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Dr. Ann Phoya, RNM, PhDGlobal Newborn Health Conference
Johannesburg, RSA
17th April 2013
How to Make System Wide Changes forNewborns: Malawi Experience
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Presentation Outline
Health Demographics before system wide changes
Justification for system wide changes
Focus areas for system wide changes The Malawi Health Sector Strategic Plan and the
Essential health care package
Health System Strengthening Strategies
Achievements
Challenges & Opportunities
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Health indicators before systemwide changes: POW 2004
4
Vacancy rate: 65%
Health human resource
density: 3 per 10,000
Health facilities able todeliver full EHP: 13%
Budget allocation for
health: > 7%
Health Centers meetingstaff norms: 10%
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Justification for implementingSystem wide changes / strengthening
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To improve performance of the sector
To align health services to the changing health needs
To deliver public health services in line with
government policy
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Focus areas for system wide changes
POLICY
InputsHuman Resources
Equipment/DrugsInfrastructure
Finance
OperationsFinancial management systems
Systems of trainingPatient care protocolsMonitoring systems
Outputs
Process indicatorsImpact/Outcome
indicators
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Framework for System WideChanges
Adopting a Sector Wide Approach ( SWAP) for planning, managingand financing health service delivery
Designing a Health Sector strategic Plan HSSP) addressing priority
areas using multi-sectoral approach Defining an essential health package ( EHP) of interventions
within the HSSP ( free of charge)includes maternal andnewborn health
Decentralization of Service delivery to District Assemblies
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The Malawi Health Sector Strategic Plan
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Core Business:Health ServicesDelivery (EHP)
Infrastructure
Development and
service delivery
Improving
Essential Basic
Equipment
Supply chain
management
stewardship ,Governance &
financing
Human Resources Support toDistrict teams
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STRATEGIES FOR SYSTEM WIDECHANGES
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Strategy 1. Integrated delivery of TheMalawi Essential Health Package atcommunity, health center and Hospitallevel
1
0
Vaccine preventable
diseases
Malaria
MNH including FP
Tuberculosis
HIV and AIDS & STIs
ARI including pneumonia
Neglected Tropical diseases
Non communicable
Diseases Nutritional disorders
Trauma & Common
injuries
Ear, Eye infections Skin conditions
Diarrheal diseases
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Strategy 1: Delivery of the EHPComponent of MNH
Use of services agreements (SLA) with other health providers
Use of services agreements (SLA) with other health providers
for MNH
Strengthening
Referral system
at community level
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Components of maternal and newborncare interventions in the EHP
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2
Pre-pregnancy interventions
through youth and adolescent
reproductive health Services
Pregnancy Care services
Intra-partum services
CEmONC and BEmONC
Postnatal care services
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Strategy 2: Increasing Human
Resources for Health: Emergency
Human Resource Program
Expanding infrastructure of training colleges, and
support for student fees to increase intake of studentsfor pre-service trainings
Introduction of a new cadre - community midwives
Increasing number of salaried Community Health
workers: Health Surveillance Assistants
Establishment of Health Service Commission and
delinking health workers from civil service
commission for speedy promotions and recruitment13
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Task shifting and task-
sharing
Improving retentionthrough salary top ups and
housing, accelerated post
basic training
Preparatory support for
licensure examinations
Increasing Human Resourcesfor Health Increasing the HRH
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Strategy 3: Strengthening HealthInformation Systems
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5
Integration of community-based maternaland neonatal care (CBMNC) indicatorswithin the national HIS
CBMNC facilitating birth notification andpregnancy identification
Birth Registration underway
Use of mobile health application for easydata capture
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Strategy 4. Strentghening SupplyChain Management
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6
Reforming the Central Medical Stores and the nationalSupply chain system
Improve supply chain to avoid episodes of stock
outs of essential newborn commodities: Injectable antibiotics Antenatal Corticosteroid (ANCS) Resuscitation Equipment Amoxicillin
Use of mobile health to improve visibility of drug stocklevels at community levels
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5. Strategy 5: Improving HealthFinancing
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Flexible funding mechanisms to accommodatepolicies of different partners (common basket fundvs vertical funding)
Use of resources mapping tool to track and redirectresources in the health sector Encouraging DPs to support existing national or
district plans than stand alone projects
Pilot PBI/RBF to improve MNH outcome Financing strategy in place to explore alternative
mechanisms of health financing
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Strategy 6: Improving Access
Institutionalization of Total Quality Improvements in servicedelivery
Building and , renovation of primary health facilities to
provide the essential health package including BEmONC
services
Standardization of essential equipment for different levels of
health facilities for easy maintenance and procurement
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I i g A t R f l C &
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Improving Access to Referral Care &
Work environment: New NkotaKota
District hospital
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Strategy 7:. Strenthening.Leadership and Governance
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0
Creation of Platforms for Coordination of all sector players, andforums for assessing sector performance i.e.
Health sector review groups
Technical working groups such as EHP, SRH and theirsubcommittees
Annual & Biannual Reviews
Financing Agreement and Memoranda of understanding with
different groups
MOH taking lead in identifying strategic interventions that are
evidence based
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Achievements:
Source: Zimba E, Kinney MV, Kachale F et al. 2012. Newborn survival in Malawi: a decade of change and future implications. Health Policy and Planning 27(Suppl.
3):iii88iii103 Data: DFID, Management Sciences for Health. 2010. Evaluation of Malawis Emergency Human Resource Progromme. Cambridge, MA: Manageme nt
114%
increas
e
53%
increas
e
Improvements in the health workforce likely contributed to progress for
newborn survival
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Achievements
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Challenges
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Some development partners preferring project approachand seeking attribution for their funds,
Partners preference for funding direct program delivery
and not and system strengthening Private health sector expanding but not contributing to
HRH development
Inadequate funding for the HSSP from both Government
and partners,
Geographical access still a problem
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Opportunities Political commitment for MDG 4 &
5 very high: Presidential safe
motherhood initiative for maternal
and neonatal health
Governance structures in place to
promote accountability for MNH &
other services
Government commitment high to
improve health budget through
alternative financin mechanisms
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ZIKOMO
THANK YOU FOR YOUR ATTENTION
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