health systems development interventions

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

Pillar #1: Strengthening of referral services GEHIP services to be added as…a

…CHPS doorstepOutreach

Level A

…Community Health

Compound careLevel 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


Sub-district emergency response system developed?



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?


Pillar #1 Referral System OUTPUTS: • Referral case volume by type Continuous variables Continuous variables




Health Systems

Development

Interventions




& training


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

Pillar #2: Training for strengthening primary Healthcare services

GEHIP services to be added as…a

Community service capabilities

Level A

Sub-district clinical capabilities

Level B

Pillar #2 INPUTSPillar #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?


• Community Health Officer resident & comprehensive reproductive health services fully functioning?


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?


Pillar #2 OUTPUTS• HMIS case volume for IMCI treatable

illness/catchment area populationContinuous 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

Pillar #3: Easing information capture for community-based healthcare workers and providing supportive information feedback

Pillar #3: Strengthening Primary Healthcare Management Information

Systems


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?


Data used for decision-making in the past three months?




Health Systems

Development

Interventions



•Strengthen the operation of the essential medicine distribution system in GEHIP districts.



& training


Pillar #4: Develop a supply monitoring

system for essential drugs and equipment.

Pillar 4: Strengthening Primary Healthcare Supply and Logistics Capabilities



Level A


Level BPillar #4 INPUTS: Stock flow monitoring capabilities developed:• Stock flow monitoring system introduced and

fully functionalYes=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




Health Systems

Development

Interventions


• 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



& training

Pillar #5Adapting Tanzania’s district

planning and reporting toolkit to Ghana: PLANREP.

The District Health Planning and Reporting Tool (DiHPART)


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.

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…

An indicator of district

system strength point is the

sum of the discrepancies

between the district disease

profile and the budget

profile for 8 intervention

categories

Pillar 5: Strengthening Primary Healthcare Planning and Resources Inputs



Level A


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


• Engagement of other sectors in health: Total District Assembly Revenue invested in implementation (as a Health Common Fund Supplement)





• Engagement of other investors in health: Investments of international partners in health in implementation (by pillar)







Health Systems

Development

Interventions





& training


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.

health systems development interventions

Documents