The UN Secretary General s Global Strategy for Women s and Children s Health: Getting it Done for Maternal and Newborn Health Innovations in Health Systems Strengthening Pat Riley, CNM, MPH, FACNM Nagesh Borse, MS, PhD January 20, 2011 Center for Global Health Place Descriptor Here
Why a Health Systems Unit within DGHA? PEPFAR II legislative mandate GHI principles Facilitate USG country teams plan cross-cutting HS interventions Define and develop best practices in HSS with an eye toward a stronger public health approach to HSS Ability to technically engage global stakeholders in HSS (WHO, GF, GAVI, WB, DFID) Promote implementation science in HS
DGHA: Health Systems/Human Resource Team Overview of: HRH Innovations HRIS African Regulatory Collaborative HS Innovations HS Research HS Metrics Initiative
HR INNOVATIONS
Health outcomes Service Utilization WHY WORKFORCE MATTERS
HRIS and Health Services Delivery: Enables appropriate selection of various HRH interventions IN-SERVICE TRAINING TASK SHIFTING MINISTRY OF HEALTH Professional Regulatory Board Data Nursing, Medical Board Laboratorian, etc. TWINNING PRIVATE SECTOR DEPLOYMENT FAITH-BASED ORGANIZATIONS PRE-SERVICE TRAINING RETENTION
Includes: Supply Data: - Numbers of providers - Students in training - Licensure info - Requests for outmigration - Professionals trained outside the country HRIS Linkage Supply Data are linked with Deployment Data (e.g., satellite connections) creating one single database system. Deployment Data: Maintained by the MOH Quarterly workforce census data collected at local facilities are entered into an electronic database system Data is simultaneously transmitted to national office - thereby ensuring its accuracy and timeliness.
Information Collected: Pre-service Data: Can be used to track students in pre-service training (from entry to graduation - including drop-outs) Registration Data: maintained by Regulatory Boards In-service Training: Continuing Professional Development (CPD) in EmOC, neonatal care, family planning update Out-migration Data: using proxy indicators Deployment Data: staff demographics, location of employment and ward, promotion hx & eligibility, in-service training, qualifications, reasons for attrition & placement of Emergency Hire staff Linked to HR Department s Personnel Management
Kenya s Provincial Health Indicators* *KDHS 2003, KAIS 2007, Facts and Figures on Health and Related Health Indicators 2008 Province IMR (2003) <5 Mortality (2003) % Birth in Health Facility (2006) % Full Immuni zation (2007) HIV Prev. % (2007) FP (any method) (2003) # ART (2007) National 77/1,000 95/1,000 39.1 73 7.4 39.3 181,458 Nairobi 67/1,000 95/1,000 77.0 78 9.0 50.7 38,948 Coast 78/1,000 116/1,000 31.7 78 7.9 24.1 14,419 Central 44/1,000 54/1,000 71.8 85 3.8 66.4 21,962 Eastern 56/1,000 84/1,000 37.6 78 4.7 50.6 11,931 N/Eastern 91/1,000 163/1,000 11.7 52 1.0 0.2 322 R/Valley 61/1,000 77/1,000 33.6 70 7.0 34.4 33,594 Nyanza 133/1,000 206/1,000 46.7 66 15.3 24.7 41,292 Western 80/1,000 144/1,000 25.7 68 5.1 34.1 18,990
Province Distribution of Kenya s Midwives by Province n = 16,713 (May 2010) Number Midwives Percent Midwives Provincial Population Nairobi 2,789 17% 3,138,296 89 Central 2,096 13% 4,110,087 51 Coast 1,386 8% 3,160,851 44 Eastern 2,745 16% 5,289,059 52 N. Eastern 392 2% 1,776,661 22 Nyanza 2,115 13% 5,125,180 41 Rift Valley 3,755 22% 9,137,616 41 Western 1,334 9% 4,146,106 34 Rate per 100,000
Kenya Nurse Supply Data September 2009
Examples of HRIS Influencing Kenya Policy HRH data rectified backlog promotions HRH data successfully advocated for increasing GoK civil service retirement age from 55 to 60 HRH data used to identify workforce maldistribution (e.g. nurse/population ratio) HRH data used to verify employment figures with regulatory data, resulting in the identification of genuine employees vs. ghost workers, non-credentialed clinicians
REGULATION African Regulatory Collaborative (ARC): South-to-South partnership with The Commonwealth Secretariat (UK) & the East, Central, and Southern Africa Health Community (ECSA) to convene nursing and midwifery leadership on a quarterly basis in order to: Ensure quality standards of nursing and midwifery practice harmonized in the region Ensure updated regulatory frameworks Build capacity of nursing and midwifery councils in key regulatory functions Establish a sustained consortia of nursing and midwifery leaders Evaluation science
HS INNOVATIONS
Health System Framework
It may simply not be possible to convince human beings rationally to take a long-term view. People do not focus on the long-term because they have to, but because they want to. (Senge, The Fifth Discipline p. 210)
Health Systems Constraints in Africa Limited availability of competent and effective health workers Poor health information systems Ineffective health financing systems Weak procurement and supply chain management systems Inadequate service delivery capacity/quality Limited planning, policy-making, management and governing capacity Prioritization
Clinical vs. Health Systems Research Clinical/ Traditional Problem >> Intervention >> Implementation >> Outcome Health Systems Research Input >> Process >> Output >> Outcome Strengthening cold chain >> Vaccine availability >> Vaccine coverage >> Improvement in child health Staff Housing >> Staff available at the facility >> Staff retention >> MCH
Inputs/ Resources Process Outputs Outcomes PEPFAR & Other GHIs Country Existing Resources Governance Health Financing Health Workforce Community Access to Health Services: Distance Quality Perception Cost Income Knowledge Education Service Utilization Health Outcomes Non-HIV Donors (GAVI, UNICEF, Other nonhealth) Information System Supply Chain Management Health Services Availability
Uganda Public Health Evaluation (Impact of HIV Investments on Maternal and Child Health) 2004 2005 2006 2007 2008 2009 2010 2011 Study Period Health Management Information System (HMIS) Monitoring and Evaluation of Emergency Plan Progress (MEEPP) database
Decentralization and District Health Offices DHOs are becoming autonomous, influential Decentralization becoming the sine qua non Controls Primary health care and referral hospitals Poor understanding of these developments and failure to recognize the DHO s vital role in decentralized health sector
Interventions Public Health System Sector-Wide Approach Norton 1998, Jeppsson 2001, Elsey 2005, Biesma 2009 and Okamoto 2009
Sub-national Institutional Capacity Gap Analysis Expected DHO Capacity Available DHO Capacity Required DHO Capacity REVIEW Existing Policies Conduct a Survey Understand Gaps and develop recommendations for MoH to develop DHO Capacity
Health Systems Metrics Initiative CDC HQ funded activity ($100K per country) CDC In-country team identifies a HS project Short-term HSS Indicator/Intervention Projects Impact of Supply Chain Management on Drug Availability at the facility Impact of integration of MCH with PMTCT on utilization Identify HSS Project Technical Assistance Implement the project Disseminate the results
Thank you! For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Center for Global Health Place Descriptor Here