Comprehensive Capacity Building in a Post-conflict Country: The Liberian experience

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Presented by Theo Lippeveld at the APHA Annual Meeting and Exposition in November 2013.

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Comprehensive Capacity Building in a Post-conflict Country: The Liberian experience

  1. 1. Comprehensive capacity-building in a post-conflict country: The Liberian experience APHA 143nd Annual Conference Boston, 2013
  2. 2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose
  3. 3. Need for capacity building • As in many low-income countries the low coverage and quality of evidence-based interventions are the result of underperforming processes and weak support systems. • Capacity building is needed to make efficient use of investments, strengthen health systems, and improve performance, thereby leading to better processes and health outcomes 3
  4. 4. Define capacity building Capacity building is a process that enables the health sector to meet its objectives and better perform, resulting in improved health outcomes. The MOHSW capacity building framework focuses on building capacity synchronously at three levels in order to achieve maximum effect • Individual: to improve the capacity of individual health workers to meet objectives; • Organizational: to improve the organizational setup and communications of implementing organizations (central MOHSW, counties, communities, other sectors); • Health system: to strengthen various elements such as policies, strategies, operational plans; and management of the overall health system and sub-systems 4
  5. 5. MOHSW Capacity Building Initiative • Initiated in January 2012 with technical assistance from RBHS • Focus on building comprehensive capacity – individual, organizational, and health systems • Follows the six building blocks of a health system framework defined by WHO • Capacity Assessments conducted at Central MOHSW and three CHSWTs – Bong, Lofa, and Nimba 5
  6. 6. WHO Health System Framework
  7. 7. Capacity Assessment s Capacity Assessment s Capacity Building Strategic Plan Capacity Building Strategic Plan Capacity Building Operational Plan Capacity Building Operational Plan •Six Building Blocks of a Health System1 •NHSWPP •County Operationa l Plans •FARA •Six Building Blocks of a Health System1 •NHSWPP •County Operationa l Plans •FARA MOHSW CHSWT MOHSW CHSWT RBHSRBHS STAKEHOLDER S (partners, donors, other govt. agencies) STAKEHOLDER S (partners, donors, other govt. agencies) •Improved quality of data •Better documentatio n of supervision •LMIS rollout complete •Trainings conducted •Better financial record keeping •Improved quality of data •Better documentatio n of supervision •LMIS rollout complete •Trainings conducted •Better financial record keeping •Responsiv e health system •Improved service delivery indicators (quality and utilization) •CHSWTs capable of managing PBCs •Responsiv e health system •Improved service delivery indicators (quality and utilization) •CHSWTs capable of managing PBCs Improved population health outcomes Improved population health outcomes InputsInputs Outputs Outcome s ImpactProcessesProcesses 1 1) Health Service Delivery; 2) Health Workforce; 3) Health Information Systems; 4) Access to Essential Medicines; 5) Health Systems Financing; 6) Leadership and Governance. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Available at: http://www.who.int/healthinfo/systems/monitoring/en/index.html Diagram 1: MOHSW Capacity Building Framework 7
  8. 8. Capacity Building Process 8
  9. 9. Capacity Assessments • Central MOHSW and CHSWT levels • Mixed methods approach – quantitative and qualitative • Quantitative provides a baseline • Qualitative provides in-depth information on specific areas to build capacity • Conducted by Capacity Assessment Team (CAT) 9
  10. 10. Rank ordered scores - Central 10
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  14. 14. Capacity Building • One strategic plan and four operational plans to build capacity across the six building blocks • One operational plan for Central MOHSW and three operational plans for each counties • Capacity building is integrated in to the overall annual county operational plans 14
  15. 15. Strategic Principles • Innovation • Coordination • Ownership • Protection and promotion of health and social welfare • Leadership and good governance • Transparency and accountability with necessary authority • Accessibility and equity of quality health services • Proficiency • Sustainability 15
  16. 16. Strategic approaches • Community participation and empowerment • Integration • Decentralization • Partnership and coordination • Synchronized operational plans • Performance-based Financing • Monitoring and Evaluation • Effective communication • Single planning cycle • Human resource management 16
  17. 17. Strategic Objectives • Listed in the strategic plan by each building block • Separate objectives for Central MOHSW and each CHT • Further organized across three levels – individual, organizational, and health systems 17
  18. 18. Operational plans • Strategic objectives need to be operationalized for implementation • Templates created by taking the Central MOHSW work plan and CHT two year operational plans in to consideration • Expanding the Central MOHSW and CHSWT two year operational plan templates 18
  19. 19. Example 1 of capacity building • Building block 1: Delivering essential health services • PBF to improve coverage
  20. 20. Results of PBF
  21. 21. Example 2 of capacity building • Building block 3: Health Information Systems • Improve quality of data collected at health facilities
  22. 22. Results on Data quality • Counterverification reports
  23. 23. Process Results • XX interventions developed to strengthen capacity across the six building blocks. • XX interventions completed • NEXT STEPS • Second round of capacity assessments to measure progress
  24. 24. Thank you! Questions? 24

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