3. Health System Strengthening Framework
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
4. HSS Objective 1: Service Delivery
By the end of four years, (180) selected townships with identified
hard to reach areas will have increased access to essential
components of MCH, EPI and EH and Nutrition as measured by
increased DPT from 70% to 90% and SBA from 67.5% to 80%
Activity 1.1: SURVEY:
Access to essential component of PHC
Surveys to establish baseline indicators & outcome, impact and
research for operations (including mapping)
4
5. For description and analysis of health system gaps and bottlenecks
at the Township level the following system areas were surveyed:
Health Management and Planning, including
Mapping hard to reach areas
Human Resource Management
Health Finance and Financial Management
Community Participation
Essential Drugs & Equipment
Infrastructure
Data Quality and Service Quality
6. HSS Objective 1: Service Delivery
Activity 1.2: SUPPLIES: (UNICEF)
Increase availability of Essential Supplies and equipment based on
needs identified in HSS Assessment and Coordinated Township
Health Plan (CTHP).
Essential Drugs supply by UNICEF will be incremental for four years
S&E to be provided to HSS townships
Sub Center drugs (Paracetamol, Septrin, Misoprostol, ORS, ZnSo4)
Hospital drugs (Inj Benzyl Pen, Gentamycin, Ampicillin, Metro,
syringes, needle, scalp vein needle)
MW kits/ Sub center kits
(23 items)
Renewable items for MW/Sub center kits
(14 items)
RHC kits
(28 items)
Renewable items for RHC kits
(16 items)
Clean Delivery Kits
(1600/tsp –total 32,000)
6
7. HSS Objective 1: Service Delivery
Activity 1.3: INFRASTRUCTURE:
Total Renovation of 540 RHCs (3 per township) Year 1 (60) RHC
Tot Construction of 324 new sub-RHCs (1.8 x 180 townships)
Year 1 (36) Sub centers will be constructed
Installation of solar for (63) RHCs at hard to reach townships
depends upon need in HSS Assessment surveys
At present-still in negotiation with UNOPS for infrastructure
7
8. HSS Objective 1:Service Delivery
Activity 1.4: TRANSPORT:
Provision of essential transport for township and BHS to reach hardto-reach areas, based on needs assessment analysis in CTHP:
Reimbursement of recurrent transport cost to (20) townships to
meet fuel cost for traveling (through CTHP)
US$ 5000/Tsp/yr
Supply of transport capital to (20) townships based on needs
identified in CTHP (Motorcycle/ bicycles/ scooters and boats)
(through -RHC Plan prioritization given to most needy)US$
?
?
?
2500/Tsp/yr
8
9. Activity 1.5: Social mobilization of NGOs, local authorities and VHWs
in developing and implementing CTHP
Supportive activities for community involvement (Health
Committee's activities)
US$ 3,000/yr/Tsp
Training/recruitment of CHW in HTR areas (20 CHW/tsp at 20
townships)
Training/recruitment of AMW in HTR areas(20AMW/ tsp at 20
townships)
Refresher training for CHW (50 CHW per tsp x 20 tsp)
Refresher training for AMW (50 AMW per tsp x 20 tsp)
10. HSS Objective 2
By the end of year 4, (180) selected townships with identified hard
to reach areas will have developed and implemented CTHP.
Activity 2.1: GUIDELINES DEVELOPMENT:
Development and implementation of CTHP and financing schemes
Guidelines development for CTHP
(including financial management and health financing) & supervision
at all levels
Print and production of Guideline for CTHP (English & Myanmar)
Workshop on dissemination of HSS Assessment and sensitization of
CTHP to S/R and townships and NHSC meeting
Conduct CTHP at 20 townships with BHS using Assessment results
10
11. HSS Objective 2
Activity 2.2. HEALTH FINANCING RESEARCH (mainly by DHP)
Health financing research on financial management capacity and
feasibility and effectiveness of health financing schemes in all HSS
targeted townships
Development and production of policy brief and guidelines and SOP
for initiation of Maternal voucher scheme (MVS)
Advocacy meeting to central level and township on MVS
Training to township level personnel on MVS
Awareness raising activity for MVS in the township
Actual implementation of piloting MVS in Yedarshay township in
two contracts of six months
Administration & supervision cost for MVS
11
12. HSS Objective 2
ACTIVITY 2.3: TRAINING
Training programme on coordinated management through the
Management and Leadership program(includes health planning and
supervision) in HSS targeted townships
ACTIVITY 2.4: PLAN DEVELOPMENT
Management Support includes supervision and planning activities
(from CTHP-for 20 townships)
(US$ 10,000/Tsp/Year)
ACTIVITY 2.5: RESEARCH AND EVALUATION
Research and evaluation of process and impact of coordinated State
and Township coordinated health planning and dissemination of
findings
Annual Programme Review (Central level/townships including
responsible persons from States/ Divisions)
HSR training workshop/ and Support for HSR (For HSS focused in
targeted townships & For Central & S/D)
12
13. HSS Objective 3: Human Resource
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.
Activity 3.1: RESEARCH:
Strengthening Health Workforce at hard to reach areas in selected
townships
Research Programme for HR Planning with focus on distribution mix,
function and motivation and management capacity (including
financing)
Development of conceptual framework and research on
performance based systems and motivational factors for retention
of Rural Health Workforce (Consultation to Dr Kyawt San Lwin, PhD
Student for PH, UOPH)
13
14. HSS Objective 3: Human Resource
Multi-sector Workshop on development of HR Plan recommending
financial/management/other support strategies for retention of
health staff in HTR
Development of National HR Strategic Plan including strategies for
retention and deployment of health staff in HTR
Feasibility Testing of HR Plan on retention and deployment of staff
at township level based on analysis and research findings (one
Township)
14
15. HSS Objective 3: Human Resource
Continuing training in coordinated MCH, EPI, Nutrition and EH
training programmes applying the principles of MEP Approach
(Capacity building from CTHP)
Township level training for Coordinated Action of four programmes
applying MEP approach
International Short Course for health financing (HITAP Training-
Economic Evaluation and Health communication)
50,000
Asia Region Study Tour on PHC planning & delivery system (Central
+ S/D + Township)
15
16. HSS Objective 3: Human Resource
HR Finance incentive scheme development for health staff in remote
areas - identified in township coordinated plans
Financial Support (Per-diem) for health staff in HTR areas (20
Townships) (20 Tsp x 5,775)
US$ 115,500
Leadership development programme
SSA for 4 Central Medical Officers (Programme
management, Training and Research, M&E and Finance)
SSA for 14 HSSOs
Supporting activities for implementing HSS
Copier, LCD& Office Equipment, Computer, printer for S/R and
township levels
16
17. M&E Indicators
Impact and Outcome Indicators
1.
(morbidity, mortality and program coverage)
Under 5 mortality (Township)
2.
Township DTP3 coverage (%)( Pentavalent coverage)
3.
4.
Number / % of districts achieving ≥80% DTP3 coverage
(National)
Delivery by Skilled Birth Attendants (HSS targeted Townships)
5.
Rate of ORT Use of <5 children (Township)
6.
% of 6-59 months children having Vitamin A during past 6
months (Township)
17
18. M&E Indicators
8.
Output Indicators (health system capacity)
% of townships have developed and implemented coordinated plans
according to national framework
Number/% of RHC visited at least 6 times in the last year using a quantified
checklist (supervision)
Number/% of sub centre visited at least 6 times in the last year using a
quantified checklist (supervision)
Number of managers/ trainers / BHS trained for Management and Leadership
at each level per year (management training)
Proportion of RHCs with no stock out of essential supplies in the last 6 months
(availability, service access, utilization, quality)
No: of RHC and sub RHC renovated and/or constructed per year, including
improved drinking water and sanitation facilities
% of selected Townships with identified hard to reach areas staffed by
midwives and PHS2 according to the National HR Standards.
% of Townships implementing Community based health insurance scheme
9.
% Townships holding monthly Township Health Committee meeting
1.
2.
3.
4.
5.
6.
7.
10 % Townships have coordinated MCH package of services (ANC, Nutrition, ES,
EPI)
.
18
22. Summary Report Township X after HSS Assessment
Availability of services - health services infrastructure, human resources
and essential drug and equipment for example exist in adequate supply.
Non availability of services - absence of human resources or ED or
subRHC in a hard to reach or unreached area of the Township.
Figure 8 Making a Summary Report
Accessibility refers to the capacity of the population to access the service.
Thou’ infrastructure and health staff and essential drugs may be available
in the area, but the population may not be able to access the services due
to physical barrier or financial constraint or inability to communicate with
the health staff.
Poor accessibility to health services can lead to low utilization of services.
High utilization however does not necessarily mean high impact.
The services are required to be of sufficient quality to ensure that there is
public health impact.
22
23. Linking HSS Assessment to CTHP
COORDINATED TOWNSHIP HEALTH PLAN
STATION HOSPITAL & RHC COORDINATED PLANS
Health System Areas
Planning & Management
Service Delivery
Human Resources
Community Participation
Infrastructure
Essential Drugs & Logistics System
Transport
Finance & Financial Management
24. 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
24
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,
