The Open Health Initiative to Improve Maternal and … · The Open Health Initiative to Improve...

The Open Health Initiative to Improve Maternal and Child Health in the East

Africa Partner States

June 6th, 2012 Arusha, Tanzania

Overview of the Open Health Initiative

Accountability for Results and Resources

Results-Based Financing

Innovation

Knowledge Sharing for Action

Maternal and Child Health Acceleration Fund

Implications and Next Steps

Agenda

What is the Open Health Initiative…

To improve the health of women and children by focusing on three thematic areas:

Accountability of Resources and

Results

Results Based Financing Innovation

Contribute to the improvement of maternal and child health and ultimately the achievement of the Millennium Development Goals (MDGs 4 and 5) within the

East African Community Partner States

Goal:

Objectives:

The ‘Open Health Initiative’ aims to encourage countries and their partners to be more accountable for women's and children's health by promoting openness, transparency, and knowledge sharing, and accelerating impactful interventions

In conjunction, the three thematic areas can support the region towards reaching MDGs 4 & 5

Date Milestone Key action point Com March Sectoral Council of the

Ministers of Health Open Health Initiative discussed and agreement that the Initiative be included in the Heads of State Summit agenda

April – May In-country consultations Key stake holders in-country support the development of the Initiative while best practices and interventions are mapped

End May East African regional inter-parliamentary forum

Discussed access to health information to improve maternal and child health; supported OHI

Beginning of June

Initiative Review by an Expert Committee

Draft v1 of the ‘Open Health Initiative’ is prepared through Partner State input

June – July Country validation through in-country workshops

Draft v2 of the ‘Open Health Initiative’ is prepared through in-country validation workshops

Mid July Joint EAC Technical Working Group review and feedback

Draft v2 is discussed and edited as needed by TWG on Health Systems and Policy and TWG on Maternal, Reproductive and Child Health

August 16th Ordinary Meeting of the Health Sector Committee

Draft v.3 of the ‘Open Health Initiative’ strategy is presented and discussed

End August Final draft of the Open Health Initiative is completed

Final ‘Open Health Initiative’ is disseminated to Partner States ahead of Council of Ministers

The Open Health Initiative is being developed through country level input and regional consultation

The Expert Committee met over the previous two days and draft v.1 will be ready by the end of next week

Accountability for Results and

Resources


Innovation

Knowledge sharing for

action

MCH Acceleration

Fund

From country consultations, 3 themes were confirmed and 2 cross-cutting approaches added




Innovation




Agenda

Why accountability:

Results Resources

Allows countries to: • Allocate and realigned existing funds

to high impact interventions • Get more out of each health dollar • Keep donors, programs, and

governments accountable for the funds committed to health

Allows countries to: • Accelerate improvement in health by

targeting interventions based on accurate and timely information

• Provide timely and relevant information on progress against targets

Accountability for Results and Resources is growing in importance across all countries and sectors. It speaks to both programmatic accountability as well as financial accountability. Together with the notions of transparency and greater openness, this is at the heart of current global and regional efforts to accelerate progress towards the MDGs and improve the efficiency and effectiveness of major global and national public health efforts.

Accountability at the heart of ensuring progress towards MDGs 4&5

Timeline of Political Commitments

1994 International Conference for Population and Development 1995 Beijing Declaration and Platform for Action: Fourth World Conference on Women 2000 Millennium Development Goals 2001 Abuja: African Summit on HIV/AIDS, Tuberculosis and Other Related Infectious

Diseases 2006 Maputo Plan of Action for the Operalization of the Continental Policy Framework

for Sexual and Reproduction Health and Rights 2007-2010

2005 Paris Declaration on Aid Effectiveness

2007 Third Session of the African Union Conference of Ministers of Health 2008 Accra Agenda for Action 2009 Campaign for Accelerated Reduction of Maternal Mortality In Africa 2011

Commission on Information and Accountability for Women's and Children’s Health

2012 Access to Health as a Basic Right: The Role of Parliaments in Addressing Key Challenges to Securing the Health of Women and Children

2012 Commitments to the Global Strategy for Women's and Children's Health

Accountability of Results Towards Commitments

Key issues raised with achieving accountability commitments: • Many commitments made at different levels (regional, national,

global) • Not enough follow-up and limited visibility • Losing track of what has already been committed • Some global commitments not easy to track regularly at country

level (e.g. most indicators from Commission on Information and Accountability are only capture through DHS)

Best practices: • Reports regrouping all previously made commitments • Strong political commitment from Heads of States • Key issues should be addressed at the highest levels

Key issues and best practices were identified in achieving previous commitments made

• Produce standard yearly reporting against all the commitments, which will be made public following EAC health committee review and discussion by Council of Ministers

• Facilitate agreement on what to report on - minimum common indicators from HMIS: Immunization, Skilled birth attendance, eMTCT, Family Planning, Malaria IPT2, post-natal care

• Support efforts across the region to help countries integrate means of reporting on important indicators not already being tracked effectively today: EMOC, Exclusive Breast Feeding, Birth Registration

• Use OHI vehicle to bring to fore key issues requiring strong political commitment such as

• Birth and death registration • HRH crisis – retention, quality, incentives • Health Financing – Universal Coverage; make more efficient use of

resources; need to do more to increase domestic revenue collection towards health and MDGs 4&5 in particular

To address the issues and to achieve the best practices in the region the EAC will…

Discussed and agreed best practices: • To effectively address MDGs 4 & 5 all governments, donors, and partners have to be

open with their budgets • To efficiently address MDGs 4 & 5, budgets will be analyzed annually at national and

regional forums to ensure all resources were allocated and variances discussed • Resource tracking tools from across the region should be leveraged to accelerate

uptake – Rwanda was cited as example to follow • NHAs play a positive role and should continue to be done on a routine basis

Best practices and key action areas for the OHI have been identified

Key Action Area to be Addressed in the Open Health Initiative: • The OHI can help countries implement a budget tracking tool by Q2 2013. This

tool will be broken down by activity, disease, geographical area, and other agreed upon criteria at country level. All countries will track expenditures against budgets by Q4 2013

• All data will be made publicly available after review by Health Committee and Council of Health Ministers

Accountability of Resources

The role of the EAC and how this will be accomplished will be discussing in the upcoming

slides




Innovation




Agenda

Burundi

Kenya

Rwanda

Uganda

Tanzania

• National supply side PBF focused on a wide range of health indicators; successfully linked to the introduction of free care for MNCH services

• National Community PBF

• Voucher scheme targeting FP and safe motherhood in selected districts • PBF pilot incentivizing quality of care and utilization of services • Pilot community PBF

• National supply side PBF focused on a wide range of health indicators; includes a quality index

• National Community PBF

• Pilot voucher scheme promoting safe motherhood in private facilities • Pilot FP voucher scheme • Pilot referral scheme, with cyclist to bring pregnant mothers to facilities

• Large-scale pilot pay-for-performance (P4P) scheme in MNCH • Pilot insurance scheme for pregnant women

Consensus that RBF-type of approach must be encouraged and supported across the region

Some good practices and potential risks to avoid

• Government-led at all levels and from the start

• Should be part of a comprehensive health financing plan

• Independent verification is key • Leverage existing RBFs in the regions • Comprehensive review of budgets for

the scale-up plan • Quality (can be in second phase) &

Quantity; rigorous supervision; district management team important

• Demonstrating sustainability, at least over medium to long term

• Community PBF is critical element

• Must not be seen as a single solution

• Reducing donor dependence • Poor quality of data

• Thinking that a pilot will provide

all the answers: even going to scale requires change and evolution

• Donor support can create

challenges such as approach towards incentivizing contraceptive usage

Good practices Potential risks to avoid

• Advocacy for commitment towards RBF

• Sharing of information/best practices – not just in RBF, but health financing and innovative financing more broadly; seeing how different approaches can be combined

• Developing standard operating procedures/’how to’ guide/ preconditions necessary before implementation – sort of ‘accreditation’ of RBFs

• Focus on facilitating network of experts & country support through ad hoc regional task force - need to focus on implementation support/scale-up

• Resource mobilization to support scale-up & to support move away from a project approach to institutionalization

The EAC, through the Open Health Initiative, has a role to play to support effective scale-up




Innovation




Agenda

• Health care innovations come in many shapes and sizes

• Examples of “innovations” in health can be new tools, strategies, approaches and/or technologies (e-health and m-health) working towards: • Eliminating barriers • Increasing access for hard to reach populations • Improving the performance of health systems

What is the added value of innovation in health care?

Examples of current innovations that could be leveraged across the region

Mother-Baby Passport

E-learning for health staff in rural areas

Mpaka HCW fellowship program Doctor to doctor

mentorship program

Rapid SMS application for MNCH at the community level

E-health strategy developed; move towards integration of platforms

Some examples of technological innovations

Country Innovation Stage in Development

Kenya Epromise: a M&E project accountability software National Kenya SMS for CHWs in hard to reach populations Pilot Rwanda Data dashboards to get a snap shot of data National Rwanda Rapid SMS to track pregnancies and support maternal, neonatal

and early child health at the community level National

Tanzania mHealth Partnership to support a scalable, cost-effective and sustainable national health information system

Being scaled

Tanzania Mobile phones to take pictures, diagnose patients in remote areas Pilot Uganda Rapid SMS Mother Reminder for ANC appointments Pilot Uganda Mobil vital registration services to register births and deaths in

community Pilot

Zanzibar Wired Mothers Standing: linking mothers with facility through mobile phones; worked best in urban and peri-urban areas

Ended

Zanzibar MCH: transportation for mothers to facility- TBAs and taxis paid- SMS data collected as well through their phone

Being scaled

Some examples of non-technological innovations

Country Innovation Stage in Development

Burundi Providing incentives for TBAs to bring women to facility Being scaled Burundi Doctor shadow program to train new doctors further in MNCH National Kenya MNCH Boma Maternal Health Delivery Model bringing services to

community level National

Kenya Kenya Adolescent Reproductive Health Project Being scaled Rwanda CHW model: 4 CHWs in each village to cover mother, newborn,

child, and admin National

Rwanda Kangaroo Mother Care: skin-to-skin contact to health of LBW babies

National

Tanzania Mkapa fellowships: improving HRH system National Tanzania Safe motherhood kit for mothers to combat stock-out challenges Pilot Uganda Child Health Cards National Uganda Training Traditional Birth Attendants: to ensure all providers of

maternal care were properly trained District level

Technological Innovation Non-technological Innovations

An ICT/ e-health division established within the MOH and staffed with the appropriate technical expertise

Toolkits and strategies are reviewed by MOH and disseminated widely to avoid duplication and share what is already working well

Countries develop a national e/m-health strategy to effectively identify and implement innovation under the MOH guidance

Establish forums to share e/m-heath activities- including the private sector

Regular meetings to share innovations beyond Ministry of Health to look for opportunities to collaborate

Agreed upon best practices to support in-country innovation

• Establish a knowledge sharing hub to increase communication through a website and/or newsletter

• Support countries in creating a national e-health strategy • Establish a health innovation and research committee to

collect reports, strategies, tools, etc from countries and share widely

• Promote use of PPPs and engage private sector • Facilitate operational research to further innovations

between and within countries • Mobilize resources to support scale-up of successful

interventions and new ideas for innovation

The OHI has a role to play in supporting effective scale-up




Innovation




Agenda

• During the in-country consultations, a common theme that was brought up by ministries, stakeholders, and multilaterals was the absence of structured knowledge sharing mechanisms in the region.

• All of the Partner States said that they would like more formal, more consistent mechanisms where they could learn and leverage the successes, limitations, and lessons learned from their neighbors.

Knowledge Sharing for Action: Background

Knowledge Sharing for Action: Moving forward

• Four suggested

knowledge-sharing mechanisms

• Two suggested new positions

How does the OHI make these ideas into reality for the

EAC countries?

• Rational: There is limited knowledge and access to information on pilots, interventions, and innovations currently being implemented in the neighboring countries

• Way forward: Collection of all relevant pilots, interventions, innovations, documents contacts, and tools within MCH

• Rational: Virtual operational research and impact evaluation platform to increase access and information flow between the major research organizations in each country

• Way forward: Linking relevant institutions across the region in order to facilitate collaboration and encourage cross border research and acceptability of research findings across countries

Knowledge Sharing for Action: 4 Possible Mechanisms (1 of 2)

A regional, web accessible database

A regional operations research/evaluation virtual platform

• Rational: Encourage professional knowledge sharing and receive information from public health area experts within the region

• Way forward: EAC Secretariat would maintain an online database of technical experts by background, area of expertise, etc. and facilitate targeted country support visits

• Rational: Limited exposure beyond the country of key facility-based staff or ministry staff , thereby limiting new perspectives and ideas

• Way forward: Facilitate an exchange program (one-for-one) between countries as a development opportunity and means to share best practices

Knowledge Sharing for Action: 4 Possible Mechanisms (2 of 2)

Assemble and make available a regional expert task force

Facilitate on-going technical exchange program

• Based within the MOH of each country, most probably within RMCH unit • Supporting the knowledge-sharing mechanisms previously described • Attending TWG meetings and engaging in relevant forums in order to share

information and make linkages within and between countries • Providing the essential linkage with the EAC and other countries to provide full

information flow

Knowledge Sharing for Action: 2 Possible New Positions (1 of 2)

1 Country Level Position

1 EAC Secretariat Level Position

• Supporting in-country position, ensuring effective communication flows • Identifying successful interventions and packaging them for possible

effective dialogue in the other Partner States • Supporting the expert task force contact list and facilitating cross border

OR opportunities and exchange programs • Ensuring maintenance and enhance of web interface (with support of

existing staff)

Country Based Open Health Initiative (5

officers)

MoH

Country Info

Regional Info

Knowledge Sharing for Action: 2 Possible New Positions (2 of 2)

EAC Secretariat Based Open

Health Initiative (2 positions, one of which covered

already)

Country Info

Regional Info

How would these positions connect?




Innovation




Agenda

OHI must have a direct impact at service delivery level, potentially through additional funding

Basic principles

• To make a big impact on MCH outcomes in a short amount of time by supporting successful innovations

• Decision and disbursement must be rapid, i.e. not get slowed by bureaucratic processes

• Principles of RBF should apply

• Complementarity with domestic resources (co-funding)

Some options on how it would be managed

• Programs to support would be proposed by countries

• EAC-wide committee would select based on agreed upon criteria

“traditional” model

• ‘Cash-on-Delivery’ approach, whereby disbursement is based on progress against high-level indicator(s)

• Resources would be flexible within scope of OHI

• Countries would need to report transparently on use of resources and be subject to independent verification

“innovative” model

A number of questions still need to be addressed

• Why are successful pilots currently not being funded – is it really just lack of funds?

• Who would hold and manage the funds?

• How would funds flow in-country (e.g., to pool fund, project account, etc.)?

• How to ensure sustainability?

This will require further investigation over next few weeks




Innovation




Agenda

Priority Actions along 3 themes

Acco

unta

bilit

y

Make all health data available freely to all stakeholders in and across Partner States based on existing health information systems – including the tracking of all births and maternal & child deaths

Detailed tracking of all government and donor resources in each country so as to ensure optimal resource allocation (by intervention, geography, activity, target population, cost category, etc.)

Reposition RMNCH as essential part of comprehensive health care and increase domestic resources targeting women and children’s health

Report the status of MDGs 4 & 5 every year at the Council of Ministers and Parliamentarians

RBF Ensure that all RBF programs have a MDG 4 & 5 component

Establish regional RBF Task Force to accelerate introduction or scale-up of RBF best-practices

Inno

vatio

n

Work towards a common regional open-source ICT standard to leverage technology and expertise across the region

Work together to leverage cross-border PPP opportunities

Actively support knowledge sharing across the region in a timely and transparent manner to accelerate key innovations – strengthen regional and country capacity to deliver

Establish “Maternal and Child Health Acceleration Fund”: building on RBF principles, accountability and supporting the scale-up of innovation interventions

In summary…

Knowledge and Best Practices

sharing for action

MCH Acceleration

Fund

Implementing the OHI will have the following requirements, yet to be quantified

• Documentation sharing • Web platform development/enhancement • Regional EAC and country ‘OHI’ staff • Operational support for expert task force, exchange

programs and regional research/evaluations • Focused capacity building at regional and country level

(e.g. on use of data, RBF, knowledge management, etc.)

• Outreach for PPP or other sources of partnerships • Funding for Acceleration Fund • Fund management

The bulk of the work to establish OHI must be completed by end August, before adoption in November

June - July Country validation through in-country workshops

Draft v2 of the ‘Open Health Initiative’ is prepared through in-country validation workshops

Mid July Joint EAC Technical Working Group review and feedback

Draft v2 is discussed and edited as needed by TWG on Health Systems and Policy and TWG on Maternal, Reproductive and Child Health

August 16th Ordinary Meeting of the Health Sector Committee

Draft v.3 of the ‘Open Health Initiative’ strategy is presented and discussed

End August Final draft of the Open Health Initiative is completed

Final ‘Open Health Initiative’ is disseminated to Partner States ahead of Council of Ministers

End September

8th Meeting of EAC Sectoral Council of Ministers of Health

‘Open Health Initiative’ is considered and forwarded to the EAC Council of Ministers for approval

End November

Council of Ministers ‘Open Health Initiative’ approved by Council of Ministers for adoption by Heads of States

End of November

The 14th Ordinary Summit of the EAC Heads of States

‘The Open Health Initiative to Improve Maternal and Child Health in the EAC Partner States’ is approved for implementation through a Communiqué and/or Declaration by the EAC Heads of States

The Open Health Initiative to Improve Maternal and … · The Open Health Initiative to Improve...

Documents

Transcript of The Open Health Initiative to Improve Maternal and … · The Open Health Initiative to Improve...