The document outlines the terms of reference for the Health Systems Strengthening Officer (HSSO) position. It details 11 main responsibilities for the HSSO including: 1) facilitating health system planning and assessments, 2) supporting development of coordinated township health plans, 3) assisting in research and development of health financing schemes, 4) supporting capacity building activities. It provides context on problems identified in the health system and responses planned to strengthen planning, service delivery, financing, human resources, infrastructure, supplies and equipment, supervision and data quality. The role of the HSSO is to support and monitor implementation of these strengthening activities.

1. Terms of Reference for HSSO
Dr Wai Mar Mar Htun
Deputy Director (Planning)

2. Terms of Reference for HSSO
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In collaboration with the Division of Planning, States/
Region Directors and Township Medical Officers, to:
Facilitate the development of health system planning
guidelines.
Conduct baseline health system assessments of selected
Township clusters.
Facilitate the development of Coordinated Township
Health Plans.
Support States and Divisions to conduct programs of
supportive supervision according to guidelines developed.
Participate in research and development of Health
Financing schemes in Township clusters.

3. Terms of Reference
6. Assist in the development and oversight of new costing
guidelines of coordinated Township Health Plans.
7. Assist in the development and oversight of strategies to
revitalize health committees and CHW participation in
preventive health programs
8. Facilitate communications between NGOs and the DOH for
Agreements of Work in hard to reach or never reached
areas.
9. Assist in the development and oversight of human
resource development activities, including integrated
training programs, and the design and evaluation of
retention schemes for rural midwives and PHS 2.
10. Support the enhancement of M & E activities (including
programs of annual review) within the current system of
HMIS).

4. Terms of Reference
11. Periodically report to the HSS working group on the
research, development and implementation of health
systems innovations (health planning, health
financing, social mobilization).
12. Assist the DOH and HSS Working Group to facilitate
uptake of findings into policy and practice by
disseminating findings of research in public health
forums, HSS Working Group Meetings, Annual
Program Reviews and through publications.

5. Planning & Management
PROBLEMS found during HSS Assessment
Lack of coordinated plan
lack of management training
Infrequent supervision and monitoring
RESPONSE
• CTHP (costed)
• Financing of supervision of regular supervision at
all levels
• Quarterly and annual review meetings

6. PLANNING & MANAGEMENT
To strengthen the Township Health Systems we have
invested in…
1. HSS Assessments (with guidelines) √
2. Mapping HTR (detail mapping identifying P, E, S
barriers) √
3. Coordinated Township Health Plan (including
RHC/SH plans) (with guidelines) √
4. Costed Planning with Financial Analysis and Gap
identification √
5. Monitoring and supervision according to CTHP

7. Role of HSSO:PLANNING & MANAGEMENT
• Full Partipation in HSS assessment √
• For those who will get to townships ahead of
assessment, start with preliminary collection of
data and filling in tables for planning and
management, helping midwives to fill in mapping
data for 2012, HR tables, Infrastructure tables etc,
after negotiating with TMO √
• For those townships where assessment was
conducted in 2013 (2012 data), also try with
collection of 2011 data as above √
• Mapping HTR (detail mapping identifying P, E, S
barriers) –try to make sure midwives understand
P,E,S barriers in identifying HTR √

8. Service Delivery
PROBLEMS found during HSS Assessment
Low skilled birth attendance
Lack of access in HTR area by pregnant mothers (P,E,S barriers)
PLAN RESPONSE
• FINANCING strengthening referral systems between village and
hospital (patient referral fund HEF) - includes improved transport
from village level and costs of treatment
• MOBILITY increased TA/DA for midwives to move to additional
villages more frequently (villages under her sub centres) plus
Package service according to micro plan (MCH + Nutrition + ES
+EPI)
• COMMUNICATION regular meetings with local authority/ VHWS
and advocacy to local authority (for identification of poor/
referral/selection of AMW/VHW etc)

9. Service Delivery
To strengthen the Township Health Systems we have
invested in…
(to be implemented from 2013)
1. Delivering package of service (MCH +EPI +
Nutrition + EH) by Group of BHS
2. Develop micro plan for this service in group at
each RHC emphasizing to reach mothers and
children from HTR
3. Delivering quality of service
4. Supporting DA/TA for those activities (calculation
in CTHP)

10. Roles of HSSO: Service Delivery
• Monitor and supervise the package of services
for Quality service provision
• Check whether they follow their tour program
• Check whether they've filled up the data in fields
• Sometimes ask the community with your own
interest whether there is improvement in quality
of service (random)
• U1 forms preparation for them to get per-diems
and U2 for support for travel

11. Health Financing
PROBLEMS found during HSS Assessment
Lack of operational finance for providers and
economic barriers in the community
RESPONSE
• Costed CTHP with financial support for operations
• Referral funds (HEF) to solve economic barriers in
the community

12. FINANCING
To strengthen the Township Health Systems that we
have invested in…
1. Hospital Equity Funds for the poor to access
2. MVS and later CBHI
3. Health Financing Management Skill
4. Development of Sub Committee for Funds
Management
5. Following Financial Management Guidelines
6. Identification of poor (work together with TMO)

13. Role of HSSO: FINANCING
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Discussing with TMO/staff to get ideas on how to
initiate Hospital Equity Funds (write down the
discussion points)
Try to ask about THC's activities
Ask permission to attend future THC meeting as
observer and to include HSS in agenda and assist
TMO in developing meeting minutes;
Ask when will the sub committee for fund
management under THC/THSC will be formed and
note down the process
Assist TMO with ideas for identification of poor
according to guidelines

14. Human Resources
PROBLEM
Low midwife population ratio and incorrect skill mix
Poor retention of staff in HTR
PLAN RESPONSE
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Training of the auxiliary midwife and CHW
Refresher training of the AMW and CHW
Regular CME from BHS to VHW at RHC and sub RHC
Renovation of RHC/construction of sub centers
Per-diems for operations

15. HUMAN RESOURCE FOR HEALTH
To strengthen the Township Health Systems that we
have invested in…
1. Recruitment/Training of AMWs & refresher
training
2. Recruitment/Training of CHWs & refresher
training
3. HR Research (for retention of HWF) and follow up
thereafter

16. Role of HSSO: Human Resource for Health
• Discussing with TMO/staff in identifying
AMW/CHW from HTR areas/villages where
midwives cannot reach and where there is a need
(20 each for recruitment and training)
• If TMO permits, involve in training of CHW/AMW
for some parts

17. Training
PROBLEM
Lack of training on management & research
RESPONSE
• Modified MEP training
• HSR training
• HSR grant

18. Capacity Building for Management &
Leadership
To strengthen the Township Health Systems that we
have invested in…
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TOT given to HSSOs on M&L & then to BHS
Improve facilitating skills of BHS
Improve team building amongst BHS
Improve knowledge management
Improve Continuous Personal Professional
Development

19. Capacity Building for Health Systems Research
To strengthen the Township Health Systems that we
have invested in…
•
1. TOT given to HSSOs on HSR & then to BHS
2. S/D personnel conducting operational research
on HSS implementation at respective townships
3. Ignite and assist TMO/senior HAs to write
proposal for operational research and conduct
research (evaluative)

20. Capacity Building for Evaluation Tools
To strengthen the Township Health Systems that we
have invested in…
1. TOT given to HSSOs on Evaluation tools & then to
BHS
2. TOT on coordinated action of 4 programs to
HSSOs & then to BHS
3. TOT on financial management

21. Infrastructure
PROBLEM
10 sub RHC have no building
Only 1 facility with a delivery room
Limited housing for retention of staff
Limited water and electrical supply (no power in sub
centres)
RESPONSE
• Increased institutional delivery through improved facility
(constructions and renovations including delivery room at sub
RHC and RHC)
• Include water/sanitation/electrical supply in construction work

22. Infrastructure
To strengthen the Township Health Systems we have
invested in…
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Constructing new Sub Centers
Renovating RHCs
Installing solar
Identification and prioritization of most needy
with TMO/BHS

23. Essential medicines
PROBLEM
Limitations in supplies of ED and equipment (no
replenishment for 10 years)
RESPONSE
• Essential Drugs to TH/SH/RHC/ sub center level
• Equipment (RHC kit/HA kit/MW kit/CDK)
• Incremental for 4 years

24. Supplies & Equipment
• To strengthen the Township Health Systems we
have invested in…
1. Stock out of ED
2. Equipment maintenance
3. Need for the coming year
Role: checking for incoming S&E from GAVI HSS
Monitoring use and stock out at all levels

25. Supervision
PROBLEM
Lack of supervision check list
RESPONSE
• Supportive supervision
• TA for supervision
• Check-list is the RHC plan
• Data Quality and service quality

26. DATA QUALITY and SERVICE QUALITY
• To strengthen the Township Health Systems we
have invested in…
1. HSS assessment- DQA and SQA includes for 2 HTR
and 1 easy to reach –think to expand it to others
Role of HSSO:
Data quality check whenever you visit RHC/sub
RHC and note down
Teach midwives on data quality during CME

27. HSSOs equipped
Lap Top for M&E and many other inputs/process
• If possible, open g-mail account in areas where
internet is accessible to get contact
• Always note down whatever you observe/any
progress in your lap top
•Monthly report to Division of Planning of progress
of work in writing upon the Inputs and process
whether following CTHP as planned or not
• Be innovative and be accountable and transparent
upon your job

28. Your work will be measured by the
improvement of Township you’re concerned –
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In planning and management
In service delivery (performance indicators)
In utilization of health centers by poor people
in Financial management
In HSR
In management and leadership roles
In Human Resource management
In M&E
In provision of S&E