phoya: how to make system wide changes for newborns malawi experience

7/28/2019 Phoya: How to Make System Wide Changes for Newborns Malawi Experience

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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

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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

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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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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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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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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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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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phoya: how to make system wide changes for newborns malawi experience

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