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.

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

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.

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

• the focus will be on “system planning” for maternal and child health, immunization, nutrition and environmental health.

• the planning is therefore for the coordinated management and delivery of a “package of services,” and is not simply a collection of projects and programs.

• Once the system has been designed, tested and evaluated, consideration should be given to expanding the package of services to include communicable disease control, NCDs and hospital service

PROBLEMLack of coordinated planlack of management trainingInfrequent supervision and monitoring

RESPONSECTHP (costed)Financing of supervision of regular

supervision at all levelsQuarterly and annual review meetings

PROBLEMLow skilled birth attendanceLack of access in HTR area

PLAN RESPONSE FINANCING strengthening referral systems between

village and hospital (patient referral fund) - 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)

COMMUNICATION regular meetings with local authority/ VHWS and advocacy to local authority

PROBLEM

Low midwife population ratio and incorrect skill mixPoor retention of staff in HTR

PLAN RESPONSE

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

PROBLEM

Lack of operational finance for providers and economic barriers in the community

RESPONSE

Costed CTHP with financial support for operations

Referral funds to solve economic barriers in the community

PROBLEMSome sub RHC have no building Each facility need with a delivery roomLimited housing for retention of staffLimited water and electrical supply (no power in

sub centres)

RESPONSEIncreased institutional delivery through improved

facility (constructions and renovations including delivery room at sub RHC and RHC)

Include water/sanitation/electrical supply in construction work

PROBLEM There is no ambulance at the Township

Hospital (100 bedded-Government support?)

Bicycles old and policy issues with motorcycles

RESPONSE Funding Request Procurement

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

PROBLEM Lack of training on management & research

RESPONSE Modified MEP training HSR training HSR grant

PROBLEM Lack of supervision check list

RESPONSE Supportive supervision TA for supervision Check-list is the RHC plan

HSS 180 townships in 4 years

18

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

Yr 4 (60)Yr 4 (60)

Thank You