Hss and its relation to l+m+g

1Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact

Stronger health systems. Greater health impact.

Health Systems Strengthening and its Relation to Leadership, Management and Governance

Juan-Carlos AlegreDirector, Monitoring & EvaluationManagement Sciences for HealthMay 24, 2012e (month/day/year)


HSS and its relation to L+M+G

1. HSS models

2. MSH approach to HSS

3. Contributions of L+M+G to building blocks

4. Measuring HSS

5. Experiences from the Field improving L+M+G practices and their effects on performance and health outcomes


HSS Models

• Forty-one HSS conceptual frameworks

• Great variety of ways in which health systems are understood

• Large number of conceptual issues for which greater research and deliberation is necessary

• Continued need for diversity in health systems

• Context specific, opportunities for health systems research


Aim of HSS Models

Health status Responsiveness Fairness in

financing Efficiency

Health Goals Coverage Access &

Availability Quality Demand Safety Enabling social &

policy environment

Health Outcomes


The WHO Health Systems Framework


Six Steps to Achieving Greater Health Impact

Step 1. Identify the health outcome or impact goal.

Step 2. Identify the health challenges, their causes and risk factors.

Step 3. Identify and select high impact interventions.

Step 4. Determine health systems requirements and bottlenecks to achieve coverage levels.

Step 5. Identify the critical health systems interventions that address bottlenecks.

Step 6. Select the most appropriate M&E indicators.


MSH HSS Results Model

Step 1Step 2

Step 3

Step 4

Step 5

Step 6


Contribution of L+M+G to HSS Building BlocksBuilding Block

Evidence of an Effective Health System Building Block

How L+M+G support performance and effectiveness

Human Resources for Health

• A well-performing workforce achieves positive health outcomes given available resources and circumstances

• There are sufficient staff that are appropriately distributed who are competent, supported, motivated and productive

• Development of HRH policies and procedures

• Support the implementation of HRH policies and procedures at various levels of the system

• A HRMIS supports and informs HRH management decision-making

• Build leadership and management capacity to motivate providers and managers to perform and/or excel standards


Contribution of L+M+G to HSS Building Blocks (cont.)

Building Block

Evidence of an Effective Health System Building Block

How L+M+G support performance and effectiveness

Health Info. System

• The system facilitates the production, analysis, dissemination of reliable and timely information on health determinants, coverage, system performance and health status

• Healthcare managers and providers use the information to make informed management decisions

• Develop in-country capacity to strengthen the HIS

• Leaders and managers use health data and information for performance assessment and improvement at various levels

• Information and M&E practices facilitate effective problem-solving, informed decision making and policy formulation

• Information about health systems performance is made available to the public


Measuring HSS

IHP+


HSS and Measurement Implications

• Implementation processes and outcomes

• Three major technical areas to develop better ways to measure success:

• Leadership practices

• Management systems

• Effective governance models for health

• Systems thinking approach

• Health systems research – OR studies

• National and sub-national levels

• Decentralized vs. centralized health systems


LMG Project and HSS Research

• Four country-specific OR studies• Solving implementation challenges through L+M+G

to address health systems bottlenecks• Two cross-cutting OR studies

• Contribution of gender equality, country ownership, and sustainability through HSS to improve performance and achieve health outcomes

• Country-driven applied research• Aligning with country priorities to address systemic

bottlenecks• Focus on local-capacity development

• Developing in-country capacity for M&E and applied research in health systems


LMG Project and HSS Research (cont.)

• Reviewing and developing performance indicators for L+M+G• Within MSH: existing portfolio of leadership and

management projects• Outside MSH: collaboration with CAs and other

international agencies• First LMG OR Study: Ethiopia Human Resources

for Health• Addressing competency gaps and improving

performance of Ethiopia health workforce at national and regional levels

• Other areas for developing evidence of effect of L+M+G:• Gender equality• Country ownership and transition processes • Governance for health


A Field Experience from ProACTNigeria

Strengthening Facility Health Management Information System

(HMIS) for ownership and sustainability

Uche Ikenyei


ProACT: Strengthening HMIS

The ProjectProACT has site presence in 6 of Nigeria's 36 states supporting 28 CCT and 46

feeder sites. ProACT’s strategy focuses on strengthening health systems for improved

service delivery, ownership and sustainability

HMIS system strengthening: our Intervention1. Strengthening the use of the national facility based data documentation

tools in all ProACT supported sites rather than having partner specific parallel reporting tools

2. Strengthening data documentation in all facilities and reporting from all CCTs and feeder sites to the State Action Committee on AIDS (SACA) offices.

3. Conducting joint participatory Data Quality Audits (DQAs) where the participants include M&E Officers from the SACAs, the HODs for the medical records units and MSH M&E Teams

4. Integrating the HIV medical records units into the main medical records unit to promote ownership and improve service delivery

5. Strengthening data use for health-related informed decision making

Uche Ikenyei


ProACT: Results

• 100% of all MSH supported facilities align with the national data documentation and reporting tools while 5% of all Patient management and Monitoring (PMM) tools were designed to meet the data gaps that the national tools could not capture

• 100% of our comprehensive care and treatment sites now consistently report data with the national reporting forms to their respective State Action Committee on AIDS. This is notable where no facilities were reporting prior to ProACT intervention

• Data quality in randomly selected sites improved from 58% to 68% in six months with Niger state improving from 55% to 80% within the same period

• None of the 26 CCT sites had an integrated medical records unit pre ProACT intervention. Currently, 68% (17 sites) have fully integrated HMIS with the overall hospital medical records departments. This has contributed in increasing 12 months cohort HIV client retention from 47% (2009) to 62% (2010)

• Data use to drive decision making is still nascent with currently only 5 of 26 (19%) CCT sites having started using data to make management decisions

Overview of GH Jega (Kebbi State) Medical records Library after integration

Facility Data Presentation during the Quarterly Management Team meeting (QMT) – GH Jega & GH KoKo Kebbi State

Uche Ikenyei


A Field Experience from PLAN-Health Nigeria

Leadership Development Program and

Increase in PMTCT Uptake

Dr. Lami Samaila


PLAN-Health: Leadership Development

• An adapted Leadership Development Program (LDP) was organized for several organizations working in the same state

• One shared vision was developed for the state with each organization creating a measurable result based on their organizations mandate

• Seven Local AIDS Control Agencies chose to “Increase by 25% uptake of PMTCT services by pregnant women by May 2011” as their measurable result

Dr. Lami Samaila


PLAN-Health: Results

PMTCT Uptake (2010) PMTCT Uptake (2011) % Increase

PHCs with other Implementing Partners 4,670 6,128 31%

PHCs without Implementing Partners 2,132 3,175 49%

All PHCs 6,802 9,303 37%

Dr. Lami Samaila


Increase in PMTCT Uptake Results from a Leadership Development ProgramMSH PLAN-Health Nigeria

Abba Mate

rnity

Clinic

Hashidu PHC

PHC Todi

Tal M

atern

ity Clin

ic

PHC Pantam

i

Mallam

Inna M

atern

ity Clin

ic

Kumo Town M

atern

ity

MPHC Barambu

Kupto Mate

rnity

Clinic

Ribadu M

atern

ity Clin

ic

Willi

Mate

rnity

Clinic

Ture

Balam M

atern

ity Clin

ic0

500

1,000

1,500

2,000

2,500

Pre-LDP (2010) PMTCT Uptake Post-LDP (2011) PMTCT Uptake

Dr. Lami Samaila


LGA Primary Health Care Facility PMTCT Uptake (2010) PMTCT Uptake (2011) % Increase Presence of other

PEPFAR

Implementing

Partners

Dukku Abba Maternity Clinic 213 346 62% None

Dukku Hashidu PHC 417 774 86% FHI 360

Billiri PHC Todi 404 535 32% FHI 360

Billiri Tal Maternity Clinic 801 845 5% ICAP

Gombe PHC Pantami 1,335 2,051 54% ICAP

Gombe Mallam Inna Maternity Clinic 79 247 213% None

Akko Kumo Town Maternity 1,713 1,923 12% FHI 360

Akko MPHC Barambu 528 715 35% None

Funa-Kaye Kupto Maternity Clinic 317 630 99% None

Funa-Kaye Ribadu Maternity Clinic 776 904 16% None

Kaltungo Willi Maternity Clinic 81 99 22% None

Kaltungo Ture Balam Maternity Clinic 138 234 70% None

All 6 LGA’s All 12 Facilities 6,802 9,303 37%

Dr. Lami Samaila


A Field Experience from K4HMalawi

A Demonstration Project to Address Gaps in FP/RH and HIV/AIDS Information Pathway


K4H: Addressing gaps in FP/RH and HIV/AIDS information pathway Four interventions were selected to improve KM at the National, District & Community levels:

1. Leadership Development Program (LDP). An adapted LDP for knowledge management mobilized stakeholders around creating a common vision and action plan with desired measurable results for improving knowledge management.

2. FP/RH and HIV/AIDS Toolkits. Toolkits are designed to be a central online data bank housing current country specific information on FP/RH and HIV/AIDS.

3. District Learning Centers (DLCs). DLCs were imbedded in district hospitals and serve as central hubs of information for district and community level health providers.

4. SMS Network. SMS intervention uses Frontline SMS (FLSMS) to provide nurses, doctors and Community Health Workers (i.e. Community Based Distribution Agents and Health Surveillance Agents) with immediate access to up to date, relevant health information.


K4H: Results

1. Increased efficiency of referrals because CHWs could send messages to district hospital or clinics to ensure services were available before making referrals.

2. Widened service coverage due to more time available because CHWs are no longer biking to meet with supervisors or reporting stock-outs, and so spend more time in community.

3. Prompt responses to cholera, meningitis and measles outbreaks.

4. Detection and prevention of stock-outs (i.e. averted stock-outs of DEPO, male and female condoms). When CHWs run out of supplies, they now send an SMS and are often resupplied on the same day, whereas in the past it could take up to one week.


Discussion / Questions


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Hss and its relation to l+m+g

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