WHO Early Recovery in Ebola affected countries: What did we learn? What happened? Shams Syed MD, MPH, DPH(Cantab), FACPM Department of Service Delivery & Safety WHO Headquarters ISQua 2015 October 5, 2015 "The 2014 Ebola Virus Disease (EVD, or "Ebola") outbreak continues to evolve in alarming ways, with the severely affected countries, Guinea, Liberia, and Sierra Leone, struggling to control the escalating outbreak against a backdrop of severely compromised health systems, significant deficits in capacity, and rampant fear." Dr. Francis Kateh from the Liberian Frontline If I were able to plan for this moment 3 years ago I would have 1. Built a strong primary health care system with infection control & patient safety embedded within the system. 2. Established long term trust in health care providers through community engagement (patient-provider partnerships). 3. Ensured a supply chain of essential supplies required for IPC and patient safety. 4. Developed a cadre of IPC & Patient Safety officers for the future. 5. Focused on strong safe service delivery as the basis for "preparedness". 1
1 2 3 4 5 2015 WHO Strategic Response Plan OBJECTIVES Stop transmission of the Ebola virus in affected countries Prevent new outbreaks of the Ebola virus in new areas and countries Safely reactivate essential health services and increase resilience Fast-track Ebola research and development Coordinate national and international Ebola response A new vision of health systems resilience is needed that puts infection prevention and safety, frontline health workforce support and just-in-time surveillance and information systems at the forefront. The Year at a Glance Differentiating our phases Getting to zero Early Recovery Recovery Functional health system Start 2015 2016 2017 2020 9 months 18 months 21 months 4 years From National HS Recovery Plan, Sierra Leone GETTING BACK ON AGENDA FOR PROSPERITY To build functional and resilient national and sub-national health systems that deliver safe, efficient and high quality health care services that are accessible, equitable and affordable for all Sierra Leoneans Ebola Recovery Assessment Health Sector Recovery Plan: Sierra Leone Complex multi-sectoral recovery processes requiring national & regional implementation approaches. Making the case for health services within a wider context of national recovery with multiple agencies. Key Expected Results Safe and healthy work settings Adequate Human Resources for Health Essential (basic) health and sanitation services are available Communities able to trust the health system and access essential health services Communities able to effectively communicate and effectively send health alerts Improved health system governance processes and standard operating procedures International Health Regulations (IHR) followed Patient & Health Worker Safety Health Workforce Essential Health Services Community Ownership Sierra Leone Basic Package for Essential Health Services (BPEHS) Fully implemented by 2020 Health Workforce Patient & Health Worker Safety Essential Health Services Community Ownership National & 3 regional referral PS and health services & systems Integrated Management of Childhood Illness Revise policy and hubs for quality care development Core malaria control interventions, including guidelines on Community Establish a medical post-graduate National PS policy HIV/AIDS and TB leadership centre Knowledge & learning in PS Maternal & Child life-saving interventions Community dialogue Strengthen national & 3 regional PS awareness raising Teenage Pregnancy prevention Community-based training institutions Health care-associated infections Non-Communicable Diseases approaches Establish CPD programmes for all Health workforce protection Essential Medicines & Supplies including PPEs Linkages between facility health cadres Health care waste management Improve referral including revitalization of the and community Improving individual, provider and Safe surgical care national ambulance service Improve community initiated sector performance Medication safety Diagnostic laboratories & blood transfusion health alerts Strengthening ethics and health PS partnerships Rehabilitation & facility equipping regulations PS Funding Health promotion, environmental health & PS surveillance & research sanitation Surveillance & Information Information & Surveillance Disease surveillance & database District health information system (DHIS2) Human Resource information system (HRIS) Logistics Management Information System (LMIS) Burden of disease studies National Health Accounts Enabling Environment: Leadership & Governance, Efficient Health Care Financing Mechanism and Cross-Sectoral Synergies. 2
Investment Plan for Building a Resilient Health System: Liberia Early Recovery at WHO: At a Glance IPC & patient safety Surveillance Essential package of services Health workforce People-centred services Partnerships Information, communication & technology Supply chain Health financing Knowledge harvesting Foundational Concepts Learning Point 1: Health service resilience & quality UHC UHC Ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. Quality The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Early Recovery for what? 1 Current Health Systems Fragmented Inequity Low quality Lack of resource Health workforce 6 etc IPC & Patient Safety Recovery 3 SHOCK Ebola outbreak, etc. Surveillance Transition 7 4 HOW? Quality UHC Initiative 5 2 UHC Integrated Health for all Quality Resourceful etc 1. Catalyzing global - Member States and SDG - Working Group for Quality UHC change - UHC-PSQ Learning Laboratory Network - WHO Technical Programmes 2. WHO Taskforce - WHO Regions & Sub-Regions - WHO Country Offices 3. Implementation - People-Centred Integrated Health Services - Quality & Safety Interventions & Transform - Campaigns & Challenges Essential services 1. Peoplecentred services financing 2. Health 4. ICT 5. Supply chain 3. Partnerships 6. Knowledge harvesting 1 Current Health System holds critical constraints. 2 The vision is quality recognized as a fundamental precondition to effective health service delivery in low and middle income countries working towards UHC. 3 Once a shock ( Ebola, disasters, etc.) happens in the middle of process toward UHC, health system becomes dysfunctional. Ebola affected countries and multiple countries across the world are at this stage. 4 Quality UHC Initiative supports strengthening UHC-quality convergence as well as health system recovery through implementation phase. 5 Implementation to transform is strongly linked to Health System Recovery activity. The lesson learnt from ongoing Health System Recovery would be reflected in the Quality UHC Initiative. 6 Health System Recovery action plan was developed based on the experience of Ebola response. It includes 4 technical & 6 supporting action areas which facilitates reactivation of essential health services. 7 Health System Recovery work pushes up trajectory of service delivery to baseline or above (all working toward quality UHC). 3
X-Factor Triangulation Population Universal Health Coverage Universal Health Coverage Expand coverage for populations.with health facilities that deliver quality.with trust & dignity related to WASH Services Direct Cost Deliver comprehensive package of essential health services with quality as a precondition delivered effectively in health facilities with adequate WASH Increase financial protection for people taking into account inefficiencies related to low quality care.highlighting the cost-effectiveness of WASH interventions in health facilities. "To ensure that every health care facility, in every setting, has safely managed, reliable water, sanitation & hygiene facilities and practices to meet staff & patient needs in order to provide quality, safe peoplecentred care." "Quality is recognized as a fundamental precondition to effective health service delivery in low and middle income countries working towards UHC." Learning Point 2: Synthesize & Integrate for action! 4
Early Recovery Taskforce & Toolkit Twenty technical programs/units from across WHO HQ convened to support the restoration of safe essential health services during early recovery; Development of a prototype Toolkit; Toolkit packages the plethora of tools & resources into a single source; Potential to act as a knowledge management and learning portal, capturing emerging pearls of knowledge on early recovery in a systematic way to alert relevant actors on what is working and what is not, in a timely way. Purpose of Toolkit & intended audience To give actors access to needed information and available technical approaches, quickly, across multiple vertical programs So that each country can review and map available resources to national plans And gain rapid oversight of the interrelationship of the multiple sources of technical support to synergize effort All resources and approaches identified by technical experts to ensure most important resources for early recovery are included All relevant resources in a single package (efficiency) and preventing the need to access multiple sites of information Mechanism to capture lessons learned during the early recovery period (brief case study reports) Attempt to harmonize and align vertical programs and prevent silo working during early recovery Commitment to update bi-monthly to ensure new approaches and resources are made available in real-time Intended for WHO CO for onward sharing and dissemination with MOH and partners How the Toolkit links with National Plans Learning Point 3: Power of human interaction Applying the Partnership Model Hospital Hospital Objective 1: PARTNERSHIP STRENGTH Objective 2: HOSPITAL IMPROVEMENTS Objective 3: NATIONAL SPREAD (Horizontal; Vertical; Spontaneous) 5
The Improvement Continuum Improved hand hygiene in health facilities Enhanced infection prevention & control (IPC) Safe health care delivery Improved quality of health care Robust people-centred health service delivery WHO African Partnerships for Patient Safety Sustainable, tangible improvement in service delivery is possible through catalytic role of institutional health partnerships. Flow back is evident. Human interaction counts!!! National level change can be stimulated. Strong health system Liberian Reflections 1. Needs oceanic.means limited but hope our guiding light! 2. All partners fully endorse and support national Liberian Investment Plan for Building a Resilient Health System. 3. Quality service delivery requires foundation work at all levels (national, county, district & institutional) 4. Global quality improvement community can be a key contributor through global solidarity. 5. County & district health management teams key to sustainable change in service delivery. 6. Lessons need to be harvested for application in other countries and not just low-income countries. 7. Quality considered a fundamental precondition to the success of UHC reforms. Never again! "We need to act now. We need to act with global solidarity for patient safety with vision & realism as our guide." Sam Zaramba 6