Overview of gavi hss
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The document describes a health systems strengthening framework for Myanmar that aims to address gaps in service delivery, program coordination, and human resources. It identifies key health system areas needing improvement, including increasing access to essential maternal and child health services in hard to reach areas, strengthening coordination across health programs, and improving the distribution and skills of health workers. The framework outlines objectives, activities, indicators and timelines to guide investments in infrastructure, supplies, transport, training, research and incentives over four years across 180 townships, with the goal of reducing child mortality and increasing access to primary healthcare services.
Overview of gavi hss
- 3. Health System Strengthening Framework Service Delivery Gaps Many areas of the country have low service access to MCH and other services due to a range of management, infrastructure, logistics and security barriers. Program Coordination Gaps Lack of organizational capacity, guidelines and strategic framework on how to coordinate immunization, nutrition, environmental health and RH services is leading to fragmentation and inefficiencies in health service delivery Human Resource Gaps There is lack of clarity in the roles and functions of basic health staff, and inequities in the distribution of staff, resulting in lack of access to health services in hard to reach areas. HSS Goal: Achieve improved service delivery of essential components of Immunization, MCH, Nutrition, Environmental Health by strengthening programme coordination, sub-national micro-planning, and human resources management and development in support of MDG goal 2/3 reduction in under 5 child mortality between 1990 and 2015. Theme 1 Service Delivery Reaching communities with essential health system delivery components of MCH, nutrition, immunization and environmental health, with emphasis on hard to reach areas Theme 2 Health Program Coordination and Capacity Building Strengthening coordination, management and organization of the health system at all levels with a focus on the Township Level Theme 3 Human Resource Management and Development Improving distribution, skill, number and mix of health workers with emphasis on hard to reach areas
- 4. HSS Objective 1: Service Delivery ď‚—By the end of four years, (180) selected townships with identified hard to reach areas will have increased access to essential components of MCH, EPI and EH and Nutrition as measured by increased DPT from 70% to 90% and SBA from 67.5% to 80% Activity 1.1: SURVEY: Access to essential component of PHC Surveys to establish baseline indicators & outcome, impact and research for operations (including mapping) 4
- 5. For description and analysis of health system gaps and bottlenecks at the Township level the following system areas were surveyed: ď‚—Health Management and Planning, including ď‚—Mapping hard to reach areas ď‚—Human Resource Management ď‚—Health Finance and Financial Management ď‚—Community Participation ď‚—Essential Drugs & Equipment ď‚—Infrastructure ď‚—Data Quality and Service Quality
- 6. HSS Objective 1: Service Delivery Activity 1.2: SUPPLIES: (UNICEF) Increase availability of Essential Supplies and equipment based on needs identified in HSS Assessment and Coordinated Township Health Plan (CTHP). Essential Drugs supply by UNICEF will be incremental for four years S&E to be provided to HSS townships Sub Center drugs (Paracetamol, Septrin, Misoprostol, ORS, ZnSo4) Hospital drugs (Inj Benzyl Pen, Gentamycin, Ampicillin, Metro, syringes, needle, scalp vein needle) MW kits/ Sub center kits (23 items) Renewable items for MW/Sub center kits (14 items) RHC kits (28 items) Renewable items for RHC kits (16 items) Clean Delivery Kits (1600/tsp –total 32,000) 6
- 7. HSS Objective 1: Service Delivery Activity 1.3: INFRASTRUCTURE: ď‚—Total Renovation of 540 RHCs (3 per township) Year 1 (60) RHC ď‚—Tot Construction of 324 new sub-RHCs (1.8 x 180 townships) Year 1 (36) Sub centers will be constructed ď‚—Installation of solar for (63) RHCs at hard to reach townships depends upon need in HSS Assessment surveys At present-still in negotiation with UNOPS for infrastructure 7
- 8. HSS Objective 1:Service Delivery Activity 1.4: TRANSPORT: Provision of essential transport for township and BHS to reach hardto-reach areas, based on needs assessment analysis in CTHP: ď‚—Reimbursement of recurrent transport cost to (20) townships to meet fuel cost for traveling (through CTHP) US$ 5000/Tsp/yr ď‚—Supply of transport capital to (20) townships based on needs identified in CTHP (Motorcycle/ bicycles/ scooters and boats) (through -RHC Plan prioritization given to most needy)US$ ? ? ? 2500/Tsp/yr 8
- 9. Activity 1.5: Social mobilization of NGOs, local authorities and VHWs in developing and implementing CTHP ď‚—Supportive activities for community involvement (Health Committee's activities) US$ 3,000/yr/Tsp ď‚—Training/recruitment of CHW in HTR areas (20 CHW/tsp at 20 townships) ď‚— Training/recruitment of AMW in HTR areas(20AMW/ tsp at 20 townships) ď‚—Refresher training for CHW (50 CHW per tsp x 20 tsp) ď‚—Refresher training for AMW (50 AMW per tsp x 20 tsp)
- 10. HSS Objective 2 ď‚—By the end of year 4, (180) selected townships with identified hard to reach areas will have developed and implemented CTHP. Activity 2.1: GUIDELINES DEVELOPMENT: Development and implementation of CTHP and financing schemes ď‚—Guidelines development for CTHP (including financial management and health financing) & supervision at all levels ď‚—Print and production of Guideline for CTHP (English & Myanmar) ď‚—Workshop on dissemination of HSS Assessment and sensitization of CTHP to S/R and townships and NHSC meeting ď‚—Conduct CTHP at 20 townships with BHS using Assessment results 10
- 11. HSS Objective 2 Activity 2.2. HEALTH FINANCING RESEARCH (mainly by DHP) Health financing research on financial management capacity and feasibility and effectiveness of health financing schemes in all HSS targeted townships ď‚— Development and production of policy brief and guidelines and SOP for initiation of Maternal voucher scheme (MVS) ď‚—Advocacy meeting to central level and township on MVS ď‚—Training to township level personnel on MVS ď‚—Awareness raising activity for MVS in the township ď‚—Actual implementation of piloting MVS in Yedarshay township in two contracts of six months ď‚—Administration & supervision cost for MVS 11
- 12. HSS Objective 2 ACTIVITY 2.3: TRAINING Training programme on coordinated management through the Management and Leadership program(includes health planning and supervision) in HSS targeted townships ACTIVITY 2.4: PLAN DEVELOPMENT ď‚— Management Support includes supervision and planning activities (from CTHP-for 20 townships) (US$ 10,000/Tsp/Year) ACTIVITY 2.5: RESEARCH AND EVALUATION Research and evaluation of process and impact of coordinated State and Township coordinated health planning and dissemination of findings ď‚—Annual Programme Review (Central level/townships including responsible persons from States/ Divisions) ď‚—HSR training workshop/ and Support for HSR (For HSS focused in targeted townships & For Central & S/D) 12
- 13. HSS Objective 3: Human Resource ď‚—By the end of year 4, 20 selected townships with identified hard to reach areas will be staffed by midwives and PHS2 according to the National HR Standards. Activity 3.1: RESEARCH: Strengthening Health Workforce at hard to reach areas in selected townships Research Programme for HR Planning with focus on distribution mix, function and motivation and management capacity (including financing) Development of conceptual framework and research on performance based systems and motivational factors for retention of Rural Health Workforce (Consultation to Dr Kyawt San Lwin, PhD Student for PH, UOPH) 13
- 14. HSS Objective 3: Human Resource ď‚—Multi-sector Workshop on development of HR Plan recommending financial/management/other support strategies for retention of health staff in HTR ď‚—Development of National HR Strategic Plan including strategies for retention and deployment of health staff in HTR ď‚—Feasibility Testing of HR Plan on retention and deployment of staff at township level based on analysis and research findings (one Township) 14
- 15. HSS Objective 3: Human Resource Continuing training in coordinated MCH, EPI, Nutrition and EH training programmes applying the principles of MEP Approach (Capacity building from CTHP) ď‚—Township level training for Coordinated Action of four programmes applying MEP approach ď‚—International Short Course for health financing (HITAP Training- Economic Evaluation and Health communication) 50,000 ď‚—Asia Region Study Tour on PHC planning & delivery system (Central + S/D + Township) 15
- 16. HSS Objective 3: Human Resource HR Finance incentive scheme development for health staff in remote areas - identified in township coordinated plans ď‚—Financial Support (Per-diem) for health staff in HTR areas (20 Townships) (20 Tsp x 5,775) US$ 115,500 Leadership development programme SSA for 4 Central Medical Officers (Programme management, Training and Research, M&E and Finance) SSA for 14 HSSOs Supporting activities for implementing HSS Copier, LCD& Office Equipment, Computer, printer for S/R and township levels 16
- 17. M&E Indicators Impact and Outcome Indicators 1. (morbidity, mortality and program coverage) Under 5 mortality (Township) 2. Township DTP3 coverage (%)( Pentavalent coverage) 3. 4. Number / % of districts achieving ≥80% DTP3 coverage (National) Delivery by Skilled Birth Attendants (HSS targeted Townships) 5. Rate of ORT Use of <5 children (Township) 6. % of 6-59 months children having Vitamin A during past 6 months (Township) 17
- 18. M&E Indicators 8. Output Indicators (health system capacity) % of townships have developed and implemented coordinated plans according to national framework Number/% of RHC visited at least 6 times in the last year using a quantified checklist (supervision) Number/% of sub centre visited at least 6 times in the last year using a quantified checklist (supervision) Number of managers/ trainers / BHS trained for Management and Leadership at each level per year (management training) Proportion of RHCs with no stock out of essential supplies in the last 6 months (availability, service access, utilization, quality) No: of RHC and sub RHC renovated and/or constructed per year, including improved drinking water and sanitation facilities % of selected Townships with identified hard to reach areas staffed by midwives and PHS2 according to the National HR Standards. % of Townships implementing Community based health insurance scheme 9. % Townships holding monthly Township Health Committee meeting 1. 2. 3. 4. 5. 6. 7. 10 % Townships have coordinated MCH package of services (ANC, Nutrition, ES, EPI) . 18
- 19. S/N State/Region Year 1 Townships 1. Kachin 2. Kayah 1.Bamaw 2.Shwegu Demawsoe 3. Kayin Hlaingbwe 4. Chin Hakha FIRST YEAR HSS TOWNSHIPS S/N State/Region Year 1 Townships 5. Mon 6. Rakhine 1.Thaton 2. Mudon Maungdaw 7. Shan(East) Kengtung 8. Shan(North) Hsipaw 9. Shan(South) Nyaungshwe 10. Sagaing Ye-U 11. Mandalay 12. Magway 1.Pyinmana 2.Lewe Htilin 13. Bago(East) Yedashe 14. Bago(West) Thayawady 15. Yangon Kawhmu 16. Ayeyawady Ngaputaw 17. Taninthayi Myeik
- 21. State/Region Year 1(2012) 2013-14 Kachin (16) Kayah (7) Bamaw, Shwegu Demawsoe Kayin (8) Hlaingbwe Prusoe, Shadaw, Bawlakhe, Meisai Kawkayeik, Myawady Chin (9) Hakha Htantalan, Tonzang Mon (8) Thaton, Mudon Bilin, Kyaikhto Rakhine (7) Maungdaw Ann, Gwa(replacement of Butheedaung) Moegaung, Mohnyin, Shan(East) (10) Kengtung Mongphyat, Mongpyin Shan(North) (21) Hsipaw Lashio, Kyaukme Shan(South) (14) Nyaungshwe Hopone, Loilem, Pinlaung Sagaing (13) Ye-U Wetlet, Mingin, Kalewa Mandalay (12) Pyinmana, Lewe (NPT) Thazi , Thabeikkyin, Magway (15) Htilin Setoktaya, Saw, Pwintbyu Bago(East) (6) Yedashe Thanatpin (replacement of Taungnoo),Kawa Bago(West) (6) Thayawady Paukkaung, Moenyo Yangon (11) Kawhmu Hmawbi, Taikkyi, Ngaputaw Laymyethna, Kangyidaunt Ayeyawady Taninthayi (7) (10) Myeik Taninthayi, Palaw, Yebyu
- 22. Summary Report Township X after HSS Assessment Availability of services - health services infrastructure, human resources and essential drug and equipment for example exist in adequate supply. Non availability of services - absence of human resources or ED or subRHC in a hard to reach or unreached area of the Township. Figure 8 Making a Summary Report Accessibility refers to the capacity of the population to access the service. Thou’ infrastructure and health staff and essential drugs may be available in the area, but the population may not be able to access the services due to physical barrier or financial constraint or inability to communicate with the health staff. Poor accessibility to health services can lead to low utilization of services. High utilization however does not necessarily mean high impact. The services are required to be of sufficient quality to ensure that there is public health impact. 22
- 23. Linking HSS Assessment to CTHP COORDINATED TOWNSHIP HEALTH PLAN STATION HOSPITAL & RHC COORDINATED PLANS Health System Areas Planning & Management Service Delivery Human Resources Community Participation Infrastructure Essential Drugs & Logistics System Transport Finance & Financial Management
- 24. Health system analysis examines gaps in operations across health programmes and service delivery units Making the transition from “management by project” to “management through systems” is a critical step in achieving:  Equity: in distribution  Efficiency through coordination and reduction of overlap of resources in favour of hard to reach areas  Effectiveness: improved health coverage  Sustainability: strengthening self reliance and management capacity 24
- 26. Thank You
Editor's Notes
- #3: Service delivery: preventive and curative personal health services; primary, secondary services and tertiary services (public/private/voluntary NGOs) Public health service; services for specific population groups such as children and women, or for specific conditions such as tobacco or alcohol problems Resources: trained staff, commodities, facilities and knowledge Financing: sources of funds such as user fees, insurance, tax,