1, zero otherwise Yes=1, zero otherwise • Community Health Officer resident & comprehensive reproductive health services fully functioning? Yes=1, zero otherwise Pillar #2 Curative health service inputs: • IMCI services fully functioning? Yes=1, zero otherwise Yes=1, zero otherwise • Directly Observed Therapy, Short-course (DOTS)fully functioning? Yes=1, zero otherwise Pillar #2 OUTPUTS • HMIS case volume for IMCI treatable illness/catchment area population Continuous Continuous • Kangaroo Mother Case volume/catchment area population Continuous Continuous • HMIS caseloads for seven leading causes of morbidity/population of catchment area. Continuous variables Continuous variables • HMIS immunizations by antigen Continuous variables Continuous variables
  5. 5. Pillar #3: Easing information capture for community-based healthcare workers and providing supportive information feedback
  6. 6. Pillar #3: Strengthening Primary Healthcare Management Information Systems GEHIP services to be added as…a Community-based capabilities Level A Sub-district clinic capabilities Level B Input indicator:  Simplified record keeping introduced and functioning? Yes=1, zero otherwise Output indicators:  Data feedback received in the past three months? Yes=1, zero otherwise Yes=1, zero otherwise  Data used for decision-making in the past three months? Yes=1, zero otherwise Yes=1, zero otherwise
  7. 7. Information for decision-making Leadership & governance Health Systems Development Interventions Health financing and planning Enabling sub-system inputs… •Strengthen the operation of the essential medicine distribution system in GEHIP districts. Integrated service components Health workforce size, composition & training Essential drug supply & logistics Pillar #4: Develop a supply monitoring system for essential drugs and equipment.
  8. 8. Pillar 4: Strengthening Primary Healthcare Supply and Logistics Capabilities GEHIP services to be added as…a Community-based capabilities Level A Sub-district clinic capabilities Level B Pillar #4 INPUTS: Stock flow monitoring capabilities developed: • Stock flow monitoring system introduced and fully functional Yes=1, 0=otherwise Yes=1, 0=otherwise Pillar #4 OUTPUTS: Indicators of effective stock flow management:  Number of essential (“tracer”) drugs missing among 21 possible drugs… 0, 1, 2, 3…. 21 0, 1, 2, 3…. 21  Number of essential (“tracer”) drugs missing among 21 possible drugs… 0, 1, 2, 3…. 21 0, 1, 2, 3….. 21
  9. 9. Information for decision-making Essential drug supply & logistics Leadership & governance Health Systems Development Interventions Enabling sub-system inputs… • Adapt Tanzania’s PlanRep tool for allocating healthcare resources according to burden of disease to facilitate rational healthcare planning and decision-making at the district level: District Health Planning, Analysis, and Reporting Tool (DiHPART) • Utilize DiHPART for informing resource allocation at Levels A, B, and C • Add $0.75 per year to the Common Fund Integrated service components Health workforce size, composition & training Pillar #5 Adapting Tanzania’s district planning and reporting toolkit to Ghana: PLANREP. The District Health Planning and Reporting Tool (DiHPART) Health financing and planning
  10. 10. DiHPART as a Tool… ….. allows plans and budgets to be aligned to Intervention addressable shares of the disease burden or health needs of the population, using district health intervention profile developed from DSS sites. • Monitoring the effect of DiHPART on health systems strength involves assessing the discrepancy between the actual pattern of expenditure and expected pattern, based on the district Burden of Disease profile.
  11. 11. Translating the desired profile Into an index of DiHPART action: An index of system strength at any service point is the sum of the discrepancies between actual HMIS registered services over a 90 day period and the district profile for the 8 categories of the Burden of Disease…
  12. 12. Pillar 5: Strengthening Primary Healthcare Planning and Resources Inputs GEHIP services to be added as…a Community-based capabilities Level A Sub-district clinic capabilities Level B DiHPART planning inputs: • For each service point, the sum of the HMIS case volume (by intervention) minus the expected case volume (based on the district profile for 8 classes of interventions) Continuous variable Continuous variable GEHIP Incremental resource inputs: • Total GEHIP revenue expended this quarter: Cumulative 90 day contribution in US Dollars per capita Cumulative 90 day contribution in US Dollars per capita • Engagement of other sectors in health: Total District Assembly Revenue invested in implementation (as a Health Common Fund Supplement) Cumulative 90 day contribution in US Dollars per capita Cumulative 90 day contribution in US Dollars per capita • Engagement of other investors in health: Investments of international partners in health in implementation (by pillar) Cumulative 90 day contribution in US Dollars per capita Cumulative 90 day contribution in US Dollars per capita
  13. 13. Information for decision-making Essential drug supply & logistics Health Systems Development Interventions Health financing and planning Enabling sub-system inputs… Integrated service components Health workforce size, composition & training Leadership & governance Changes in leadership capabilities at each level in the system. Strengthen the health system by team training that promotes leadership for integrated health care at each operational level.

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