The Road to Stronger Health Systems End of Project Report

The Road to Stronger Health Systems

End of Project Report

USAID-funded

Health Systems Strengthening II Project

2009 - 2014

Implemented by

Abt Associates Inc.

This report was prepared with support from the United States Agency for International

Development (USAID) through the Health Systems Strengthening II (HSS II) Project,

contract number GHS-I-00-07-00003-00


HSS II End of Project Report

I

Health Systems Strengthening II (HSS II)

The Health Systems Strengthening II Project (2009-2014) is funded by the United States

Agency for International Development and implemented by Abt Associates Inc. in

partnership with BAHA Consultant Engineering, Initiatives Inc., O’Hanlon Health Consulting,

LLC and TAGI Training.

HSS II Wadi Saqra, Arar Street, Bldg No. 215, Amman – Jordan Tel: +962-6-5655792 Fax: +962-6-5655793 www.hss.jo

Abt Associates Inc. 4550 Montgomery Avenue, Suite 800 North, Bethesda, MD 20814-

3343, USA Tel: +1-301-913-0500 Fax: +1-301-652-3916

HSS II END OF PROJECT REPORT

Task Order Contract Number:

GHS-I-00-07-00003-00

Submitted to:

Dr. Issam Omar: COR, Population and Family Health Office / USAID Jordan

Dr. Nagham Abu-Shaqra: Activity Manager / USAID Jordan

Submitted on:

October 29th, 2014

Disclaimer

The author’s views expressed in this publication do not necessarily reflect the views of the United

States Agency for International Development or the United States Government.

http://www.hss.jo/



III

MESSAGE FROM THE CHIEF OF PARTY

After an exciting and rewarding 5 years, HSS II has completed its implementation. At the

beginning, HSS II was designed to support national health priorities and improve public

sector health care with an emphasis on selected systems and services. Looking back, the

strategies we set and the programs we implemented yielded great returns, as they helped to

shape the direction of the strengthened Jordanian health system. The initial phase of

assessments was followed by intensive implementation of program activities in the field and

at the policy level by the Abt-led HSS II team, in full partnership with counterparts and

stakeholders.

Close to 85 Ministry of Health (MOH) health centers were successfully accredited.

Fourteen maternal, newborn and emergency departments at public hospitals were

renovated and equipped with state-of-the-art medical equipment. Across Jordan, hospital

staff was trained on evidence-based clinical guidelines, with best practices for maternal and

newborn care maintained at high levels. Family planning counseling and services improved in

hospitals and health centers. Upgraded health management information systems improved the use of data. Communities became more involved in the health system through more

than 100 community health committees established in different parts of the Kingdom.

While the project faced a number of challenges during implementation, HSS II continued to

meet its goals and undertake new initiatives addressing the country’s health priorities. I am

optimistic that even more progress will be achieved in the coming years. In this report, we

present some of the major challenges and lessons learned to help decision makers to further

improve health systems and services in Jordan.

None of this work would have been possible without partnerships and strong collaboration

with the true implementers of our joint programs. Without their interest, commitment and

energy, our own hard-working HSS II staff would not have been able to achieve any of the

impressive progress detailed in this report. First and foremost, these implementing partners

are the leaders, managers and health providers of the MOH, the Royal Medical Services

(RMS), the Higher Population Council (HPC) and Jordan University Hospital (JUH). Our vital

partners also included community volunteers who carried out impressive programs in their

own communities to improve health status. In addition, we have benefited from great

collaboration with other USAID projects and other organizations too numerous to mention

here.

To shape these joint efforts, we relied on excellent guidance and support from USAID,

which has been a dedicated partner ensuring that we are able to respond to emerging issues

and meet new challenges as they arise.

Finally, I would like to thank the people of Jordan not only for trusting USAID’s HSS II

project to strengthen the health system that serves them, but also for believing in the

potential for positive improvement of health outcomes.

Dr. Sabry Hamza

HSS II Chief of Party



V

TABLE OF CONTENTS

MESSAGE FROM THE CHIEF OF PARTY ............................................................. III

TABLE OF CONTENTS ............................................................................................. V

LIST OF ABBREVIATIONS ..................................................................................... VII

I. EXECUTIVE SUMMARY .......................................................................................... 1

II. ACHIEVEMENTS ..................................................................................................... 9

OBJECTIVE 1: PROMOTE THE PRINCIPLES AND PRACTICES OF KNOWLEDGE

MANAGEMENT (KM) AT THE MOH.............................................................................. 9

Context ............................................................................................................................................... 9

Approach ........................................................................................................................................... 11

Achievements ................................................................................................................................... 13

Sustainability ..................................................................................................................................... 14

Challenges ......................................................................................................................................... 14

Lessons Learned .............................................................................................................................. 14

OBJECTIVE 2: IMPROVE QUALITY OF CARE AT PRIMARY HEALTH CARE LEVEL ............ 15

Context ............................................................................................................................................. 15

Approach ........................................................................................................................................... 15

Sustainability ..................................................................................................................................... 20

Challenges ......................................................................................................................................... 21

Lessons Learned .............................................................................................................................. 22

OBJECTIVE 3: IMPROVE QUALITY OF SAFE MOTHERHOOD AT HOSPITAL LEVEL ......... 23

Context ............................................................................................................................................. 23

Approach ........................................................................................................................................... 23

Achievements ................................................................................................................................... 25

Sustainability ..................................................................................................................................... 28

Challenges ......................................................................................................................................... 28

Lessons Learned .............................................................................................................................. 28

OBJECTIVE 4: IMPROVE QUALITY OF AND INCREASE ACCESS TO FP/RH SERVICES .... 30

Context ............................................................................................................................................. 30

Approach ........................................................................................................................................... 30

Achievements ................................................................................................................................... 33

Sustainability ..................................................................................................................................... 36

Challenges ......................................................................................................................................... 36

Lessons Learned .............................................................................................................................. 37



VI

OBJECTIVE 5: IMPROVE COMMUNITY HEALTH ........................................................... 39

Context ............................................................................................................................................. 39

Approach ........................................................................................................................................... 39

Achievements ................................................................................................................................... 44

Sustainability ..................................................................................................................................... 44

Challenges ......................................................................................................................................... 45

Lessons Learned .............................................................................................................................. 45

OBJECTIVE 6: RENOVATE, EQUIP, FURNISH AND MAINTAIN HEALTH FACILITIES ....... 47

Context ............................................................................................................................................. 47

Approach ........................................................................................................................................... 47

Achievements ................................................................................................................................... 50

Sustainability ..................................................................................................................................... 52

OBJECTIVE 7: DEVELOP HUMAN RESOURCES ............................................................ 53

Context ............................................................................................................................................. 53

Approach ........................................................................................................................................... 53

Achievements ................................................................................................................................... 55

Challenges ......................................................................................................................................... 56

Lessons Learned .............................................................................................................................. 56

III. HAND-OVER OF HSS II PROGRAMS TO GOJ COUNTERPARTS AND

RECIPIENTS ......................................................................................................... 57

IV. HSS II CELEBRATES FRUITFUL PARTNERSHIP AND SUCCESSFUL

CONCLUSION .................................................................................................... 58

V. ANNEXES ............................................................................................................. 59

ANNEX 1: INDICATOR MONITORING ........................................................................................... 59

ANNEX 2: LIST OF COUNTERPART ADMINISTRATIONS AND DIRECTORATES ........................... 77

ANNEX 3: LIST OF 120 HEALTH CENTERS PREPARED FOR ACCREDITATION ........................... 78

ANNEX 4: LIST OF HOSPITALS THAT RECEIVED THE SAFE MOTHERHOOD PROGRAM ............. 81

ANNEX 5: LIST OF HOSPITALS THAT WERE UPGRADED THROUGH RENOVATION AND

EXPANSION WORKS ..................................................................................................... 82

ANNEX 6: LIST OF HOSPITALS THAT RECEIVED MEDICAL EQUIPMENT, FURNITURE AND

IT EQUIPMENT ............................................................................................................... 83

ANNEX 7: LIST OF UPGRADED TRAINING CENTERS INCLUDING EQUIPMENT AND

FURNITURE PROVIDED ................................................................................................ 110

ANNEX 8: LIST OF COMMUNITY HEALTH COMMITTEES ........................................................... 113

ANNEX 9: LIST OF HSS II PUBLICATIONS ................................................................................... 116

ANNEX 10: LIST OF HSS II STUDIES ............................................................................................. 117

ANNEX 11: LIST OF TRAINING PROGRAMS AND NUMBER OF TRAINEES ................................. 118

ANNEX 12: EXPENDITURE FOR CURRENT QUARTER (YEAR 5 – QUARTER 4) ........................ 123



VII

LIST OF ABBREVIATIONS

AIA American Institute of Architects

AMTSL Active Management of Third Stage of Labor

AWSO Arab Women Speak Out

BCC Behavior Change Communications

CHC Community Health Committee

CI Confidential Inquiry

CPAP Continuous Positive Airway Pressure

CPR Cardiopulmonary Resuscitation

CSB Civil Service Bureau

CYP Couple Years of Protection

DBE Directorate of Biomedical Engineering

DM Diabetes Mellitus

DPPM Directorate of Planning and Project Management

FP Family Planning

FP/RH Family Planning/Reproductive Health

FPLMIS Family Planning Logistic Management Information System

GOJ Government of Jordan

GP General Practitioner

GIS Geographical Information System

HA Hospital Administration

HC Health Center

HCAC Health Care Accreditation Council

HCAD Health Communication and Awareness Directorate

HD Health Directorate

HMIS Health Management Information System

HP Health Promotion

HPC Higher Population Council

HR Human Resource

HRH Human Resources for Health

HSMC Hospital Safe Motherhood Committee

HSS II Health Systems Strengthening II

IT Information Technology

ITD Information Technology Directorate

IUD Intrauterine Device

IV Intravenous

JAFPP Jordan Association for Family Planning and Protection

JHAS Jordan Health Aid Society

JU Jordan University

JUH Jordan University Hospital

KM Knowledge Management



VIII

KPI Key Performance Indicator

LAM Lactational Amenorrhea Method

LARC Long-Acting Reversible Contraception

LDP Liquid Display Panel

MCH Maternal and Child Health

MDG Millennium Development Goal

MMR Maternal Mortality Ratio

MOH Ministry of Health

NCD Non-Communicable Diseases

NGO Non-Governmental Organization

NICU Neonatal Intensive Care Unit

NNMR Neonatal Mortality Rate

OB/GYN Obstetrics/Gynecology

OJT On-the-Job Training

OPMT Operational Planning Monitoring Tool

PA Performance Assessment

PAC Post-Abortion Care

PDF Portable Document Format

PHC Primary Health Care

PIH Pregnancy Induced Hypertension

PIS Perinatal Information System

PPH Postpartum Hemorrhage

PP/PM Post-Partum and Post-Miscarriage

PRA Participatory Rapid Assessment

QD Quality Directorate

QI Quality Improvement

QUHs Quality Unit Heads

RDS Respiratory Distress Syndrome

RH Reproductive Health

RMS Royal Medical Services

RO Referral Officer

SDM Standard Days Method

SM Safe Motherhood

SHOPS Strengthening Health Outcomes through the Private Sector

TOT Training of Trainers

TWG Technical Working Group

UNRWA United Nations Relief and Works Agency for Palestine Refugees in the Near

East

USAID United States Agency for International Development

WCHD Women and Child Health Directorate

WHO World Health Organization

WISN Workload Indicator for Staffing Needs



1

I. EXECUTIVE SUMMARY

The Health Systems Strengthening II Project

The USAID funded Abt led HSS II project improved access to and quality of high priority

health care services in Jordan. Building on the partnership and experience gained under the

prior projects (PHCI, 1999-2005 and HSS, 2005-2010), HSS II continued to strengthen

health systems that directly support key aspects of the Jordanian MOH’s Strategic Plan. In

each program area, HSS II built the capacity of the appropriate government counterparts

and worked hand-in-hand with them through the stages of the project. All of the project’s

programs included capacity-building for counterparts on Needs Assessment, Joint

Planning, Use of Evidence, Best Practices and Use of Data for Improvement.

Strategies

The HSS II project focused on strengthening the Ministry of Health’s capacity by supporting

two of the Ministry’s core functions -Management (Systems and Processes) and

Service Delivery (Services and Programs). HSS II’s approach is organized into seven

strategies based on firm evidence that in order to improve delivery of priority health

services, constraints in the health system must also be addressed.

Figure 1: HSS II Strategies

Implementation Approach

To ensure integrated and institutionalized systems supporting priority health services, HSS II

worked at all levels of the Jordanian MOH system. Figure 2 illustrates the HSS II strategies

at each level and their intended purpose.

Improving Quality of and Increasing Access to FP/RH Services

Strengthening Selected Health Systems

Institutionalizing Knowledge Management Practices

Improving Quality of and Increasing Access to PHC

Services

Improving Quality of Safe Motherhood Services

Improving Human Resources for Health

Engaging and Empowering Communities



2

Central

Health

Directorate

Political Commitment at Central and Health Directorate (HD) Levels Enhanced

HD’s Capacity to Expand, Implement and Manage Systems Strengthened

Institutionalizing Knowledge Management

Practices

Strengthening Selected Health Systems

Health Management

Information Systems

Performance

Assessment

Human

Resources

Planning &

Supervision

Referral &

Appointment

Maintenance

System

Health

Centers

&

Hospitals

High Performing Systems Support Quality Health Services

Access to Essential Health Services Expanded

Quality of Essential Health Services Improved

Improving Quality of Safe

Motherhood and Emergency

Services

Quality Improvement

& Information

Systems

Renovation

&

Equipment

Improving Quality of & Increasing

Access to FP/RH Services

Method

Mix

Expansion

Decrease

Missed

Opportunities

Decrease

Unmet

Needs

Improving Quality of & Increasing Access to PHC

Services

PHC Accreditation

Community

Communities Practice Healthy Lifestyles

Engaging and Empowering Communities

Health Promotion Community Mobilization

Figure 2: HSS II Implementation Approach in Integrating and Institutionalizing Systems that Support Quality Health Services



3

Core Values Guiding Implementation: The basic principles that guided HSS II’s partnership with the Jordanian public health sector are:

Figure 3: Core Values Guiding HSS II Implementation

Core Values

Guiding Implementation

Trust and Confidence

HSS II earned trust and confidence through a variety of mechanisms including

joint planning, regular meetings and frequent communications, which

encouraged openness and transparency between the project and partners

Technical Excellence and Innovation

During its 5 years of implementation, HSS II provided the MOH and other

public health sector entities with technical assistance of the highest

standard and that reflected international best practices and

innovating

Collaboration and Partnerships

Key to the project’s approach was the spirit of collaboration and partnership with Jordanian stakeholders, whereby entities shared the risks and rewards of strengthening the health system

Results-Driven and Results-Oriented

Together with Jordanian counterparts, HSS II established realistic goals and expectations that reflected the MOH strategy, set the direction and guided

the project’s activities

Accountability

The HSS II team demonstrated commitment to working with Jordanian counterparts and

achieved the project’s milestones and results



4

Geographic Coverage

HSS II geographic coverage

extended from the central level to

the grass roots level across the

Kingdom. At the central level, the

project worked with the

Headquarters of the MOH, RMS,

HPC and JUH and other key

governoment entities and stake

holders. At the Governorate level,

the project worked with the

country’s 12 health directorates.

At the service delivery level, HSS II

programs and activities were implemented in 30 public sector

hospitals, 120 MOH health center

and more than 100 community

health committees in all areas of

the Kingdom.

Partnerships

Partnerships were central to the HSS II approach. To implement HSS II programs and

activites, Abt Associates Inc. was proud to partner with key government counterparts. In

addition Abt selected four organizations, “two international and two national”, with proven

track records in Jordan to assist with the implementation of selected programs and

activities.

Success of the Project

The USAID Midterm evaluation of HSS II was overwhelmingly positive, indicating that HSS II

was meeting its objectives and making an impact. The evaluation report, by independent

consultants, noted:

1 Irbid

2 Ajloun

3 Jerash

4 Mafraq

5 Balqa

6 Amman

7 Zarqa

8 Madaba

9 Karak

10 Tafilah

11 Ma'an

12 Aqaba

Figure 4: Governorates of Jordan

BAHA Consultant Engineering (Local)

Abu-Ghazaleh & Co. Consulting "TAG Consultants" (Local)

Initiatives Inc. (International)

O’Hanlon Health Consulting, LLC (International)

Ministry of Health

Royal Medical Services

Higher Population Council

Jordan University

Figure 5: HSS II Partners

http://en.wikipedia.org/wiki/Irbid_Governorate

http://en.wikipedia.org/wiki/Ajloun_Governorate

http://en.wikipedia.org/wiki/Jerash_Governorate

http://en.wikipedia.org/wiki/Mafraq_Governorate

http://en.wikipedia.org/wiki/Balqa_Governorate

http://en.wikipedia.org/wiki/Amman_Governorate

http://en.wikipedia.org/wiki/Zarqa_Governorate

http://en.wikipedia.org/wiki/Madaba_Governorate

http://en.wikipedia.org/wiki/Karak_Governorate

http://en.wikipedia.org/wiki/Tafilah_Governorate

http://en.wikipedia.org/wiki/Ma%27an_Governorate

http://en.wikipedia.org/wiki/Aqaba_Governorate

http://en.wikipedia.org/wiki/File:Jordan,_administrative_divisions_-_Nmbrs_-_colored.svg



5

"These strengthened health systems not only

help USAID and the project achieve their

objectives and better monitor performance,

they help the MOH do the same, which is one

of the reasons the MOH considers USAID a

critically important partner.”

The USAID HSS II Midterm Evaluation Report

"The HSS II project is highly regarded throughout the MOH for its responsiveness to

health needs and for its integrated approach to health delivery. The project has

strengthened critical health systems through its support to health management

information systems (HMIS), renovations, accreditation, referrals, and capacity-building.

Across all components, from beginning to end, the project has prioritized capacity-

building and institutionalization.”


"HSS II is on track to meet all its

objectives by the end of the project. The

project is well managed and has excellent

relations with both the Ministry of Health

and USAID".




6

Key HSS II successes:

Figure 6: HSS II Success Highlight

More information on specific successes and achievements can be found in the following pages, which summarize results by the seven HSS II technical areas.

•Renovated 9 obstetrics and neonatal and 5 emergency departments at public hospitals with state-of-the-art architectural designs, advanced equipment and best practice guidelines.

Renovated 14 Hospital Departments

•Contributed to reductions of maternal mortality from 41 to 19 per 100,000 live birth and neonatal mortality from 20 to 14 per 1000 live births.

Reduction of Maternal and Neonatal

Mortality

•Assisted the MOH to develop for the first time its five year family planning strategic plan, a major milestone in the MOH’s family planning efforts.

Family Planning Strategic Plan

•Reduced missed opportunities for family planning services and information through the introduction of post-partum/post-miscarriage services in 25 public sector hospitals.

Reduced Missed Opportunities for Family Planning

•Upgraded MOH’s data management capabilities to facilitate data-driven decision-making at all levels of the public health care delivery system.

Data Management

•Strengthened MOH’s information sharing channels through an overhaul of the MOH website and established different health management information systems.

Health Management Information Systems

• Improved the operational capability of primary health care centers through the innovative accreditation collaboratives.

Accreditation Collaboratives

• Institutionalized structured planning processes at all levels of the MOH to inform performance improvement initiatives.

Structured Planning

•Established the referral and appointment system at the MOH to streamline patient flow from the primary care to hospitals and to facilitate peer-to-peer learning between service providers at both levels.

Referral and Appointment System

•Developed the job descriptions for MOH staff to increase operational efficiency, improve staff satisfaction and enhance quality of care.

Job Descriptions

•Mobilized communities to adopt healthier life style through the establishment of more than 100 community health committee in all regions of the country.

Mobilized Communitites



7

Challenges

The extensive experience gained under HSS II and predecessor projects allows USAID, the

MOH, HPC, RMS and other counterparts to consider how best to capitalize on the

momentum achieved in recent years in strengthening health systems and improving

performance of priority programs, and to address remaining challenges that hamper the

performance of national programs including the FP program. Specific program challenges will

be comprehensively addressed within the details of the report.

Figure 7: Highlight of Challenges

Barriers to the Uptake or Continued Use of Modern FP Methods:

High use of traditional FP methods: The persistently high use of traditional FP methods in

Jordan reflects a combination of cultural preferences, misinformation about the safety of

modern methods, and lack of awareness or lack of concern about the high failure rate of

traditional methods among FP users as well as health providers.

Service-related barriers to access: The provision of IUDs by midwives remains uneven. In

2011, the MOH issued an amended job description for its midwives that included IUD

services, if they were supervised by a trained physician. This allowed the WCHD to resume

training and support for midwives to provide IUD services, but did not fully overcome the

concerns of both midwives and physicians regarding their legal protection against any

malpractice claims and about the role of the supervising physician.

Health system issues: During HSS II and its predecessor projects, the MOH received

technical assistance to improve systems and subsystems related to family planning service

delivery. Yet due to the lack of policies and logistics that are needed to enforce these

systems; the quality of services provided at the facility level is inconsistent. The supportive

supervision, planning and information systems need to be enforced at the health directorate

and facility levels.

Challenges

Barriers to the Uptake or

Continued Use of Modern FP Methods

Inconsistent Use of Data to Inform

Decision-Making

Human Resources Allocation and Management

Highly Vertical, Centralized Systems Hamper Progress



8

Outside Influences: The rapid influx of Syrian refugees and continued instability in the region

has had a profound effect on the Kingdom. Health facilities are stretching even further to

accommodate patient populations swollen with refugee families. The presence of Syrians and

other refugees in Jordan may lead some Jordanians to feel it is important to continue having

large families, in order to preserve the essential character of the Kingdom.

Inconsistent Use of Data to Inform Decision-Making

While access to data has improved, its use to inform decision-making remains inconsistent.

USAID has supported many health systems strengthening projects including HSS II to work

with the MOH to strengthen multiple data systems. However, additional efforts are needed

to ensure that MOH managers have timely and complete information, to increase the

efficiency of the public health system. Further work is also needed to support a culture of

data-driven planning among stakeholders.

Human Resources Allocation and Management

There is a lack of formal policies at the MOH to guide the allocation of staff based on the

best interests of the system. The current staff in some areas is either overstretched or

lacking the core competency needed to perform a job according to standards. This is also

associated with a lack of an incentive structure that motivates staff performance. There is a

common perception among MOH staff that their performance, good or bad, will not

influence their career development, chances of promotion or advancement, or assignments

in the future. This perception profoundly affects their attitudes and behaviors, particularly

when asked to do additional work to improve quality of care.

Highly Vertical, Centralized Systems Hamper Progress

Because of a high degree of vertical hierarchy in health services, the success or failure of

activities within a particular facility or Health Directorate often rests on a single individual.

At the same time, frequent movement of staff, especially high level staff, makes continuity of

efforts fragile.



9

II. ACHIEVEMENTS

Objective 1: Promote the principles and practices of knowledge

management (KM) at the MOH

Context

In 2009 MOH health management information systems were collecting large amount of

information at both hospital and PHC levels, both for health care and administrative needs.

However, these information systems were suffering from a number of challenges, such as

incomplete computerization, limited access to the computerized systems and the absence of

a well-developed data culture within the MOH. The importance of using information for

better decision-making was neither well understood nor appreciated.

One of USAID’s priorities is to continue supporting the MOH to develop, implement and

systematically utilize modern information systems and tools for improving the efficiency and

quality of health care. A number of HMIS were designed, upgraded and introduced in the

ten years preceding HSS II. HSS II was tasked to update and strengthen these systems to

provide the information needed, as well as to build the culture of using data for decision

making. Status of the HMIS at the outset of HSS II is detailed below:

Figure 8: Health Management Information Systems

Maternal and Child Health (MCH) Information System

This system was developed with the support of USAID during HSS predecessor project; it

used to provide management indicators and periodic reports readily available for each HC.

HSS II was tasked to link the FP data of the MCH system with the Logistics Information

system to provide a more complete picture of all family planning services provided at a HC,

indicators by HC for measuring the health status of women and children, and the means to

evaluate implementation of mandated norms. This system was partially institutionalized at

the MOH in terms of data collection, data cleaning and entry of HC cumulative data at the

HD level.

Health Management Information

Systems

(HMIS)

MCH

FP Logistics

PIS GIS

QI



10

FP Logistics Information System

This supply side system provided a complete picture of all family planning contraceptives and

supplies provided through the MOH’s Woman and Child Health Directorate. This system is

well institutionalized at the MOH.

Perinatal Information System

This system has been designed to deal with high risk pregnancies to prepare clinicians to

deal with complications before the patient presents to the hospital for delivery. The system

provides access to the patient’s record. Providers can review it prior to or upon receiving

the patient. It also reduces unnecessary or duplicate tests since a patient’s history of tests

and results are available when the patient presents at the hospital. Medical errors can be

reduced with access to the patient’s information at hospital and outpatient clinics.

Data collection for the perinatal system has started in some hospitals during the preceding project. HSS II was tasked to institutionalize this system.

Geographic Information System (GIS)

This system provided updated information on government and non-government services

that address social, economic, and personal factors which affect health. The system was

developed in the preceding USAID funded HSS project and made available on the MOH

website. At the beginning of HSS II the GIS system was not yet well utilized and the process

of updating data was not well defined at the MOH.

Quality Improvement (QI) Information System

The QI system was intended to provide performance indicators for each HC. These may be

reviewed regularly to monitor the accreditation process. This system also helps in the

development of annual work plans for improving the performance of a HC. The QI system

needed special attention under the HSS II project to improve the QI management

information system and computerization.

Performance Assessment (PA)

USAID originally assisted the MOH to introduce Performance Assessment (PA) to facilitate

the integration of an organizational culture which values and encourages good performance

and leads to the consistent practice of systematic performance assessments of individuals

and organizational units/departments. The PA-generated information was not used for policy

development or decision making which is mainly due to the lack of a monitoring and

evaluation culture at all levels of the MOH.

Knowledge management (KM)

KM appeared as an essential element of the recently developed MOH strategy. At the beginning of HSS II, introduction and subsequent operationalization of the concept of

knowledge management had not yet started at the MOH.



11

Approach

Over the course of five years, HSS II worked in full collaboration with the MOH in designing

and implementing interventions aimed at gradually developing a knowledge management

culture within the MOH. The project focused on strengthening of existing or development

of new HMIS systems where data/information is systematically used for better decision-

making.

HSS II focused on the following:

Establishing and promoting knowledge management practices

In order to facilitate the operational function and ongoing implementation of KM technical

initiatives, HSS II successfully formed and built the capacity of a Knowledge Management

Technical Team at the MOH central level. Together with this team, HSS II conducted an

assessment to explore KM practices necessary to respond to knowledge management needs

at the MOH. HSS II used the assessment results as a source for formulating the MOH’s

“Knowledge Management Strategic Plan”. To facilitate the implementation of the KM

strategic plan, a “Knowledge Management Implementation Toolkit” and a “Knowledge

Management Training Manual” were developed in collaboration with the MOH KM

Technical Team. These documents were used by the KM master trainers at the central

MOH level.

Strengthening MOH Information Technology infrastructure and staff capacity to

enable KM practices

Significant improvements were made during HSS II for each of the information systems

supported by the project in close collaboration with the MOH. This was achieved through:

Strengthening the capacity of MOH IT Directorate and HD IT units to maintain the HMIS and

MOH website

The KM Team procured IT equipment for the implementation of the HMIS in relevant

central directorates, health directorates, 120 health centers and 27 hospitals. Local area

networks were installed to enable proper connectivity and data flow.

HSS II worked closely with the MOH to improve the capacity of the ITD and the IT units at

each of the 12 health directorates, enabling them to provide increasing technical support to

health centers and hospitals. While the ITD capacity increased, HSS II gradually decreased

its technical role enabling the MOH become independent while still providing appropriate

support. As shown in the figure below, as the project progressed, more technical support

visits were carried out by the MOH ITD with an appropriate decrease in HSS II visits,

meaning that capacity was being transferred. Capacity building interventions included

provision of technical trainings aimed at strengthening skills in programming and

maintenance of systems. The project also developed processes and tools, such as IT

maintenance checklists and guidelines.



12

Figure 9: Number of Technical Support Visits by HSS II vs ITD

Towards the end of the project the interventions performed by HSS II were limited to

urgent cases only. Even in such cases, HSS II’s role was supportive as ITD staff took the lead

in providing the needed technical support:

Reviewing and updating existing HMIS (QIS, MCH, FPL, PIS, referral and appointment) and

developing new HMIS (NCD & OPMT)

In close collaboration with the MOH, significant improvements were achieved during

HSS II for each of the information systems. HSS II interventions targeted different central directorates, health directorates and facilities. Interventions included:

Forming technical committees to design the update of the tools and processes of the

HMIS. Processes included data flow, data quality checks and data analysis. Roles and

responsibilities were developed, and MOH policies were communicated to guide

implementation and ensure continuity.

Developing and printing new registries to be used as the data collection tools at the facility level. Supporting tools, such as user guides and technical documentation of

programs, were developed accordingly.

Building capacity at each point of the data flow to ensure proper updates and quality

of data.

Strengthening the capacity of the central technical directorates to assume their role

in the sustainability of the HMIS. This was done through two main strategies. First,

the project chose a programing language and architecture that would be easier to support. Second, the majority of the work was performed with full technical

involvement of the MOH ITD, thus ensuring their capacity building and knowledge of

the systems as they are developed.

Promoting the use of information generated by the HMIS by linking their output in

enhanced presentation tools (dash boards). Better and more accessible presentation

provides managers with a comprehensive view of performance and improves the

decision making process. Users from central, health directorates and facilities were

introduced to the system and the types of information generated.

30

50

80

90 95

100

125 120

102

80

65

20 15

10

30

55

35

25 30

55

75

100

120 120

0

20

40

60

80

100

120

140

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013

HSS IITechnical

SupportVisits

ITDTechnical

SupportVisits



13

Upgrading MOH website to act as a gate to access HMIS information

The MOH website was upgraded to more effectively function as a central point for sharing

information. This included upgrading the MOH hardware by providing two new high-

capacity servers, enabling better management of the increased data. Installation included a

Microsoft Share Point server as the main hosting environment at the MOH ITD, thus

reducing the amount of technical support needed in the long-term and increasing stability

and productivity.

HSS II redesigned the structure of the MOH website to function as a central collection point

for HMIS-produced data. The new design took into consideration the different types of

website users, ranging from health professionals to members of the public. Authorized users

can access, filter, and print all information related to MOH key performance indicators in

various presentation formats, including tables, graphs, Excel sheets and PDF documents.

Furthermore, through the upgrade of the MOH website, HSSII added more data analysis

functions to the Geographical Information System (GIS), which is an integral part of the

website. The GIS system is tied to all of the information systems that feed into the website,

including the human resources database, thereby making it easy for stakeholders and

decision-makers to determine the staffing needs of service delivery points.

Strengthen Performance Assessment Unit to promote a culture of performance

excellence

In addition to promoting a culture of KM, HSS II worked with MOH to instill a value of

“performance excellence” throughout the Ministry. In collaboration with the MOH, HSS II

conducted a rapid assessment in Year One to better understand the Performance

Assessment Unit’s staff capacity, processes and procedures and to develop a plan to

strengthen its capacity. Moreover, HSS II updated the PA methodology to reflect

international best practices and the King Abdullah Award for excellence requirements in the

field of PA. All change requires leadership commitment. HSS II worked over the life of the

project to foster, obtain and build MOH commitment for the PA plan, a PA culture and PA

practices. Interventions to build commitment included: raising awareness on best practices

of PA in public sector both in Jordan and elsewhere and establishing PA technical teams at

Central and HD levels to become change agents and early adopters of PA practices.

Achievements

These approaches enabled HSS II to meet its contractual results, and in some cases results

exceeded expectations. Results included, but are not limited to, the following:

120 health centers equipped with IT equipment

Technical departments at the HD and Central level received IT equipment

Technical MOH capacity at different levels strengthened to sustain the HMIS

Upgraded MOH website launched and functioning

Upgraded MCH information system functioning

Upgraded FP logistic information system functioning

NCD information system introduced

An electronic operational planning monitoring tool designed and introduced

Better documented use of HMIS

HD IT units assuming their role in maintaining the HMIS



14

Sustainability

HSS II worked in close collaboration with the MOH at different levels to obtain

commitment for continuity. Several interventions targeting sustainability were implemented

throughout the life of the project:

Empowered ITD with skills and tools related to maintaining and upgrading the systems.

Tactics included switching to more affordable technologies that can be maintained within

the available budget at the MOH. As an example, switching the website architect from

PHP and Oracle to Microsoft SharePoint enables the MOH ITD to better allocate

technical resources needed for scaling up the website.

Enhancing the linkages between central technical directorates (data owners) and the ITD

by defining roles and responsibilities and establishing needed communication channels

among relevant staff to ensure continuity.

Expanded the capacity of ITD programmers to be able to build software technical

documentation, upgrade and maintain the information systems.

With regards to infrastructure, HSS II installed devices at ITD that ensures the safety

and security of data such as firewall and backup devices.

Empowered HD IT units with needed skills and tools related to maintaining and

supporting facilities and improved the communication channels with the central ITD.

Challenges

High turnover of technical staff

Capability of MOH to recruit highly skilled software developers

Procurement mechanisms for IT maintenance support

Budget limitations for IT equipment

Lack of IT regional training labs

Weak culture of data use and IT capacity among MOH staff at all levels.

Lessons Learned

Involving technical data owners from the early stages of the design increases the level of

commitment and ownership

Engaging staff in all levels of data flow improves overall success and provides appropriate

distribution of responsibilities.

Strong leadership at each level of the MOH (central, HD and facility), coupled with

mandates and policies, is needed in order to ensure data generation and use.

Availability of technical staff close to data collection points will enhance and improve the

data collection process. IT units are assuming a very good role in solving field technical

issues.



15

Objective 2: Improve quality of care at primary health care

level

Context

In the late 1990’s, the Ministry of Health recognized the need to improve the quality of

Primary Health Care (PHC) provision to the Jordanian public. Being the most accessible healthcare outlet, the PHC system of the MOH includes 81 Comprehensive, 367 Primary,

and 252 Village Health Centers across the 12 governorates. Two USAID funded Abt-led

projects, the Primary Health Care Initiatives (1999-2005) and the Health Systems

Strengthening Project (2005-2010), created an enabling environment by establishing a robust

quality improvement structure at the central, health directorate, and health facility levels of

the Ministry of Health.

While the foundation for quality improvement was established, the MOH still in needed to

further develop the capacity of its staff, both technically and organizationally, in order to

apply quality improvement to the provision of PHC. With the support of the HSS II Project,

modern approaches to improving quality have been integrated into the primary health care

system and the QI structures that were established during Abt’s predecessor projects.

Approach

HSS II identified the need to integrate improvements in systems and services, accrued at the

health center level, under the umbrella of Primary Health Care Accreditation. As a result,

HSS II identified the “Collaborative Approach” as a mechanism for enhancing quality

improvement processes at the primary health care level thus advancing the process of

accrediting MOH health centers. Furthermore, and at Health Directorate Level, HSS II

recognized the need to foster the role of the quality councils in supporting accreditation of

health centers by strengthening operational planning and supportive supervision. In addition

HSS II helped the MOH implement a nationwide referral and appointment system. This system ensures that timely referrals to specialists are organized for patients who need them,

and unnecessary or self-referrals are avoided and assisted to improve operational planning

and supportive supervision systems.

Preparing 120 health centers for accreditation

HSS II systematically introduced, supported and implemented a PHC/FP QI Collaborative

approach that successfully prepared primary health care centers for accreditation.

The Accreditation Collaborative (AC) approach combined a traditional accreditation

preparedness method with a participatory improvement model that promoted rapid scaling

up of best practices through a planned spread strategy. Abt’s HSS II project led and assisted

the MOH to prepare 120 health centers for accreditation using the 18-month collaborative

approach, in which, multidisciplinary PHC teams participated in monthly learning sessions to

share experiences, understand the requirements of the accreditation standards and produce

action plans. In between sessions, PHC teams implemented standards, collected data, and

ran Plan-Do-Study-Act (PDSA) cycles. Together, MOH and HSS II teams provided technical

support to address barriers to standard implementation. At the end of the preparedness

phase, centers were formally surveyed by the Health Care Accreditation Council. Through

continuous capacity building, fully engaging MOH staff at all levels, and supporting systems at



16

the MOH, HSS II prepared the MOH to assume leadership of this process. Ninety five per

cent (95%) of participating health centers achieved accreditation following this approach.

The goal was ensuring that at least 50 of those centers would become accredited during the

lifetime of the project. Of the 120 health centers participating in the collaborative approach,

a total of 100 centers were nominated by the MOH to undergo a final survey by the

independent Health Care Accreditation Council (HCAC) in order to evaluate standards

being met. During the first and second collaboratives, 75 health centers received

accreditation. For the third collaborative, preliminary results indicate that 11 more centers

will achieve accreditation, bringing the total to 86 accredited centers nationwide.

Through its continuous collaboration with the MOH, HSS II ensured that the MOH was

prepared to assume responsibility for the process after the project ends. HSS II has shown

that a systematic design and application of PHC/FP QI Collaboratives to achieve large-scale

accreditation in a middle-income country like Jordan is feasible and effective. Adequate

capacity and leadership of the MOH is vital to its success. The MOH has demonstrated this capacity by initiating and leading their own PHC QI collaboratives in parallel with the

ongoing 2nd and 3rd collaboratives in the directorates of Mafraq and Ajloun, where each of

the two HDs worked with two of their health centers and with the QD in preparing for

accreditation.

In the 3rd collaborative, new family planning domains and standards were created by HSS II

staff working with WCHD. FP-specific learning session modules were also developed and

focused on improving access to long-term reversible FP methods, reducing missed

opportunities for FP services and improving quality of services. In order to be compliant

with standards, HCs were expected to have a minimum of four FP methods and provide

comprehensive counseling services. At baseline, 11 of the 31 participating HCs provided a

long acting reversible FP method. However, by March 2014, 20 of the 31 centers offered at

least one of these methods.

Two client satisfaction surveys were conducted during the 2nd Collaborative in 25 of the 59

participating health centers, and included 1,749 patients. Satisfaction was a composite of

client perceptions of how services and information were provided during their visit. Mean

scores were 77.5 percent for the 1st survey and 87.9 percent for the 2nd, illustrating a

highly significant (p<0.001) difference in client satisfaction between the two surveys:

1st Survey Score

Mean

2nd Survey Score

Mean Mean Difference (%)

Overall 76% 84% 8%

Section

‒ Access and Courtesy

‒ GP Services

‒ Dental Services

‒ Nursing Services

‒ MCH

‒ Pharmacy

‒ Accounting

84%

82%

72%

80%

75%

69%

73%

88%

88%

84%

87%

85%

82%

85%

4%

7%

12%

7%

10%

13%

12%

HC Environment 74% 89% 15%

Table 1: Client Satisfaction Surveys



17

Implementing a nationwide referral and appointment system

A high proportion of clients seen at hospital outpatient departments could be appropriately

treated at primary health care centers at lower cost to the client and the health care

system. In the past, referrals were not tracked, and feedback regarding services provided

was not received. Unnecessary referrals flooded the hospital system, overloaded specialists and staff, and hindered the ability of the government health system to provide optimal health

services. It is for this reason that the Ministry of Health, with the assistance of the USAID-

funded Health Systems Strengthening I and II projects prioritized strengthening the referral

and appointment system from primary health care centers to hospitals.

At all levels within the health care system, serious efforts have been made to implement

referral structures and processes to ensure adequate and timely referral of patients in need.

HSS II worked with the MOH to develop an effective referral system between health

centers and hospitals. To determine the effect of the AC on referrals, HSS II reviewed 30

health centers participating in the 2nd collaborative and a control group of 30 non-

participating health centers. The control group were selected from the same health

directorates and matched on health center type and average numbers of monthly patient

encounters with the participating AC centers.

Overall, referral system functioning in the 2nd accreditation collaborative health centers was

significantly higher (see table 2). In total, these centers implemented 78 percent (305/390) of

the referral requirements as compared to 72 percent (279/390) in the comparison group; a

statistically significant result (p<0.001). This can be attributed to the combined technical

assistance received by AC centers: mentoring by technical HSS II field coordinators,

strengthening adherence to standards including referral, and participating on HC

committees that monitor results.

Referral Functions 2nd Collaborative

(%)

Control Group

(%)

1. Administrative staff trained (Clerk) 87% 87%

2. Technical staff trained (Doctors and Nurses) 77% 90%

3. Phone lines and/or extension for referral

functioning 87% 83%

4. Referral register available 100% 97%

5. Referral forms available 100% 100%

6. HC Clerk enters patient referral data in a register 97% 93%

7. Hospital schedules appointments for referred

patients 80% 70%

8. Appointments noted in register 80% 40%

9. Patient referral forms received from hospital 78% 67%

10. Referral feedback entered in register 53% 47%

11. Monthly referral report produced and forwarded

to HD 100% 100%

12. HD referral analysis received 47% 50%

13. Referral analysis review by HC QI team 33% 7%

Total 78% 72%

Table 2: Improved Referral Functions at Health Centers



18

Table 3 shows the progressive improvement of the referral system at the collaborative

health center. Multiple functionality review were conducted periodically in participating

health centers which showed that the referral functions improved significantly in all health

centers where the total number of referral functions implemented increased from 61

percent to 78 percent. Maintaining trained staff remains a challenge; Table 3 indicates that

only 68 percent of clerks and 65 percent of doctors and nurses were found to be trained in

the 3rd review. High staff turnover and a lack of real-time monitoring of referral training

needs by referral officers at the HD level contribute to this weakness.

Al-Bashir is the MOH’s largest Hospital and is the Kingdom’s only tertiary referral hospital,

and thus it receives referrals from all directorates. In 2012, Al-Bashir’s emergency room,

operating seven days a week, saw 387,456 patients of which 281,540 were emergency cases.

The outpatient department (OPD), open five days a week, saw 554,434 patients, excluding

dental cases. To treat this high volume, Al-Bashir has 279 specialists who rotate through the

OPD. Comprehensive health centers (CHCs) are intended to take the majority of referrals

from primary health centers (PHCs) and serve as the source of referrals to Al-Bashir. HSS II worked with the MOH on improving the referral network of 17 satellite CHCs surrounding

Al-Bashir Hospital to streamline patient flow and enhance adequate and timely referral and

appointments. This required developing the referral capacity of the 17 CHCs as well as their

communication and referral links to Al-Bashir Hospital. The project also investigated referral

patterns between PHC centers and Al-Bashir Hospital to both evaluate provider adherence

and in order to better understand the factors prompting referrals.

Health Centers: 13 Functions

Implemented Referral

Functions

1st Review 2nd Review 3rd Review

1. Administrative staff trained (clerk) 75% 75% 68%

2. Technical staff trained (doctors and nurses) 73% 66% 65%

3. Phone lines and/or extension for referral

functioning 70% 77% 82%

4. Referral register available 95% 91% 93%

5. Referral forms available 98% 89% 98%

6. HC clerk enters patient referral data in register 81% 77% 95%

7. Hospital schedules appointments for referred

patients 50% 61% 79%

8. Appointments noted in register 61% 61% 77%

9. Patient referral forms received (by HC) from

hospital 52% 50% 70%

10. Referral feedback entered in register 30% 36% 75%

11. Monthly referral report produced and forwarded

to HD 73% 81% 98%

12. HD referral analysis received 25% 38% 49%

13. Referral analysis review by HC QI team 3% 25% 58%

Total 61% 64% 78%

Table 3: 1st, 2nd, and 3rd Reviews of Health Centers



19

Improving MOH strategic, operational, and action planning

For many years, inadequate strategic and operational planning at different levels in the

Jordanian health care system hindered performance improvement. Against this background,

USAID invested time and resources to support the MOH in strengthening and

institutionalizing the planning process at all levels: central, health directorate, hospitals and

health center.

The HSS II project was tasked with aligning the goals and objectives of the central MOH, the

health directorate and the health center to create a unified, but complementary approach to

planning. HSS II’s top-down, bottom-up approach to planning ensures that all ministry levels

create plans that are in line with the strategic priorities of the Ministry, while HD priorities

are shared with the HCs and HC targets are defined based on center capacity. HSS II

strengthened the planning process at all MOH levels: central HD and HCs through the

following accomplishments:

1. Developed and disseminated the MOH Strategic Plan 2013- 2017

2. Incorporated elements of the MOH Strategic Plan into Operational Plans at Health

Directorates and Action Plans in Health Centers;

3. Developed a monitoring and evaluation electronic tool to track progress in these plans,

in all health directorates and 3 central directorates that review their own progress

toward specific KPI and report to the planning directorate

4. Organized regular review meetings to assess progress of the MOH Strategic Plan

5. Supported the Quality Directorate to develop its strategic and operational plans, both of

which included specific objectives, targets and needed actions.

6. Assisted health directorates and the central MOH to conduct a mid-term review of the

annual operational plans

7. Established quality councils in the 12 HDs. These councils work as management bodies

to organize and coordinate the work in each health directorate.

8. Supported HDs to develop operational plans on yearly basis, Updated operational plans

included clear objectives, indicators, and results. Progress was monitored according to a

systematic rigorous progress.

9. Worked with all of the 120 health centers enrolled in the Primary Health Care/Family

Planning (PHC/FP) QI Collaborative to collect and analyze data on hypertension and

diabetes screening and management.

Improving supportive supervision systems

One of the project’s core strategies was to build the capacity of managerial and clinical staff

to sustain improvements. A strong supervision system can improve the effectiveness and

sustainability of the processes and systems that improve the quality of and access to high

priority health services. The rationale for choosing supportive supervision is that the

approach is facilitative and promotes mentorship, joint problem-solving and communication

between supervisors and supervisees. At the central level, the project focused on three

directorates: Quality, Women and Child Health (WCH), and Health Communication and

Awareness. The supportive supervision system was composed of four technical components: health promotion (HP), MCH, PHC, and quality. Supervisors from the central

directorates played an important role in ensuring the relevant supervisors at the 12 health

directorates supported the provision of service at the health facility level. HSS II assisted

MOH in the following:



20

1. Helped the MOH develop, introduce, and institutionalize a supportive supervision

system that encompasses the three ministry levels

2. in each HD, supervisors responsible for quality improvement (QI), maternal and child

health (MCH), primary health care (PHC), and health promotion (HP) were trained in

the supportive supervision approach and use of tools, consisting of supervision

guidelines and checklists

3. HD WCH unit heads and midwifery supervisors were also trained and supported to

strengthen HD supervisor skills and knowledge of supportive supervision

4. Roles and responsibilities of HD supervisors were defined and included in the newly

developed job description book.

5. Established a process for documentation of supervisory meetings and recommendations.

6. Assisted with the development of MCH central supervision guidelines.

7. Established the Quality Council, which included supervisors to review supervisory and

performance data during their monthly meetings.

8. Conducted assessments, developed supervision guidelines, checklists and training

curricula.

There is a supervisory structure in place at every HD and selected central directorates;

supervisors have been trained and have tools to guide their supervision visits. Some

supervisors are following the guidelines for the supervisory steps, including orienting and

updating of HC manager on the visit, use of checklists, feedback and joint development of a

provider improvement plan, as well as post-visit documentation of the findings. Two

supportive supervision assessments were conducted during HSS II. In 2010, the first

assessment found the supportive supervision system improved provider performance,

service quality and resolution of work problems, adherence to standards, and better

communication and follow-up. Areas for improvement include poor planning of visits, focus

on criticism, lack of regular supervisor visits and follow-up. The 2012 assessment focused on

MCH supervisors and service providers. Satisfaction with the supportive supervision

approach and support was over 70 percent among MCH supervisors, while 37 percent of

providers were always and 43 percent were sometimes satisfied. Preparation for

supervisory visits was high; more than half of the supervisors use checklists and follow

guidance on delivering supervision. Both supervisors and MCH service providers perceive

supportive supervision as effective and agree that supervisors were helpful in resolving

problems at the HD level.

Sustainability

The HSS II strategy for sustainability includes building on previously established work,

instilling sustainable quality improvement processes and procedures, and building the

capacity of the MOH to utilize those systems. The approach also aligns with the existing

MOH QI systems as it activates QI departments and policies in order to implement

accreditation standards in health facilities, thus improving the provision of health services.

The technical and organizational achievements render the MOH systems ready to achieve

further improvements in the provision of care:

The MOH showed its commitment by drawing on multiple central directorates

and departments, such as the Directorates of Planning, Quality Director,

Administrative Affairs, and Supply and Maintenance, to support the quality improvement

collaborative approach.



21

Health directorate and quality directorate staff has improved their fluency with

the standards and effective actions to increase adherence. As agents of change,

the staff is better able to transfer their knowledge to assist implementation of quality

improvement principles.

The MOH was able to initiate, implement and lead the PHC/FP QI Collaborative

Approach in the two governorates of Ma’an and Mafraq, with 3 of the 4 health centers

involved showing positive preliminary results for accreditation.

All 12 QUHs, one from each of the 12 HDs, has earned the consultant status through

the HCAC Accreditation Preparedness Consultant Training which was designed jointly

by HSS II and HCAC. The QUHs have the capacity to manage learning sessions,

and both QUHs and quality coordinators have monitored and aided HCs in interpreting

and achieving standards through using quality improvement methods, and can therefore

duplicate the process with the remaining MOH health centers.

The PHC Accreditation Implementation Toolkit was developed and includes all

MOH policies and procedures plus key steps for supporting the preparation phase and

resources for conducting learning sessions, monitoring progress, conducting evaluations, developing action plans for meeting the standards. This Toolkit may be

used by the MOH to duplicate the accreditation effort in additional health

centers.

The government has also recognized and endorsed the value of the Collaborative

Approach in improving health systems by including accreditation goals in its

official Strategic Plans along with earmarking a specific budget for its

activities. These are essential pillars needed to sustain the continuous quality

improvement processes following the HSS II Collaborative Approach.

Challenges

Overall, commitment and strong leadership are essential for the success and sustainability of

any improvements at the PHC level. True engagement, with the full assumption of roles and

responsibilities, as well as accountability ensures the continuity of quality improvement in

the technical and organizational processes of the provision of care.

Factors that may continue to challenge further success include:

1. High turn-over of staff, especially of those staff trained and established in their roles.

2. Lack of sufficient resources, including logistic support and specific budget for quality

improvement.

3. Weak engagement and commitment from leadership at any of the three levels: facility,

Health Directorate, or central. In the MOH, the central directorates and departments

may depend completely on one person, and technical and organizational reach to the

directorates and facilities is greatly diminished

4. Effective communication and feedback between the MOH organizational levels, and best

practices should be documented and shared within and across directorates, further

spreading development.

5. Leadership at the MOH much set up clear and complete criteria for selecting health

centers to participate in accreditation.



22

6. The health directorate should ensure adequate staffing, competent and well-resourced

QI teams, and release of QUH and QC for monthly supervision visits to review

adherence and support change to maintain quality services.

7. Budgets are needed for new and refresher training on accreditation and standards and

annual mock surveys to ensure gaps are identified and addressed early.

8. At the HC level, the manager’s commitment to maintaining accreditation standards and

supporting quality teams is a key success factor, and should be addressed by the HD

and the central QD. Immediate orientation of new staff on service delivery standards

and engaging all HC staff in monitoring standards is part of sustaining accreditation.

9. Incentives and recognition of HC achievements should be institutionalized and include

those who support HC staff as well as those who implement the changes.

Lessons Learned

The PHC/FP Quality Improvement Collaborative Approach is a participatory and

transparent improvement model that engages all relevant stakeholders and allows for rapid

scaling up of best practices through a planned spread strategy. While the traditional method

addresses single technical areas, the Collaborative Approach brings the advantage of

allowing a group of centers to cover a comprehensive cluster of health care services at a

time. Involved stakeholders thus gain capacity in applying continuous quality improvement

principles and that capacity is expandable to other areas of their work.

The referral system success was also impacted by the quality improvement collaborative

approach. Health centers participating in the collaboratives scored 78 percent on referral

functions; a similar control group scored only 72 percent; the results were statistically

significant. As important was the difference in implementation of the referral functions that

the HC is responsible for executing; the collaborative sites scored 73 percent, while the

control group scored only 57 percent. This demonstrates that learning in the collaborative

had an effect on the implementation of the referral functions.



23

Objective 3: Improve quality of safe motherhood at hospital

level

Context

According to a survey during 2007, deliveries and miscarriages accounted for 54% of female

admissions to obstetric and gynecological wards in MOH hospitals. But maternity beds are in short supply in densely populated urban areas. At Al-Bashir Hospital in Amman, the

MOH’s largest referral hospital, more than 20,000 deliveries took place in 2008 with many

women coming as “un-booked” cases. Optimal quality of care for mothers and neonates

cannot be achieved given this situation. Implementation of recently developed clinical

guidelines and accreditation standards presents a challenge to public sector hospitals. While

there is some difference of opinion over the actual maternal mortality ratio (MMR) in Jordan

of 41/100,000 live births from a 1995 study or WHO estimates of in 2005 at 62/100,000,

the policy implications and clinical interventions remain the same.

Infant and under-five child mortality has decreased to levels that are better than many

developing countries. However neonatal mortality represents 70 percent of infant mortality and will not likely be significantly reduced until focused efforts at improving key aspects of

in-hospital obstetrical and neonatal care are implemented and institutionalized nationwide.

Approach

In partnership with the Ministry of Health (MOH), Royal Medical Services (RMS) and Jordan

University (JU) hospitals, HSS II helped the Government of Jordan (GOJ) strengthen safe

motherhood services in the public sector. The Safe Motherhood (SM) activities are built on

earlier program accomplishments and designed to ensure that international best practices

are integrated into all public SM services. Among other priorities, HSS II works to

strengthen linkages between SM and family planning (FP) services, and foster continuous

quality improvement.

HSS II addressed SM goals using a multipronged approach aimed at improvement and

sustainability of high quality services:

Renovate, expand and equip MOH, RMS and JU hospitals to enhance their SM services.

(Discussed under Objective 6 of this report.)

Build the capacity of MOH, RMS and JU hospital staff to deliver high-quality obstetric,

neonatal and family planning services. Provide training on the mother-newborn package

of care to ensure understanding and use of best practices.

Strengthen the capacity of MOH, RMS and JU hospital managers to supervise the

delivery of high-quality SM services through Hospital Safe Motherhood Committees

(HSMCs).

Renovated, expanded and equipped MOH, RMS and JU hospitals to enhance

their SM services

HSS II worked with the MOH, RMS and JUH to institute improved quality oversight and

technical processes in public hospitals across Jordan to improve overall quality of care and

patient safety (discussed under Objective 6.)



24

Built the capacity of MOH, RMS and JU hospital staff to deliver high-quality

obstetric, neonatal and family planning services; provided training on the

mother-newborn package of care to ensure understanding and use of best

practices

Capacity building activities included:

•Developed maternal and neonatal best-practices guidelines for implementing the mother-newborn package of services, and disseminate to all public sector hospitals.

Best Practices

•Developed neonatal aseptic IV fluids preparation protocol and guidelines, and disseminate to all public sector hospitals.

Neonatal Aseptic IV Fluids Preparation

Protocol

•Developed Perinatal Information System (PIS) to track high risk pregnancies.

Perinatal Information System (PIS)

•Developed and used clinical performance checklists as a monitoring and educating tool to verify the quality of care.

Clinical Performance Checklists

•Conducted didactic and OJT training sessions on clinical guidelines and best practices to increase the healthcare providers competency with special focus on high risk cases including Magnesium Sulfate (MgSO4) use for patients with pregnancy induced hypertension (PIH), partograph use to prevent prolonged labor, active management of third stage of labor (AMTSL) to decrease postpartum hemorrhage (PPH), and provision of family planning (FP) postpartum PP/post-abortion care (PAC) services. Focus areas for neonates included: Introducing nasal continuous positive airway pressure CPAP system as a first line management for neonates with respiratory problems, neonatal resuscitation program (NRP), and support for breastfeeding and use of LAM

Didactic and on-Job Training

•Transferred lead responsibilities to the core trainers in MOH, RMS and JUH hospitals to provide supportive supervision, didactic and OJT for maternal and neonatal best practices.

Transferred Lead Responsibilities

•Developed standardized Essential Obstetric Care and Neonatal Care medical records to enable health providers to provide high quality services, improve their ability to monitor the implementation of the clinical practice guidelines, and to increase the readiness of the hospitals to respond to one of the accreditation requirements to have standardized medical records.

Medical Records

• Institutionalized structured planning processes at all levels of the MOH to inform performance improvement initiatives.

Monitored Maternal and Neonatal Indicators



25

Strengthened the capacity of MOH, RMS and JU hospital managers to supervise

the delivery of high-quality SM services through Hospital Safe Motherhood

Committees (HSMCs)

To achieve sustained quality improvement in maternal and newborn care, the project

established Hospital Safe Motherhood Committee (HSMC) in 30 public hospitals. The

purpose of this committee is quality planning, monitoring and improvement. The HSMCs’

achievements include:

1. Raised awareness of the hospital staff about

main causes of maternal and neonatal

mortalities and morbidities through

confidential inquiry into maternal mortality

and near-misses.

2. Monitored the quality of safe motherhood

services by evaluating certain disease specific indicators, generated data on

regular basis to inform quarterly safe

motherhood improvement plans.

3. Improved the documentation within the

medical records

4. Regular committees’ monthly meetings

were held in which they discussed

problems, gaps and constraints.

5. Annual hospital operational plan developed

by the HSMC members with certain goals

and objectives to further reduce morbidities

and mortalities.

Achievements

Improved Neonatal Survival with Enhanced Technology: HSS II provided 30

hospitals with the CPAP system, and built the capacity of health providers on its use in

managing premature neonates with respiratory distress. This technology is non-invasive

and can substitute for the use of a ventilator in many cases. Its use in Jordan’s public

hospitals has resulted in pronounced improvement in neonates suffering from

respiratory distress with more than 90% survival rate.

Figure 10: HSMC Meeting

Figure 11: Neonatal Nurses Practice Assembly of

CPAP

87%

89%

92% 92%

2011 2012 2013 2014

Improved Neonatal Survival Rate

27 public hospitals reporting

Figure 12: Neonatal Survival Rate in Public Hospitals during

Years 2011-2014

There is consistent improvement in the

survival rate of inborn neonates

admitted into the neonatal intensive

care unit. The target for Y5 is 90%.

HSS II has exceeded its target on this

indicator. Several significant changes

introduced by HSS II have contributed

to this improvement: infrastructure

renovation including state of the art

incubators, better – trained service

providers, and introduction of CPAP and

aseptic preparation protocols.



26

Reduced the Risk of Neonatal Sepsis: according to the Jordan Perinatal and

Neonatal Mortality Study Final Report, January 17, 2013 (UNICEF), respiratory distress

syndrome (RDS) was the leading cause of death (53.5%). The most common cause of

death following RDS was sepsis (16.2%). HSS II therefore performed a needs assessment

report on IV preparation at the neonatal intensive care units in public hospitals, and

developed recommendations to overcome the practical challenges in infection

prevention that are faced by the staff in public Neonatal Intensive Care Units in Jordan.

HSS II formed and supported an interagency technical working group (TWG) from the

three public institutions to develop “Aseptic I.V. Preparations and Infection Prevention

Guidelines” and to train core trainers from each institution to introduce them to NICU

staff. Data shows the decrease in neonatal sepsis in selected hospitals.

Year

Total

Number of

Newborns

Delivered

Total

Number of

NICU

Admissions

Number of

Neonatal

Deaths in

NICU

% of Death

among NICU

Admissions

Number

of Death

due to

Sepsis

% of

Sepsis as

a Cause

of Death

2009 3467 909 68 7.5

2010 4165 820 77 9.4 12 38.7

2011 4061 730 71 9.7

2012 4127 857 47 5.5 - -

2013 4204 751 39 5.2 8 20.5

2014

(Jan-June) 529 523 15 2.9 0 0

Table 4: Reduced Deaths due to Neonatal Sepsis at JUH, the Largest Referral

Hospital in Jordan

Reduced the Risks of Pregnancy and Child Birth: in an effort to further reduce

maternal mortalities in hospitals, HSS II has helped the public hospitals to institutionalize

best practices embraced by the international health community, including but not limited

to the systematic use of:

Active Management of Third Stage of Labor (AMTSL) to reduce post-partum

hemorrhage deaths

Partograph to monitor women and babies during childbirth and to prevent prolonged labor and its complications

Perinatal information system (PIS) to track high risk pregnancies

Magnesium sulfate to manage pregnancy-induced hypertension and to prevent

convulsions

Use of confidential inquiries into maternal deaths and near misses to improve the

quality of safe motherhood services

Created a Culture of Quality: HSS II helped form and activate 30 (23 MOH, 6 RMS,

and 1 JU) HSMCs in public hospitals to act as supervisory bodies for safe motherhood

and neonatal care. Main roles and responsibilities of HSMCs are planning, monitoring

and quality improvement of all SM interventions within their hospitals.



27

77%

81%

86% 87%

91%

2010 2011 2012 2013 2014

% of women monitored with

partograph 23 public hospitals reporting

Figure 14: %of Patients with PIH Managed according to Clinical Guidelines

79% 79%

88%

86%

89%

2010 2011 2012 2013 2014

PIH patients managed according to

clinical guidelines 23 public hospitals reporting

HSS II introduced an improved

partograph to public hospitals.

The chart shows a consistent

increase in the percentage of

women monitored with this

improved partograph.

HSS II has contributed to a 10%

(Y1-Y5) increase in cases of

pregnancy-induced hypertensive

patients managed according to

best practice guidelines.

25%

40%

65% 65%

2011 2012 2013 2014

% of Hospitals using Confidential

Inquiries 29 public hospitals reporting

There is a significant

improvement in this indicator

from Y2 to Y5.

Figure 13: % of Women Monitored during Labor Using Partograph

Figure 15: % of Hospitals Using CI into Maternal Mortality and Near-Misses



28

Sustainability

Hospital Safe Motherhood Committees (HSMC) functioning in 30 Hospitals are a key

aspect of institutional sustainability. Their tasks include tracking performance indicators,

developing action plans to address any weaknesses and presenting progress reports to

the Hospital Director on a regular monthly basis.

A Technical Working Group (TWG) led by the Chief of Ob/Gyn Specialty from central

MOH and including all the Heads of Ob/Gyn departments of the six teaching hospitals is

meeting regularly to jointly analyze confidential inquiries into maternal mortalities and

near-misses, implement safe motherhood improvement interventions and submit reports

to the MOH leadership.

Core trainers in MOH, RMS and JUH hospitals are capable to lead provision of

supportive supervision, didactic and OJT for maternal and neonatal best practices and

clinical guidelines

Health Directorates and HSMC use an operational planning system for SM services to

monitor and improve hospital’s performance on annual basis

New standardized Essential Obstetric Care and Neonatal Care medical records will

enable health providers to provide high quality services, improve their ability to monitor

the implementation of the clinical practice guidelines, and to increase the readiness of

the hospitals to respond to one of the accreditation requirements to have standardized

medical records

Challenges

Unmet need for central MOH support to Hospital Safe Motherhood Committees

Inconsistent commitment of HSMCs to work because of lack of recognition, incentives

or sanctions concerning their roles and responsibilities

Reluctance of hospital staff to fully implement confidential inquiries into maternal

mortalities and near-misses, mainly because of fear from punishment and litigation

Lack of consistent PIS data entry, and data utilization for decision making

Lack of sufficient qualified human resources, because of the high turnover of trained staff

to health centers

Lack of sufficient funds for organizing and conducting trainings, incentives for core

trainers, and transportation reimbursement for trainees coming from remote areas

Lessons Learned

The commitment of the hospital’s staff in establishing and activating HSMCs and

sustainable hospital interventions is a crucial point for the success and sustainability of all

interventions. Recognition, incentives, and the presence of an oversight body from the

central Ministry of Health to encourage and support the hospitals is a critical factor for

success.

The CPAP technology proved to be non-invasive with an excellent survival rate

exceeded 90 percent. Therefore, consumables needed for CPAP system should be

included in the annual procurement list of MOH and RMS.

Didactic and on-job training of SM providers is an on-going need that requires extensive

use of human and financial resources. Longer term solutions must be pursued within the

MOH that includes recognition of the extra work done by core trainers and recognition

of decentralized on-job training.



29

Staff performance should be supportively supervised and closely monitored to improve

the effectiveness of various safe motherhood interventions.

Information/data from the perinatal and supervision monitoring systems should serve as

the basis for regular monitoring and feedback in order to ensure that safe motherhood

interventions are meeting their targets and objectives.

The current Safe Motherhood Committees in hospitals have to be translated into a

more institutionalized and supported system. This system must be able to track and act

upon maternal and neonatal deaths in all public hospitals, through maternal mortality

surveillance system.



30

Objective 4: Improve quality of and increase access to FP/RH

services

Context

Improving access to and quality of family planning services is a priority for USAID and the

Government of Jordan because high rates of population growth will impede continued social and economic progress in Jordan and have a negative impact on maternal and child health.

After impressive progress in earlier decades, the modern contraceptive prevalence rate

plateaued at 42% since 2002 and the total fertility rate has hovered around 3.6 since 2007; it

was 3.8 as of the start of the project in 2009, according to the Jordan Population and Family

Health Survey. In 2009 the use of traditional family planning methods such as withdrawal

was high at 17% among married women and 26% of married women stated their last

pregnancy was unintended.

Health Centers of the MOH, supported by Health Directorates in each of the 12

governorates of Jordan, are the main source of primary health care including family planning

(FP) for many women in Jordan, especially those of middle and lower income. Therefore the FP services provided at these centers, and the management of these services at the

governorate level, are critical factors in FP program growth. The method mix at the lowest

level of the public health system at the start of the project was limited; especially access to

long acting reversible methods - IUDs and Implanon. Access to female physicians was and is

low in the public sector; women health providers are the preferred source of FP in general

and IUDs in particular. In 2010 an additional issue emerged – trained midwives who had

previously been providing IUD services in MOH health centers (HCs) were advised they had

no legal coverage for this service, so provision of IUD services in MOH HCs declined

sharply over the following year.

Public hospitals also constitute an important source of reproductive health care; 65% of Jordanian women deliver in public hospitals and post-miscarriage treatment constitutes

around 8% of obstetrics and gynecology (Ob/Gyn) admissions at MOH hospitals. At the

start of the project none of the public hospitals in Jordan were providing FP information,

counseling or services to women in the postpartum/post miscarriage period before they

were discharged from the Ob/Gyn department.

To ensure availability of high quality FP services, related policy and health systems also

needed support. There was no MOH policy specifically related to FP services; health

managers at different levels had insufficient information regarding FP service delivery; and

the supervision system needed improvement. The lack of clarity regarding MOH

authorization of midwives to perform IUD services hampered access to this popular method. Midwives were not exposed to FP during their pre-service education, and general

physicians were not prepared to supervise them in their FP work.

Approach

Building the managerial and clinical capacity of the MOH, the Royal Medical Services (RMS)

and other key institutions in FP has been a core strategy under HSS II. The HSS II team

collaborated with these stakeholders to enable them to improve access to high-quality

family planning information and services throughout the Kingdom.



31

The Women and Child Health Directorate (WCHD) of the MOH led most of these

activities, since this directorate is in charge of family planning service delivery throughout

the MOH. HSS II supported the WCHD to work with other national stakeholders to

accomplish the above results, organized around three main objectives:

In addition, to support increased use of family planning services, HSS II worked to engage

and empower communities to adopt healthier lifestyles, including birth spacing, as explained

under Objective 5.

A) Strengthening the supportive policy environment for FP

In coordination with the Higher Population Council and through evidence based advocacy

and policy dialogue, HSS II assisted the MOH and RMS to address policy issues that impeded

progress in FP services. HSS II assisted the MOH WCHD and the other stakeholders to

accomplish the following steps:

1. Developed and disseminated the MOH FP Strategic Plan 2013-2017;

2. Incorporated elements of the MOH FP Strategic Plan into Operational Plans at Health Directorates and Action Plans in Health Centers;

3. Developed a monitoring and evaluation framework to track progress in these plans,

including formation of FP Committees in all Health Directorates that review their own

progress, develop plans to address challenges and report to the Women and Child

Health Directorate;

4. Organized regular regional and national review meetings to assess progress of the MOH

FP Strategic Plan and of RMS FP activities;

5. Participated in the development of the National FP Strategy with the Higher Population

Council;

6. Helped address specific MOH policies and regulations on FP service delivery; advocated

to add IUD services to the job description of midwives and to issue a policy that

addresses deployment of trained providers ;

7. Developed policies regarding postpartum and post-miscarriage FP services and

outpatient FP services in hospitals

8. Assisted in expanding human resources for FP service provision through a task-shifting

approach; this includes introduction of FP counseling by regular MCH nurses, with initial

training of the nurses on FP counseling

9. Integrated family planning information and standards in nursing, medical and

pharmaceutical curricula of Jordan University and Jordan University for Science and

Technology and the midwifery diploma at Princess Muna Nursing College.

•Develop and implement policies and strategies that created a supportive environment for FP in the Kingdom.

Supportive Environment

for FP

•Improve quality of, and increase access to, family planning counseling and services in public health centers and at public hospitals

Improve Quality and Access to FP

•Expand and improve performance of systems that support quality FP services

Improve Performance of

Systems

Policy

Systems Services



32

B) Increased access to and quality of modern FP methods

HSS II used a comprehensive approach to improve public sector FP services, working with

the WCHD and other stakeholders such as the Royal Medical Services and Jordan

University Hospital in public health centers, health directorates and hospitals to expand and

upgrade their FP approaches and services. To strengthen FP service delivery in primary

and comprehensive health centers, HSS II worked closely with the MOH WCHD to

undertake a series of steps:

1. Updated evidence-based clinical guidelines for FP services, and disseminate these to all

Health Directorate and HC staff;

2. Established a core of family planning trainers within the MOH and RMS

3. Developed and implemented didactic and on-the-job training approaches to reinforce

compliance with the updated FP clinical guidelines;

4. Provided in-service clinical training of 125 midwives and 69 physicians on IUD services

and 187 physicians on Implanon services;

5. Supported Health Directorates to increase supportive supervision of FP providers in

health centers using updated supervisory tools;

6. Strengthened midwives’ and nurses’ capacity to provide high-quality FP counseling

services through didactic and on-the-job training programs on FP counseling;

7. Built HC staff capacity to manage FP issues by encouraging them to develop their own

action plans, using FP quality indicators to monitor their progress;

8. Reduced missed opportunities for FP by raising awareness of other health providers at

the center (those providing curative care, for example) to identify and refer women with

unmet needs for family planning services to the MCH unit of the clinic;

9. Fostered a positive attitude among midwives, nurses and physicians from MOH health

centers toward FP, through structured behavior change communication sessions that provided convincing evidence of the value of FP in protecting health, and corrected

common misconceptions about side effects.

10. Provided clients with FP information within the health facilities through visual aids such

as posters and calendars, particularly in the immunization and general practitioner areas

of health centers;

To expand access to FP services in hospitals, HSS II helped the MOH, RMS and Jordan

University integrate them within postpartum and post-miscarriage (PP/PM) services:

1. Developed the Standards for Postpartum & Post-Miscarriage Family Planning Services

and related training curriculum;

2. Built the capacity of Ob/Gyn wards and out-patient clinics service providers on FP counseling and services using updated FP clinical guidelines;

3. Developed and introduced the use of FP-related job aids in hospitals;

4. Developed and implemented a regular reporting system in which midwives in each

hospital completed forms that were reviewed within the hospital and then submitted to

the central MOH (WCHD and HA);

5. Assured that the Hospitals’ Safe Motherhood Committees monitor PP/PM FP services

through agreed upon performance indicators using the reports that are discussed within

their monthly meetings and semi-annual meetings with other hospitals;

6. Strengthened midwives’ and nurses’ capacity to provide high-quality FP counseling

services through didactic and on-the-job training programs on FP counseling;



33

7. Supervised the implementation of PP/PM FP policies disseminated at hospitals through

field visits and OJT;

8. Established, equipped and furnished a special FP counseling and services room within the

Ob/Gyn wards of 15 hospitals.

C) Expand and improve performance of systems that support quality FP services

Many of the systems and processes introduced, expanded or improved in collaboration with

the MOH and other counterpart institutions under other HSS II objectives, notably under

the Knowledge Management and Quality Improvement objectives, directly support quality

FP services. These included:

Under Objective 1:

1. Improved the MOH Logistics Management Information System to generate indicators

needed to track progress of the MOH FP strategy

2. Improved the performance of the MOH Maternal and Child Health Information System

by updating the parameters collected from health centers, developing a full set of

indicators sheets, related log books and reporting forms, with HD data entered into the

MOH website.

3. Facilitated MOH FP program management through the creation of a dashboard that

displays regularly updated key indicators such as CYP by health directorate and by

facility and number of HCs providing at least four modern FP methods;

4. Developed a computerized system to enter monthly PP/PA FP reports from hospitals

and generate related indicators and graphs;

Under Objective 2:

1. Used the Operational Planning and Action Planning systems introduced in Health

Directorates, HCs and hospitals to develop specific indicators and targets for FP and to

monitor their progress; and

2. Improved the oversight and quality of FP services through the enhanced MCH Supportive Supervision System performed by HD MCH staff and WCHD staff in the

central MOH.

Over the course of the project, HSS II also undertook in-depth studies to better

understand the dynamics of FP provision, acceptance, and behaviors in Jordan. These studies

were useful in achieving consensus with key stakeholders concerning specific aspects of FP

service provision and informed subsequent work plans.

As explained under Objective 5 in this report, HSS II also worked extensively to engage

and empower communities to adopt healthier lifestyles, including birth spacing.

Achievements

The combined efforts of the MOH Women and Child Health Directorate, Hospital

Administration, Health Directorates, hospital and health center staff, RMS and JUH with HSS

II project personnel were instrumental in re-energizing FP service delivery and helping

improve access to high-quality family planning information and services throughout the

Kingdom.



34

The MOH FP Strategic Plan 2013–2017, a first for Jordan, sets clear objectives and timelines.

Activities to meet the goals of the plan are systematically included in health directorate and

health center action plans, and their performance is regularly monitored. HSS II also helped

the MOH Women and Child Health Directorate reverse a 2010 MOH decision to ban

midwives from inserting IUDs. Over two thirds (68%) of post-partum patients now receive

FP counseling before discharge at 25 public hospitals that offer postpartum FP services. The

percentage of MOH primary health and comprehensive health centers offering four or more

family planning methods, including at least one long-acting reversible method, rose from a

low of 19% in 2011 to 33% by end March 2014.

This chart shows CYP for all MOH

health facilities (clinics, hospitals) in

Jordan. Increasing CYP has been

challenging, mainly due to

interruptions in service provision as

a result of conflicting regulations

regarding IUD insertion by

midwives. (These challenges have

been discussed at length in previous

reports.) However, as the chart

shows, overall, there is a clear

upward trend in CYP levels

between 2011 and 2013. The

sustained increase health centers

inserting IUDs and four modern

methods, as shown in the following

chart, attests to this upward trend.

Figure 17: Number of MOH HCs Providing at least 4 Modern FP Methods

Here again we observe a significant upward trend in the number of HCs providing at least four

modern methods. The data are from the Logistics System, an institutionalized health information

system at the MOH. According to the latest figures (January – March, 2014), 33% of MOH HCs are

providing at least four modern methods.

106

92

80

97

111

127 118

128 131 138

130 137

145

Number of MOH HCs Providing at least 4 Modern FP

Methods

110,258 115,697 113,038

2011 2012 2013

Couple Years of Protection

Figure 16: CYP for MOH Health Facilities in Jordan



35

Figure 18: Number of HCs Inserting IUD Each Year

In order to get a better picture of uptake of modern FP trends, it is useful to disaggregate modern

FP methods. This chart shows the consistent increase in the number of HCs providing IUDs, which

are the most popular modern method in Jordan. Between 2011 and 2014, the number of HCs

providing IUDs increased two fold.

Figure 19: % of PP/PM Clients who Received FP Counseling and Services before Discharge from

Public Hospitals

88

114

133

160

2011 2012 2013 2014

Number of HCs Inserting IUD

(for at least 8 months in each year)

33%

19%

43%

21%

38%

24%

36%

16%

53%

32%

54%

24%

68%

34%

59%

27%

% of PP Counseled % of PP Received Modern FP

Method

% of PA Counseled % of PA Received Modern

FP Method

Percentage of Postpartum (PP) & Post-Miscariage (PM) Clients

Received Family Planning (FP) Counseling & Services before

Discharge from Public Hospitals

Jun-Dec 2011 (13 Hosp) Jan-Dec 2012 (17 Hosp)

Jan-Dec 2013 (22 Hosp) Jan-Aug 2014 (25 Hosp)

“I wish that earlier on I had someone talk to me about family planning. I am glad now that I will

have a reliable method that will allow me to take more care of myself and my kids, and will

enable me to continue breastfeeding Ra’fat for two years.”

Sumaia, a 20 year old Jordanian mother who gave birth to her third baby, Ra’fat, at Prince Faisal MOH

Hospital in Zarqa in June 2013



36

Sustainability

Key personnel (FP managers, trainers, supervisors, clinicians and counselors) at every level

of the MOH system currently have the technical capacity to maintain FP services within

health centers and hospitals. They also have established systems and processes to support

them, including standardized operational planning, supervision, monitoring and reporting

systems.

The MOH FP Strategic Plan is used at every level of the MOH to track progress, with

accountability for performance at the HD, Hospital and national levels (e.g., FP

committees, HSMCs)

Core trainers are capable of training staff in FP operational planning, counseling,

contraceptive technology updates, clinical services and logistics

Supportive supervision policy and system for FP services that Health Directorate and

WCHD can use to monitor and improve performance

The WCHD has demonstrated leadership in engaging HDs, other Directorates of the

MOH, and other partners to review their own progress in supporting FP services,

identify weaknesses and make plans to address these weaknesses. The formation of FP

Committees in every HD, and regular regional meetings among FP managers and

supervisors to review their progress, are good examples of this type of program

leadership that bodes well for sustainability of the national FP program.

The WCHD has taken responsibility for aggregating FP data from all MOH, RMS and JU

hospitals providing PP/PM FP services and generating related indicators.

Prior to the project, the MOH took on full responsibility for purchase and distribution

of contraceptive commodities for its own facilities and for other partners participating in

the national FP program, including the RMS, JUH, JFPP and UNRWA, and the NGOs and

private physicians collaborating with the SHOPS project. To date they have fully met

the current demand for contraceptives across all of these organizations.

However, there are several issues that hamper sustainability of the national FP program,

acknowledged by our counterparts. These are discussed in detail in the Challenges section

below.

Challenges

The challenges described below affect not only access to and quality of FP services in the

public sector, but also the long term sustainability of the national program.

A major challenge that affected FP results over the first part of the project was a debate

within the MOH over the legitimacy of midwives providing IUD services that came to a

head in late 2010 and caused most MOH midwives to stop providing IUD services over

the course of 2011, greatly affecting FP program performance. The loss of FP program

momentum and corresponding decreases in CYP from the MOH in 2010 is directly

related to this issue. This challenge was partially resolved in late 2011 after considerable

advocacy and support from HSS II, when the MOH issued an amended job description



37

for its midwives that included IUD services among their responsibilities, if they were

supervised by a trained physician. This allowed the WCHD to resume training and

support for midwives to provide IUD services, the most popular method in Jordan, but

did not fully overcome the concerns of both midwives and physicians concerning

ambiguities about their legal protection against any malpractice claims and about the role

of the supervising physician.

Continued and growing reliance of many couples on traditional FP methods, especially

withdrawal, with a considerable number of midwives using or supporting use of

withdrawal as a contraceptive method. Deep suspicions about the health impact of use

of hormonal contraception persist among the general population and even among some

health professionals.

Lack of sufficient qualified human resources at the central MOH (WCHD), HDs, HCs

and hospitals specifically assigned to support FP services. The current staff is

overstretched and relies on technical support from the project to complete some of the essential processes for which they are responsible, such as supervision and training in

long term reversible contraception.

Lack of sufficient funds for organizing and conducting training. This includes lack of a

clear process for paying for logistics such as meals and overnight lodging if needed,

reimbursing trainers for their extra efforts, and compensating participants for their out-

of-pocket costs to attend training. The ability of HSS II to organize trainings and provide

logistics has been a great help to the MOH and other partners in overcoming logistical

issues but not compensation of trainers or participants. Given high turn-over of staff and

attrition of trainers, this inability to conduct regular in-service training without external

support is a major concern for sustainability.

Lack of clarity of linkage between individual performance regarding FP and any

recognition, or conversely, negative consequences. There is no distinction made

between those who make extra efforts and those who do nothing, when it comes to

promotion, assignment of tasks, or any other aspect of recognition. While scrupulously

following Tiahrt and other regulations, the MOH could still make major improvements

in performance assessment that could inspire staff to continue their efforts, or motivate

those who currently under-perform.

Lack of good grounding in family planning and contraception among recently graduated

midwives and physicians, which causes a constant need for in-service training in the

MOH, RMS and other public organizations that provide FP services.

Lessons Learned

A clear lesson from HSS II is that true program ownership at all levels of the MOH and

other partner organizations is vital to success of all FP efforts, in the near term as well as in

the longer term. Structured processes for program planning, monitoring and analyzing

performance enable the actors at all levels to consider how best to meet their own goals

and to identify barriers that must be addressed. The extensive experience gained under HSS

II and predecessor projects, allows the MOH, HPC, RMS, other counterparts and USAID to

consider the optimal ways to capitalize on the program momentum achieved in recent years

and address the remaining challenges that hamper national FP program performance.



38

1. The persistently high use of traditional FP methods in Jordan reflects a combination of

cultural preferences, misinformation about the safety of modern methods, and lack of

awareness or lack of concern about the high failure rate of traditional methods – not

only among FP users or potential users but among health providers themselves. Training

in counseling for health providers is necessary but not sufficient to address these factors.

More creative and effective ways to enable providers to overcome their own resistance

to modern methods and to provide accurate information and support for FP acceptors,

and to reach men and women with counseling and services adapted to their needs, are

necessary. Introduction of a modern natural method, SDM, is one option to be tested,

but it must be done carefully to overcome strong concerns of MOH program staff that

this could undercut their progress in making long acting reversible contraception more

accessible and acceptable in Jordan.

2. In-service training of FP providers is an on-going need that requires extensive use of

human and financial resources. Project assistance in this area is necessary for the near

future, but longer term solutions must be pursued, including pre-service education of midwives, physicians and nurses concerning family planning counseling and services, an

organized and funded in-service training process within the MOH that includes

recognition of the extra work done by trainers; and recognition of decentralized and on-

the-job training as legitimate, certified ways to achieve proficiency in specific aspects of

service delivery.

3. Supportive supervision, which can and should include on-the-job training, is a powerful

tool to maintain and improve competency and adherence to performance standards. The

supportive supervision system has been embraced by the different levels of the MOH,

but adequate technical and logistic support for supervisors to carry out this system must

be available at HDs and at the central MOH level.

4. Increasing the linkages between public hospital services and the different sections in

health clinics is an important way to improve quality and access to FP services. From a

client’s perspective, consistency in information and services is reassuring and supports

adoption and continuation of FP. The introduction of PP/PM FP counseling and services

in 25 hospitals was a major contribution to increasing access to FP, that should be

continued and expanded. Increasing internal referral for FP within health clinics is

another proven way to increase access. Hospital outpatient departments provide

minimal FP services; they would benefit from increased involvement of midwives in

delivery of FP and oversight of their services by MCH supervisors.

5. Because of a high degree of vertical hierarchy in health services, the success or failure of

FP activities within a particular facility or Health Directorate often rests on a single

individual. At the same time, frequent movement of staff, especially high level staff, makes

continuity of efforts fragile. Team-based program leadership and management must be

supported to improve and sustain program performance.

6. The success of the FP QI Initiative introduced in 20 health centers in 2013 shows the

power of collaborative efforts to improve quality of FP care, Quality assurance at all

levels must be an essential part of family planning services, to ensure that clients are receiving safe, respectful care that meets their expectations. For long term continuity of

these family planning standards, HCAC should be encouraged to integrate them into the

current accreditation standards for health clinics.



39

Objective 5: Improve Community Health

Context

Approximately 50% of the Jordanian population relies on primary health centers or clinics

for outpatient services; the MOH remains the main and sometimes sole source of health

services for populations living in remote areas and for lower income groups. Given the

current social, demographic and economic pressures, the role of the primary health care

system is vital in sustaining and advancing the health gains of the last two decades. Thus, a

major intervention and important focus for USAID is strengthening and expanding the

linkages between the community and the primary health center.

USAID, through multiple health systems strengthening projects (HSS & HSS II), has assisted

the MOH to develop and implement a community mobilization model which is a set of

integrated interventions to increase the demand for, improve the quality of and expand

access to primary healthcare services throughout the country. The model is designed to

foster a partnership characterized by interdependency between health care services and the community. In selected geographic areas, specifically catchment areas surrounding a PHC,

the model helps empower communities to ensure that they become active participants in

the health system and play a role both in managing their own health and in utilizing the

system effectively and responsibly through appropriate health seeking behavior.

Furthermore, USAID supported the MOH to design and implement a health promotion

(HP) program at primary health care centers. The aim of the HP activities is to empower

individuals with knowledge and skills needed to assume healthier lifestyles and to manage

their own health. An important goal of HSS II is to support the Ministry of Health (MOH) to

institutionalize the community health program, emphasizing the importance of individual

responsibility in managing one’s own health, and understanding one’s rights.

Approach

Building on the above established momentum and in close collaboration with the MOH,

Health Communication &Awareness Directorate (HC&AD), the HSS II project team

worked side by side with health centers and local communities to establish Community

Health Committees (CHCs) throughout Jordan. The aim was to encourage the CHCs to

mobilize and organize the efforts of all community members and groups, and direct them

towards participatory work with all entities that function locally in the health area.

A CHC is a committee of volunteers structured at the community level. It consists of

12-15 representatives from various sectors in the local community, such as religious affairs,

education, and nongovernmental organizations, as well as staff from the health center.

The CHC members help in identifying the local community’s health needs: planning

and implementing interventions that provide people with health information and

create opportunities for people to practice healthy lifestyles.

From the establishment of community organizations to maturity

HSS II worked with the different levels at the MOH to strengthen their capacity to establish

and supervise the work of CHCs across the Kingdom. Interventions were targeted at the

central, health directorates, health centers and community levels.



40

Central MOH level

HSS II provided technical and managerial support to HC&AD staff to better assume their

role in managing the community health program. Capacity building at the central level

included an update to the health promotion strategic and operational plans, and certification

of HP trainers. Furthermore, HSS II supported the HC&AD in supervising the HP staff at the

health directorates to ensure proper implementation of the community health interventions.

HSS II also supported advocacy efforts to increase the visibility of the community health

program. Advocacy efforts focused on recognition of HP trainers and clarifying the job

descriptions of HP staff at different MOH levels.

Health Directorate level

HSS II continued strengthening the capacity of the 12 health directorates to improve

planning, coordination and implementation of behavioral change interventions targeting high

priority audiences at the facility and community level. Health directorate operational plans

and health center action plans included health promotion/behavioral change activities that

respond to defined health priorities and focused on mobilizing communities to increase

access to family planning and PHC services. Capacity building activities included health

promotion approaches related to increasing the use of modern FP methods and the

management of chronic diseases, as well as planning and expanding facilitative supervision.

HSS II developed the tools and guidelines to assist the HDs and HCs to establish and

monitor the work of the CHCs.

Health Center level

With the MOH, HSS II trained staff at 120 health centers on health promotion concepts and

practices, and health promotion action plans were developed. A special focus was

developing stronger connections between the health facility and the community through the

establishment of the CHCs.

Community level

A CHC is expected to play an active role in directing community resources to address

health issues and assisting the health center (HC) staff to reach community members with

health education and screening, as well as promoting the HC services. For a HC to be

accredited as a high quality service delivery point, it needs to have an active CHC that is

engaged in the leadership and management committee of the HC. Interventions targeting

CHCs passed through three phases:

Phase 1: Establishment

HSS II conducted several meetings with HD and HC personnel to introduce the approach and identify the catchment area for the CHC. In this phase, the primary local players were

identified and officially asked to participate. Furthermore, terms of reference of the CHCs

and agreement on capacity building activities for the members were completed.

Phase 2: Capacity-building and action planning

HSS II and the MOH conducted Participatory Rapid Appraisal (PRA) workshops with CHC

members. PRA is a hands-on methodology that helps CHCs define health needs and develop

their action plans accordingly.



41

CHC members collected information about the HC catchment area population, HC

services, the economic sectors, relevant community-based organizations in the area, and

health needs. Data were analyzed and used by CHC members to identify and prioritize

needs. Using the community action cycle, CHCs developed their action plans to address the

identified issues.

In selected areas in Irbid and Maan, HSS II conducted focus group discussions with women’s

and men’s groups to define barriers to receiving family planning services. Results of these

discussions were used to direct the action plans of the CHCs to design activities that

address local barriers and increase demand for FP services.

The following three graphs show results of a case control study done in Irbid to evaluate the

impact of community-led FP promotion activities. As can be seen, interventions in treatment

communities significantly increased the number of FP visits to the clinic. Furthermore,

interventions that targeted both women and men resulted in a relatively higher number of

FP visits than interventions that targeted women alone.

116 151

217 247 241

193 164

226

2012 2013 2012 2013 2012 2013 2012 2013

Ramtha Al-Sareeh Al-Kareema Deir Abi Sa'eed

"Women Only Intervention"

Total Number of Visits

2012 (June-September) vs. 2013 (June-September)

76

230

127

213 222

323

16

91

2012 2013 2012 2013 2012 2013 2012 2013

Huwara Al-Mazar Kafar Yuba Hartha

"Men and Women Interventions"

Total Number of FP Visits


Figure 20: Number of FP Visits in Selected Irbid Communities for Men and Women Interventions

Figure 21: Number of FP Visits in Selected Irbid Communities for Women Only Interventions



42

Figure 22: Number of FP Visits in Selected Irbid for Control Community

Furthermore, HSS II assisted three active CHCs to transition into voluntary societies. In

collaboration with the USAID-funded Civic Initiative Program, HSS II offered capacity

improvement activities including finance, grant management, advocacy and communication

trainings.

Phase 3: Monitoring and follow-up

All CHCs were supported by HSS II and MOH staff while implementing their planned

activities, CHCs also advocated for local support, and networked with different entities in

implementing their activities. The role of the MOH Health Directorate was essential in this

phase. It helped to identify gaps and provide ongoing support for the CHCs, ensuring they

stay on track and implement their respective work plans.

Studies measuring effect of CHCs on increasing demand on FP services were conducted in

Irbid and Ma’an. The studies provided qualitative and quantitative information on the impact

of encouraging volunteer community health committees to work with health centers, both

on attitudes towards FP and on increasing demand for FP methods in health centers.

Through the CHCs the project worked on mobilizing communities to adopt healthier

lifestyles and increase demand for FP/ PHC services. Mobilization efforts included:

Figure 23: % of Active CHCs in Health Directorates

151 137

29

72 82

69 71

33

2012 2013 2012 2013 2012 2013 2012 2013

Haneena Um-Qais Waqaas Deir Yousef

"Control Community"

Total Number of Visits


28% 29%

90% 87% 78%

% of Active Community Health

Committees in HDs

2010 2011 2012 2013 2014

There are currently 106 CHCs.

In the latest round of

evaluations, 86 were eligible for

assessment in the final quarter.

Results showed that 78% are

currently active; slightly below

the target of 80%. A committee

is considered active if it has a

demonstrated SOW; updated

annual work plans addressing

health issues; and 60% of the

activities in the annual work plan

implemented within the

allocated timeframe.



43

Designing and implementing community mobilization campaigns

“Family Planning and Healthy Lifestyle” campaigns were designed and implemented in three

health directorates in full collaboration among Health Directorates, the WCH Directorate

and the Health Communication and Awareness Directorate. The campaign activities

included health fairs, edutainment and screening activities. Partnership and collaboration

with local organizations such as Greater Amman Municipality, Ministry of Education, Ministry

of Religious Affairs, JAFPP and local voluntary and charitable societies helped to ensure

maximum outreach in each location. The USAID-funded Ta’ziz (SHOPS) Project and the

Jordan Health Communication Project actively participated in the campaign with a number

of FP and health promotion booths during the health fairs. National NGO partners included

the Jordan Breast Cancer Program, the Royal Health Awareness Society and the King

Hussein Cancer Foundation.

Forming women’s, men’s and youth family planning advocacy groups

Women’s family planning advocacy groups

HSS II helped promote family planning as a means of improving quality of life and

empowering women to meet their reproductive goals. Using the JUH - “Arab Women

Speak Out” (AWSO) approach, HSS II formed 39 women’s FP advocacy groups around the

country. Participating women were trained on family planning, healthy lifestyles,

communication between spouses and general communication skills. They also developed

action plans to spread their new knowledge to other women in the community with the

help of the local Health Center and the Health Directorate.

Youth Peer Education

Thirty-six groups of youth peer educators were trained in ten governorates to promote

family planning among their peers as part of life planning. Peer educators were trained on

healthy lifestyles, life planning, and introduced to the concept of small family size.

Reaching men in their workplaces

In an effort to reach men and to inform them about the benefits of birth spacing and family

planning, HSS II identified contact officers at various workplaces who were tasked with

spreading the information and knowledge shared during special training sessions. Ten men’s

groups were formed and assisted to reach men in their workplaces, promoting family

planning and available services at health centers. Workshop participants in turn conducted

additional workshops at schools and mosques to reach their colleagues with messages

relevant to healthy families and family planning.

The CHC Recognition Awards

HSS II and the MOH recognized that the CHC mission requires extraordinary efforts,

outstanding commitment and exceptional dedication to achieve goals through the members’

voluntary contributions. HSS II acknowledged these efforts by introducing “CHC

Recognition Awards” aimed at enhancing and promoting the voluntary spirit among CHC

members and motivating existing CHCs towards sustainability. Twenty-two CHCs

competed, submitting projects on women’s and children’s health, chronic diseases and

healthy lifestyles for youth. The six winning CHCs were announced at the CHC Recognition

Awards Ceremony and received health promotion equipment and limited financial support for continued activities.



44

Figure 24: The CHC Recognition Awards Ceremony

Achievements

Approximately one third of the committees have reached a level of maturity that allows

them to continue activities without the support of HSS II and achieve their goals. CHCs also

help the HCs in achieving primary health care quality improvement accreditation since

community engagement is part of the core standards. By strengthening community networks

and increasing the interaction between community members and CHC staff, the project’s

community health work contributes to the sustainability of HSS II’s achievements.

106 CHCs established and functioning.

6 CHCs recognized for their outstanding initiative and granted Recognition Awards.

3 CHCs have legally registered as community-based organizations, allowing them to

raise funds.

39 women’s family planning advocacy groups are operational

36 youth peer educators groups have been launched

10 men’s FP advocacy groups formed and engaging men on this sensitive topic

15 HP certified trainers available at the MOH to expand the HP program

HP training curriculum approved by MOH technical committee

HP indicators integrated in the updated MCH and NCD information systems

120 health centers actively designing and implementing health promotion activities

12 Health directorates active in mobilizing communities and promoting health.

The MOH adopted a supervisory role toward the CHCs, helping them focus on health

priorities.

Selected CHC catchment areas showed an increase in demand for FP.

The CHC role in monitoring health services has increased in some areas, creating

community pressure on the Health Directorates to improve services.

Sustainability

At the MOH, the HC&AD and HD HP have the capacity to manage the health promotion

and community mobilization program going forward. Processes and tools were designed in

full collaboration and partnership with the HP staff at different levels and properly tested in

the field to ensure appropriateness.



45

The HP training curriculum was reviewed and approved by MOH technical staff.

A group of certified HP trainers are available at the MOH central and health

directorates to address the high turnover of HC staff by providing ongoing trainings.

Over the past two years, the HC&AD has assumed responsibility for overseeing the

CHCs. In year three the HC&AD began supervising 14 CHCs. This allowed sufficient

time to ensure that skills and tools were provided as needed.

The HP staff at the central and HD level received IT equipment needed to sustain their

activities and support the health centers and CHCs as needed.

CHCs are trained on networking and accessing local resources when implementing their

activities. During the life of the project CHCs were able to attract local funds for various

activities, increasing independence and chances of sustainability beyond the project life.

CHCs were used by other programs at the HC&AD as a platform for implementing

activities such as care for the elderly and anti- smoking programs.

Challenges

The limited availability of MOH budgets to strengthen central directorate support and

ownership of CHCs made it much harder for health centers to actively support their

work.

The weak linkages between different technical directorates at the central level dilute the

efforts to ensure that community activities receive highly needed support from different

health programs.

The high turnover of MOH staff slowed the pace of implementation and increased the

need for continuous training. This has resulted in occasional dropping of outreach

activities and lack of support from health center management for CHC activities.

The MOH did not provide any special recognition of the HP trainers and supervisors, to motivate them and sustain their energy for continued community engagement efforts.

Determinants of health go beyond the health system. HSS II was not designed to address

the social determinants of health but achieved considerable success within its sphere of

influence.

Measuring behavioral change requires specific research which falls outside of the scope

of the project. As a result, the MOH has anecdotal evidence of the impact of the CHCs’

activities but there was no comprehensive evaluation of the effectiveness of this package

of interventions.

Lessons Learned

HSS II has defined the following elements at the community level that enable a successful community health program:

Commitment of other sectors with the local community is essential to engage with the

CH program and address health issues

Availability and willingness of well-established community-based organizations enhance

the link between program and community

Integrating other development actors help to maximize the benefits of the CH program

For a community mobilization program to succeed, the following steps are vital:



46

Create a sense of ownership by establishing and maintaining an ongoing dialogue with

community members in all phases of the program’s development, implementation and

evaluation.

Identify and create relationships with external resources such as the private

sector/donors and community based organizations to identify additional sources of

support.

Ensure the commitment of the MOH to support all phases of implementation to achieve

results, since community mobilization is a long-term process and cannot be achieved in a

short period of time.



47

Objective 6: Renovate, equip, furnish and maintain health

facilities

Context

Jordan’s health infrastructure is well-developed compared to other emerging economies.

However, many facilitates do not comply with international quality standards of maternal and neonatal health care practices. Moreover, many facilities have either non-code

compliant design problems or are not appropriately maintained.

The physical condition of a health facility is an important element to ensuring the quality of

health care provided and to meeting infection prevention and the requirements of other

international standards.

At the beginning of HSS II, only three regional primary health training centers were

renovated, equipped, and furnished. However, the geographic location of these centers did

not facilitate the convenient attendance of trainees coming from health directorates that are

distant from the training centers.

Approach

Strengthening national capacity to design and build health facilities

A comprehensive approach was used to design

health facilities involving a multidisciplinary

team comprised of engineers, clinicians, and

health managers from the MOH, RMS and JUH.

A key ingredient to the success of these

projects was establishing an agreement on

roles and responsibilities among stakeholders.

During the design and build process, the

project staff built the institutional capacity of

the facility owners and government oversight

bodies to conduct infrastructure assessments,

review and approve blueprints and designs and oversee the contractor performance during

construction. HSS II strengthened the MOH capacity to assume the responsibility of

planning and conducting hospital upgrades of obstetrics, neonatal and emergency

departments according to the American Institute of Architects standards.

The capacity of local contractors in renovation and expansion work of hospitals was also

built during the process, enabling them to continue renovations and improvements using

standard safety and quality protocols. An Environmental Mitigation Plan was also developed,

outlining processes that must be used to ensure worker and patient safety during the period

of renovation or construction. The HSS II teams worked with the MOH to identify and

select a list of priority equipment that would improve neonatal and maternal services.

Priority was placed on procuring resuscitation and life-saving equipment that was suitable to

Jordan, notably equipment that was serviceable in Jordan and matched international

standards.

Figure 25: Engineers during the Implementation of

Construction work at Jordan University Hospital



48

Using an international competitive bidding process, HSS II procured, delivered and installed

equipment and furniture at selected health facilities

Strengthening capacity of health workers to correctly use new equipment and

technologies

Through hands-on training and field coaching, HSS II teams focused on improving the

technical capacity of physicians and nurses to correctly operate and maintain medical

equipment. These inputs assisted them to provide timely, quality services and to improve

the outcome in emergency cases.

Building national and hospital level capacity to maintain hospital improvements

The project teams helped representatives from

both the MOH and the Ministry of Public Works

to form a central-level Maintenance Task Force.

The Maintenance Task Force developed and

institutionalized a Maintenance System Policies

and Procedures Manual for the Ministry of Health

Facilities in 2012 which includes policies and procedures for use in all their hospitals to ensure

appropriate maintenance of newly installed

electrical and mechanical systems.

This first-ever Maintenance Manual includes supervisory tools, record keeping, an inventory

system and maintenance policies and procedures.

HSS II also supported the formation of hospital

maintenance committees in each hospital to

implement the maintenance plan using the

maintenance manual. Twenty-two hospital

maintenance committees were trained on the

maintenance system. After the training, HSS II

supported MOH Engineers to conduct Key

Performance Indicator visits, to ensure that the

maintenance contractor applied the policies and

procedures. This helped the MOH ensure that

the maintenance contractor performs preventive

maintenance measures correctly.

After the period of contractor maintenance warranty (one year for civil works, two years

for electromechanical elements) the project supported a smooth transition of health facility

maintenance to the MOH Directorate of Buildings and Maintenance, as well as the smooth

transition of equipment maintenance from the different vendors to the Directorate of

Biomedical Engineering (DBE) at the MOH. This process included working with each of the

facilities to develop an inventory system and to identify priority equipment maintenance

needs. The DBE was trained to take over the responsibility of long-term maintenance.

Medical equipment that the DBE will maintain includes neonatal incubators, vital signs

monitors, resuscitators, ventilators, surgical tables, anesthesia machines, CPAP units,

delivery beds and inpatient beds.

Figure 26: Upgraded NICUs Enable Providers

to Work in Comfortable and Safe

Environments

“The maintenance manual that HSS

II developed is important for the

longevity and efficiency of hospital

improvements. We even use the

manual in other facilities around the

hospital.”

Eng. Suad Nayef, Head of Maintenance

Department, MOH



49

Activity Actions Stakeholder Involvement Timeframe

Assess

Conduct comprehensive physical,

functional and infrastructure assessment,

including mechanical and electrical works:

- heating, air conditioning, and ventilation

- sanitation and fresh water

- lighting and electrical sockets

- medical gases

HSS II

Hospital management team

(director, head of departments,

physicians, nurses)

Directorate of Planning / MOH

Directorate of Buildings and

Maintenance / MOH

Biomedical Engineering

Directorate / MOH

Ministry of Public Works and

Housing

1 month

Design

Develop schematic design to meet functional, infrastructural and infection prevention

requirements in accordance with American

Institute of Architects Academy for Health (AIA)

standards

Prepare final designs in compliance with AIA

standards, as well as the rules, requirements, and

regulations of the Hashemite Kingdom of Jordan,

USAID and Abt Associates

USAID/Jordan

HSS II

Hospital management team

(director, head of departments,

physicians, nurses)

Directorate of Planning / MOH


Maintenance / MOH

Biomedical Engineering

Directorate / MOH

Ministry of Public Works and

Housing

2 months

3-4 months

Bid

Award

Prepare tender documents and contract

conditions

Pre-qualify contractors based on technical and financial capabilities

Invite qualified contractors to bid

Review bids with USAID and award to the

successful contractor(s)

USAID/Jordan

HSS II

Contractor(s)

2 weeks

1 month

1 month

3 weeks

Renovate

Construct

Provide support and supervision during the build

phase including daily management provided by

on-site project managers, and senior

management from HSS II to ensure contractor

meets quality standards

Conduct commissioning and testing of the electrical, medical gas, water systems to ensure

functioning and safety

HSS II

Contractor(s)

8-10 months

2 weeks

Hand

Over

Convene a handover committee to receive

the completed facility

Transition of equipment maintenance from

the different vendors to the Directorate of

Biomedical Engineering within the Ministry of

Health

Provide comprehensive equipment management training through on-the-job

training and coaching to improve technical

capacity of healthcare service providers

(physicians and nurses) to correctly operate and

maintain the medical equipment

HSS II

Hospital Handover Committee


Maintenance / MOH

Directorate of Biomedical

Engineering / MOH

Contractor(s)

Hospital Management Team

Healthcare service providers

(physicians and nurses)

2 months

Maintain

Establish hospital maintenance committees to assume responsibility for ongoing

maintenance of renovations and

electromechanical systems using the

maintenance manual

Hospital Maintenance Committee

MOH Engineers from


Maintenance / MOH

MOH Maintenance Contractor

HSS II

The premise is under MOH

responsibility

after the HSS II

renovation

warranty period

(1 year civil

works and 2

years electrical/

mechanical

works)

Table 5: Phases of Upgrading Hospital Departments



50

Achievements

During HSS II, ten primary health training centers were

renovated and furnished. Nine obstetrics and neonatal

departments at major public hospitals were renovated

and equipped with state of the art biomedical machines.

Five emergency departments were renovated and

equipped. In total, HSS II renovated 15,848 m2 and

constructed 17,403 m2 of hospital spaces, as the following

table shows.

Figure 28: Chart Indicating % of Expansion Area Compared to Exiting Area for Each Hospital Department

before Renovations

Figure 29: Chart Indicating % of Total Expansion Area Compared to Total Exiting Area for All 14 Renovated

Hospital Departments

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Existing Surface Area (m2) Actual Surface Area

Renovated & Expanded (m2)

15,845

33,248

Existing Surface Area (m²) before Renovation Vs. Actual

Surface Area (m²) Renovated & Expanded for

14 Hospital Departments

Figure 27: Plaque at the HSS II

renovated central MOH training center



51

Figure 30: The Newly Constructed Obstetrics and Neonatal Departments Building at JUH,

the Largest Expansion Works Executed by HSS II

Figure 31: Inauguration of the Upgraded Obstetrics and Neonatal Departments at Queen Alia

Military Hospital



52

Sustainability

Building National and Hospital Capacity to Maintain

Hospital Improvements: The project teams helped

representatives from both the MOH and Ministry of Public

Works and Housing to form a central-level Maintenance Task

Force. The Maintenance Task Force developed and

institutionalized a Maintenance System Policies and Procedures

Manual for Ministry of Health Facilities in 2012 which includes

policies and procedures for use in all their hospitals to ensure

appropriate maintenance of newly installed electrical and

mechanical systems. This first-ever Maintenance Manual

includes supervisory tools, record keeping, an inventory

system and maintenance policies and procedures.

HSS II also supported the formation of hospital maintenance

committees in each hospital to implement the maintenance

plan using the maintenance manual. Twenty-two hospital

maintenance committees were trained on the maintenance system. After the training, HSS II

supported MOH Engineers to conduct Key Performance Indicators visits, to ensure that the

maintenance contractor applies the policies and procedures. This has helped the MOH

ensure that the maintenance contractor performs preventive maintenance measures

correctly.

Figure 33: On-Job-Training for Maintenance Staff and Service Providers on the Installed

Electromechanical Systems

After the period of contractor maintenance warranty (one year for civil works, two years

for electromechanical elements) HSS II supported a smooth transition of health facility

maintenance to the MOH Directorate of Buildings and Maintenance, as well as the smooth

transition of equipment maintenance from the different vendors to the Directorate of

Biomedical Engineering (DBE) at the MOH. This process included working with each of the

facilities to develop an inventory system and to identify priority equipment maintenance

needs.

Figure 32: The Maintenance

System Policies and Procedures

Manual



53

Objective 7: Develop Human Resources

To respond to the health system priorities of the Ministry of Health and support the

sustainability of health system improvements in other program areas, Objective 7 was

amended in the approved Year 5 Work Plan to read:

Support the MOH to identify and begin to address human resource issues that

affect performance and sustainability of key health programs, especially

MCH/FP and PHC.

Context

The Ministry of Health (MOH) included human resources for health (HRH) as an important

area for action in its MOH Strategy 2013-2017. Family planning and reproductive health

(FP/RH) are priorities of both the Ministry of Health in Jordan and the US government, and

are directly affected by human resource constraints. In September 2013, HSS II helped the

MOH analyze the current status of HRH and to consider options to strengthen the health

workforce and increase access to effective health services including family planning. HE the

Secretary General of the MOH designated a group of senior health officials and managers to

participate in this analysis.

HSS II worked intensively with these key MOH officials and other stakeholders such as the

Higher Population Council, Higher Health Council and Jordan Nursing Council to identify

important HRH challenges, the main causes of these challenges, and potential ways to

address them. An HRH Technical Working Group (HRH TWG) was constituted by the

Secretary General to continue work on HRH. Membership in the HRH TWG, under the

leadership of the Planning Administration with strong support from the Directorate of

Personnel Affairs, includes not only central directors but also representation from Health

Directorates.

The HRH TWG members identified human resource priorities that they felt were important and within the ability of the MOH to address in the context of their current five

year strategy. HSS II worked with the committee to select activities that could benefit from

HSS II support during the final year of the project.

Approach

Assist the MOH to assess staffing patterns and gaps in primary and

comprehensive health centers

HSS II helped the HRH TWG introduce and pilot the Workload Indicators of Staffing

Need (WISN) tool, working with the team of the Balqa HD. The WISN methodology

was developed by the World Health Organization in the 1980s and improved in 1998 &

2010 to support rational allocation of staff. It is based on actual work that health workers do and can be applied to all personnel categories, both medical staff and non-

medical staff. The Balqa HD team applied the tool in five health centers of different

sizes, assessing all tasks performed by all cadres there and the volume of services they

produced. HSS II also organized a workshop at which technical representatives agreed

on the average time needed for each task. Results of these exercises were used to chart

the allocation and productivity of staff across the five health centers.



54

Support MOH deliberations to improve retention and quality of existing staff

HSS II supported regular meetings of the TWG in which key themes were introduced

and discussed, such as identifying gaps in staffing, developing functional competencies for

at least one cadre of staff that would help the MOH to determine eligibility for

promotion, and ways to improve the staff appraisal process. HSS II helped ensure that

the committee invited relevant central and health directorate staff to each meeting so

that decisions made over the course of their deliberations would receive consensus

from the broader group of stakeholders. HSS II also organized a policy formulation

meeting concerning HR for senior MOH managers during the WISN workshop, which

presented key concepts of effective policy development and implementation.

Develop core competencies and career ladder for MOH midwives

HSS II helped the Jordan Nursing Council and the MOH to form an expert group to

define the core technical requirements of midwives as they progress through their

careers, based not on current pre-service training but on actual responsibilities once they are MOH service providers. With technical assistance from HSS II, the expert

group agreed on the final wording of the core competencies and the career ladder for

midwives (four levels). These documents define provision of IUD services as a core

competency expected of all midwives as of their licensure, which was well accepted by

the Jordan Nursing Council and by the MOH HRH TWG. The methodology used to

develop these documents was provided to the MOH Director of HR Employee

Relations so that this process can be replicated for other staff categories.

Support strengthening of MOH personnel appraisal process

HSS II supported the MOH Director of HR Employee Relations to provide refresher

training to 150 MOH managers, including all Directors and HR managers of all 12 Health

Directorates, on use of the Civil Service Bureau (CSB) appraisal process to assess

performance of their staff. In three one-day workshops, the participants were shown

how to apply the appraisal to medical professionals in a way that will allow managers not

only to assess staff but also to link those assessments to requests for promotion or

recommendations for sanctions, if appropriate.

Disseminate WISN process and results, core capacity exercise and

performance appraisal tools to key stakeholders

In several meetings, the HRH TWG discussed the results of the WISN exercise in Balqa

and agreed it provides an objective way to determine staffing needs, and decided on the

usefulness of establishing core competencies and career ladders as a way to guide initial

training, hiring and promotion of MOH employees. As part of the series of three

workshops cited above, HSS II then worked with the Director of HR Employee

Relations to disseminate the processes, tools and results of the WISN exercise in Balqa

to the other HD Directors and their HR managers, as well as central ministry staff. The

core competencies of midwives, and the proposed career ladder for them, were also

presented and discussed. HD staff generally agreed that these tools should be formally

adopted as MOH policy to guide deployment, careers and annual appraisals.



55

Prepare policy advocacy tool for the HRH TWG

HSS II developed a report that explained the process used to develop and test these

tools and to gain acceptance of key stakeholders, and assisted the HRH TWG and the

Director of HR Employee Relations to consider next steps in mandating the use of

WISN to make staffing decisions. The TWG stated that their objective is to mandate the

use of WISN for determination of staff deployment in 2016.

Achievements

Within the last year of the project, significant progress has been made in identifying key

aspects of human resource management in the MOH that needed strengthening, and in the

understanding and confidence of key MOH managers that these problems can be addressed

using a variety of tools and processes.

Core competencies and a career

ladder for midwives that includes IUD

services as an essential part of their

work have been prepared and

accepted by the Jordan Nursing

Council and the MOH HRH TWG.

The use of WISN as a tool to make

rational decisions about staff allocation

has been practiced and embraced by

the HRH TWG, and the Balqa team is

ready to coach other HDs in its

application.

The Director of HR Employee Affairs

has improved the understanding HD

staff in the use of the CSB performance

appraisal process to assess staff

performance more accurately and fairly

than has been the case in the past.

The HRH TWG and the Balqa HD

team have the capacity to carry on

strengthening HRH, using a policy

advocacy process and specific tools and

products produced with HSS II

support.

Staff Category

Required

Staff based on

WISN

Current

Staff at Facility

Difference Staffing

GP 5 2 -3 Shortage

Midwife 2 3 1 Surplus

Registered Nurse

1 3 2 Surplus

Nurse Associate

1 4 3 Surplus

Dentist 1 1 0 Adequate

Pharmacist 2 1 -1 Shortage

Assistant Pharmacist

2 2 0 Adequate

Medical Clerk

2 3 1 Surplus

Figure 35: MOH Officials Discuss the Value of WISN for

Improving Staffing Efficiency in Health Care Facilities

Our work with HSS II on HRH issues including the development of the WISN tool put

us on the right track towards improving the management of our health staff and the

delivery of health care services, as well as strengthening the health system as a whole.

Mr. Ghaleb Qawasimi, Director of the Employee Affairs Directorate, MOH

Figure 34: Example of WISN Output for a Comprehensive

Health Center



56

Challenges

The human resources work that was begun in the final year of the HSS II project was a good

start in addressing longstanding issues in management of health staff, as a core aspect of

health system strengthening. For this work to lead to system-wide improvements in

delivery of health services, much more effort will be needed in the future. Key challenges

that still need to be tackled include:

Perception of MOH staff that their performance, good or bad, will not influence their

career development, chances of promotion or advancement, or assignments in the

future. This perception profoundly affects the attitudes and behaviors of health care

staff, particularly when asked to do additional work to improve quality of care.

Lack of formal policies within the MOH to guide allocation of staff

Weaknesses in pre-service education of physicians, midwives and nurses that result in a

need for the MOH to undertake a large volume of in-service training to meet their

program needs

Continued lack of clarity or agreement across the different health professions

concerning the competency of midwives to perform IUD services, despite this being part

of their job description within the MOH.

Lessons Learned

Engaging with the MOH and other counterparts to help them address human resource

needs created considerable interest and energy among them, and raised interest in and

expectations for future support in this area. Some of the lessons learned from this first year

of HRH work include:

The HRH TWG proved to be a very viable body to tackle HR issues within the Ministry,

and should be offered further support if at all possible. The opportunity for central and

HD staff to discuss HRH together and work on solutions was perceived by all involved

as extremely helpful.

Professional bodies have a strong role to play in determining optimal roles for each type

of staff, as shown by the very positive engagement of the Jordan Nursing Council in the

development of midwifery competencies and career ladder. Their continued

engagement, as well as that of other health profession organizations, will be vital to turn

promising approaches into policy that is broadly applied, within or even beyond the

MOH.

Remaining tasks include formalizing specific approaches developed with HSS II support,

such as the use of WISN for staffing decisions and the development of core

competencies to guide professional development, so that they are applied more broadly

in the future, especially by the MOH. The momentum and energy behind the use of the

WISN to determine staffing needs must be sustained through further application of the

tool, but also through specific policy decisions by senior officials of the MOH that

endorse the use of WISN results in staff allocation.



57

III. HAND-OVER OF HSS II PROGRAMS TO GOJ

COUNTERPARTS AND RECIPIENTS

Building the capacity of managerial and clinical staff of the MOH, RMS and other key

institutions such as JUH to sustain program improvements was a core strategy of the

project. To ensure sustainability of gains achieved to date, HSS II implemented a hand-over

strategy with related counterparts which included three levels: hand-over of materials and

tools, hand-over of approaches and for specific elements, hand-over of full responsibility to

allow recipients to assume responsibility to continue without further support from the

project.

1) Materials: Policy documents, guidelines, curricula, manuals, documentation of events,

studies. Materials and products developed with the support of HSS II (policy documents,

guidelines, curricula, manuals, documentation of events, studies) were handed over to

HSS II counterparts. Well-organized, labeled and branded packets of CDs distributed to

the following:

USAID Population and Family Health Office (all materials)

MOH:

Director of Project Planning and Management Directorate (all materials)

Relevant Central Administrations and Directorates (all items specifically relevant to each of them)

Each HD (all items specifically relevant to that HD)

HPC (relevant materials)

RMS (relevant materials)

JUH (relevant materials)

2) Approaches: Training, supportive supervision, equipment and infrastructure

maintenance, IT system maintenance, performance monitoring and reporting through

graphics, etc. Hand-over of approaches is more complex, and in addition to the CDs, it

required more active handover of data sets to ensure that trained staff is capable of

updating them. A working event for each HD was conducted, in which all technical

aspects of the program were covered in effective way to recognize and support

continued decentralization of responsibility.

3) Full Responsibility transferred: Hand-over of full responsibility for specific tasks

were done for certain aspects of our program that USAID does not expect to support

in the future. This included, full MOH responsibility for leading HCs through the

accreditation process, sustaining infrastructure, and maintaining the referral system.

“The hand-over event for the Capital Health Directorate is a valuable

road map that will help my team to continue on the different

successful programs and sustain gains achieved with support of HSS II

project”

Dr. Leil Al Fayez, Director of Capital Health Directorate in a hand-over

event conducted on August 11, 2014



58

IV. HSS II CELEBRATES FRUITFUL PARTNERSHIP AND

SUCCESSFUL CONCLUSION

On September 22, 2014, following 5 years of dedicated work, the USAID-funded Abt-led

HSS II project successfully concluded its implementation in Jordan in an event held under the

patronage of HE Minister of Health to celebrate the fruitful partnership with public health

sector entities. It was attended by the USAID Mission Director and senior leaderships from

the MOH, RMS, HPC, JUH, Jordan Nursing Council, Higher Health Council, implementing

partners and key stakeholders, in addition to the entire HSS II team including current and

former staff.

The event opened with guests touring a gallery of posters highlighting the joint achievements

of the Abt-led HSS II in partnership with the public health sector in Jordan represented by

the MOH, RMS, JUH and HPC, followed by

speeches from senior officials, viewing the end of

project movie and ended with presenting

recognition plaques to project partners.

During his speech, the MOH Secretary General

renewed commitment to sustain HSS II's

successful programs and achievements. USAID

Jordan also expressed ultimate satisfaction for the impact of HSS II on improving the quality

of health services in Jordan and the project’s dedicated team. This was evident from the testimonial given by Mission Director, Ms. Beth Paige to the project.

Figure 36: HSS II Team with the US Ambassador, USAID Mission Director, Minister of Health and Abt CEO at the

Inauguration of the Emergency, Obststetrics and Neonatal Departments at Karak Hospital

“Ms. Paige, Dr. Sabry, the MOH

promises to take the lead and continue

building on the joint accomplishments”

Dr. Deifallah Al-Louzi, MOH Secretary

General during his speech in the EOP event

“The success of the project would not have been possible without the incredible passion and

team work of the HSS II project team. Anytime you’re with this group, you can feel the energy

and the passion about what they’re doing, and the results are seen every day”

Ms. Beth Paige, USAID Mission Director

“HSS II’s leadership is remarkable and the project team is the favorite among all USAID activities” Ms. Sarah Blanding, Director of the Population and Family Health Office / USAID



59

V. ANNEXES

Annex 1: Indicator Monitoring

Performance Monitoring Matrix

Status for each indicator is calculated based on the percent deviation from

target.

% Deviation = (Actual value – Target value) / Target value * 100 (NOTE: Indicators below

target will have a negative deviation and vice versa)

Deviation Color Legend:

▌ Red: % deviation > 30%

▌Green: % deviation ≤ 10%

▌Orange: deviation of 10% - 30%

N/A = Not Available



60

Objective 1: Promote the principles and practice of knowledge management at the MOH

Result 1.1 MOH staff at the central, Health Directorate, hospital and health center levels have documented use of information generated by various health

information systems for decision-making and quality improvement of services

Performance

Indicator Definition

Data

Source,

Method &

Frequency

Base

Line Year Target

Results %

Deviation

from

Target

Status Q1 Q2 Q3 Q4 Total

1.1 Score for

the level of

maturity of

knowledge

management

practice at the

MOH measured

by the KM

assessment tool

A knowledge maturity model

defines stages of maturity that

an organization can expect to

pass through in its road to

improve its overall knowledge-

centric practices and processes

and ultimately business

performance.

The KM maturity model defines

five maturity levels of

knowledge management, each

of which has special

characteristics and emphases.

KM Survey

assessment

to measure

the KM

maturity at

MOH

Biannual

1.74

Y1 0 --

Y2 BL 1.74 Baseline

Y3 2.0 (Cancelled)

Y4

Y5 2.3 2.24 -2.6%

Result 1.3 The Performance Assessment system is institutionalized at the MOH

1.2 Number of

Performance

Assessment

Reports

developed by

PA department

This is a binary indicator

whereby the finalization and

dissemination of the PAR

identifies that the indicator has

been met. The PAR is a final

report summarizing the results

of an MOH-wide Performance

Assessment study using pre-

selected indicators.

Project

reports

Biannual

0

Y1 0

Y2 1 0 -100%

Y3 1 1 0%

Y4 0

Y5 1 1 0%

End of Project Target / End of Project Achieved 2 / 2



61

Objective 2: Improve quality of care at primary health care level

Result 2.1: 120 health centers are fully prepared for formal accreditation and at least 50 of the 120 health centers are formally accredited

Performance


Data

Source,

Method &

Frequency

Base

Line Year Target

Results %

Deviation

from

Target


2.1: Number of

health centers

accredited by

HCAC

This indicator measures the

number of health centers

that fulfill the requirements

for HCAC Accreditation and

get awarded the HCAC

Accreditation Status in

recognition for their

achievement.

Quality

Directorate

– MOH

Annual

0

Y1 0

Y2 0

Y3 20 26 30%

Y4 N/A

Y5 30 49 63%

End of Project Target / End of Project Achieved 50 / 75

Result 2.2: A functioning referral and appointment system in all 12 HDs

2.2 Number of

HDs with

functioning

referral and

appointment

system

This quantitative indicator

measures functionality of the

referral and appointment

system. This system is

considered functional in an

HD when the following

criteria are met:

1. The existence of at least

one hospital with an

appointment unit in a given

HD.

2. 20% of referral forms are

returned from Specialists

in the Hospital to GPs at

the HCs.

3. HD generates monthly

reports on HC referrals.

HD Records

Annual

0

Y1 6 2 -66%

Y2 10 1 -90%

Y3 10 6 -40%

Y4 10 8 -20%

Y5 10 7 -30%



62

Result 2.3: Operational planning, supervision and monitoring systems are functioning in all Health Directorates

Performance


Data

Source,

Method &

Frequency

Base

Line Year Target Q1 Q2 Q3 Q4

Yearly

Average

(%)

%

Deviation

from

Target

Status

2.3a Percent

of controlled

hypertension

patients

attending

MOH PHC

facilities

This indicator is an outcome

indicator, intending to

measure the % of patients with

essential hypertension who

have their blood pressure

controlled (less than 140 mm

Hg for systolic and/or 90 mm

Hg for diastolic measurement,

and less than 130 mm Hg for

systolic and/or 80 mmHg for

diastolic measurement in

diabetic patients; according to

WHO guidelines), among

registered hypertensive

patients visiting the health

center.

Numerator: Number of

patients with essential

hypertension who have their

blood pressure controlled

Denominator: Total of

hypertension patients who are

registered and regularly

attending the health centers

HDs QI

reporting

system

Semiannual

59.56

Y1 BL 59.6% Baseline

Y2 60% 62.8% 60.9% 61.7% 2.8%

Y3 60% 63% 67% 65% 8%

Y4 60% 66.5%1 61.7% 64.1% 6.8%

Y5 60% 62.2%2 61% 61.6% 2.6%

1 Data do not included Tafilah HD, which was experiencing IT issues at the time of data collection. 2 Data do not included Tafilah HD, which was experiencing IT issues at the time of data collection.



63

Performance


Data

Source,

Method &

Frequency

Base

Line Year Target Q1 Q2 Q3 Q4

Yearly

Average

(%)

%

Deviation

from

Target

Status

2.3b Percent

of controlled

diabetic

patients

attending

MOH PHC

facilities

This is a quantitative indicator

that measures the percentage

of controlled diabetes patients

attending MOH PHC facilities.

A patient is considered as a

controlled diabetic patient if

his/her fasting plasma glucose

level is < 130 mg/dL

Numerator: Number of

diabetic clients with fasting

plasma glucose level < 130

mg/dL at HSS II intervention

MOH/PHC facilities during 6

months

Denominator: Total number

of diabetic clients from the

same facilities tested for

fasting glucose level during the

same 6 months

HDs QI

reporting

system

Semiannual

41.6%

Y1 BL 41.6% Baseline

Y2 40% 44.2% 45.5% 44.9% 12.3%

Y3 42% 44.9% 44.3% 44.6% 6%

Y4 42% 50.8%3 44.9% 47.8% 13.9%

Y5 42% 55% 53% 54% 28.6%

2.3c Number

of HDs

operational

plans that

include

interventions

addressing

Long Acting

FP methods

This is a quantitative indicator

that is based on a binary

measurement of whether or

not the operational plans

developed by HDs contain

interventions that address

Long Acting FP methods

Operational

plans at 12

HDs

Annually

0

Y1 0

Y2 12 11 -8.3%

Y3 12 12 0%

Y4 12 12 0%

Y5 12 12 0%

3 Data do not included Tafilah HD, which was experiencing IT issues at the time of data collection.



64

Objective 3: Improve quality of safe motherhood at hospital level

Result 3.1 Documented improvements in maternal and neonatal mortality and morbidity at public sector hospitals (MOH/RMS)

Performance


Data Source,

Method &

Frequency

Base

Line Year Target

Results %

Deviation

from

Target

Status Q1 Q2 Q3 Q4

Yearly

Average

(%)

3.1a Percent of

women

monitored

during labor

using the

partograph

This is a quantitative indicator that

measures the percentage of women

in active labor who are monitored by

partograph. A woman in active labor

will be considered as monitored by

partograph, if the partograph four

components have been filled: I-

Assessment of the fetal condition. II-

Progress of labor. III- Assessment of

the maternal condition. IV- Outcome

of labor.

Numerator: Number of women in

active labor who are monitored by

partograph during three-month

period

Denominator: Number of women

in active labor who are admitted to

the hospital during the same period

Hospital Medical

Records

Partograph Sheet

Monthly

Partograph

Reports

Quarterly

80

Y1 80% 74% 79% 76.5% -4.4%

Y2 85% 81% 80% 82% 82% 81% -4.7%

Y3 90% 84% 84% 88% 89% 86% -4.4%

Y4 95% 91% 82% 85% 89% 86.7% -8.7%

Y5 95% 90% 91% 92% _ 91% -4.2%

3.1b Percent of

inborn neonates

admitted to the

Neonatal

Intensive Care

Units at selected

MOH/RMS


measures the percentage of inborn

neonates admitted to the intensive

care units at selected MOH/RMS

hospitals and discharged alive. A

surviving newborn is an inborn

neonate admitted to the neonatal

Neonatal

Logbook

Quarterly

86.3

Y1 0

Y2 86.5%

BL

86.

3%

86.5

% 86.5% 0%



65



Performance


Data Source,

Method &

Frequency

Base

Line Year Target

Results %

Deviation

from

Target

Status Q1 Q2 Q3 Q4

Yearly

Average

(%)

hospitals who

are discharged

home alive

intensive care unit for any medical or

surgical intervention and discharged

home alive after completing the

required hospitalization period.

Selected hospitals are those with

upgraded neonatal intensive care

through renovation, equipment and

capacity-building for the service

providers.

Numerator: inborn neonates

discharged alive after being admitted

to the neonatal intensive care unit

Denominator: total inborn

neonates admitted to the neonatal

intensive care unit

Y3 88% 87% 88% 89% 91% 88.7% 0.8%

Y4 89% 93% 92.7

% 92% 92% 92% 3%

Y5 90% 92% 92% 93% _ 92% 2.2%

3.1c Percent of

pregnancy

induced

hypertensive

clients managed

according to

clinical

guidelines

This quantitative indicator measures

the percentage of pregnancy induced

hypertension (PIH) patients managed

according to the clinical guidelines

according to the following

management procedures:

1. History: Inquired on headache,

epigastric pain, blurring of vision

or fits upon admission.

2. Examination: Checked blood

pressure, reflexes, FHS according

to guidelines.

Hospital Obstetric

Records

PIH Forms

LIH Logbook

80

Y1 80% 78% 79% 78.5% -1.25%

Y2 85% 81% 77% 73% 82% 79% -7.1%

Y3 90% 85% 88% 88% 89% 88%

-2%



66



Performance


Data Source,

Method &

Frequency

Base

Line Year Target

Results %

Deviation

from

Target

Status Q1 Q2 Q3 Q4

Yearly

Average

(%)

3. Investigations: Checked for urine

albumin upon admission.

4. Active Management: Gave

magnesium sulfate according to

guidelines.

Numerator: Number of women

admitted to hospital with pregnancy

induced hypertension who are

managed according to clinical

guidelines in 3 months

Denominator: Number of women

admitted to hospital with pregnancy

induced hypertension in 3 months

Quarterly Y4 95% 92% 80% 82% 88% 85.5%

-10%

Y5

95%

87%

90%

91%

-

89.3%

-6%

3.1d Percent of

hospitals using

confidential

inquiries into

maternal deaths

and near misses

to monitor the

quality of

maternal care


measures the percentage of hospitals

using confidential inquiries into

maternal deaths and near misses

according to guidelines. A hospital

will be considered as implementing

Confidential Inquiry if it fulfills the

following criteria:

1. All cases of maternal deaths are

audited according to the

confidential inquiry surveillance

cycle.

Confidential

Inquiry forms

Delivery Logbook

HSMC MOM

0

Y1 0

Y2 25% 0% 25% 25% 0%

Y3 50% 28% 52% 40% -20%



67



Performance


Data Source,

Method &

Frequency

Base

Line Year Target

Results %

Deviation

from

Target

Status Q1 Q2 Q3 Q4

Yearly

Average

(%)

2. 75% of cases of obstetric:

hemorrhage, severe-preeclampsia

and eclampsia are audited

according to the near misses

review cycle.

3. Data should be collected and

investigation done monthly.

Numerator: Number of hospitals

using Confidential Inquiry into

maternal deaths and near misses in 6-

month period

Denominator: Total number of

hospitals trained on using the

Confidential Inquiries into maternal

deaths and near misses during the

same period of time.

Semiannual

Y4 75% 60% 70% 65% -13%

Y5 85% 63% 66% 65% -23.5%



68

Objective 4: Improve quality of and increase access to FP/RH services

Result 4.1 increased use of modern family planning methods, a shift from traditional to modern method use, and decreased total fertility and

discontinuation rates

Performance


Data

Source,

Method &

Frequency

Base

Line Year Target

Results %

Deviation

from

Target

Status Q1 Q2 Q3 Q4

Yearly

Average

(%)

4.1 Percent of

MOH health

centers

providing at

least 4

modern FP

methods


measures the percentage of health

centers providing a range of modern FP

methods, with a minimum of 4 modern

methods. This indicator assures that

clients have a wider choice of method

selection that meets their needs and

desires. It is expected to contribute to

increasing the access to FP services. A

health center will be considered if at

least four modern FP methods are

provided to FP clients; modern

methods are IUD, OCs, condom,

injectables and implants.

Numerator: Number of health

centers providing at least 4 modern FP

methods during 3 months

Denominator: Total number of MOH

health centers providing FP services

during the same 3 months

Logistics

Information

System

Quarterly

29.7

Y1 BL BL

29.7% Baseline

Y2 35% 24.8

%

24.6

%

24.5

% 21.3% 23.8% -32%

Y3 40% 18.5

%

22.2

%

25.4

% 28.7% 23.7% -41%

Y4 35%* 26.5

% 29%

29.4

% 31.1% 29.0% -17%

Y5 40%* 29% 31% 33% - 31% -22.5%

*Target was modified in consultation with USAID in Y4.



69

Objective 4: Improve quality of and increase access to FP/RH services

Result 4.2 A more comprehensive client‐centered ESP that enables service providers to expand their services and provides clients and communities with

better-quality family planning information and services

Performance


Data Source,

Method &

Frequency

Base

Line Year Target

Results % Deviation

from

Target

Status Q1 Q2 Q3 Q4

4.2 Percent of

missed

opportunities

for FP

counseling at

MOH PHC

centers.


measures the percentage of missed

opportunities for FP services at MOH

PHC centers. A client is considered to

be a missed opportunity for FP if she is

a married woman in reproductive age

currently not using an FP method and

does not receive FP counseling when

attending an MOH PHC facility. This

indicator will be measured through a

client exit study at a sample of PHC

centers.

Numerator: Number of non-FP users

married women in reproductive age

(MWRA) attending MOH PHC centers

participating in the study who are not

counseled on FP services

Denominator: Total number of non-

FP users MWRA who are eligible for FP

counseling at same MOH facilities

Client Exit

Interview Study

Annual

82.5

Y1 0

Y2 75% 75.9

% -1.2%

Y3 70% 65% +8%4

Y4

No data will be collected by HSS II in Year 4 and Year 5 for this

indicator, since it is being collected by another institutionalized survey

(DHS). Y5

4 Figure is positive because lower discontinuation rates are desired.



70

4.3 Health care providers are counseling and motivating women to use long‐term contraceptive methods and to minimize discontinuation.

Performance


Data Source,

Method &

Frequency

Base

Line Year Target

Results % Deviation

from Target Status

Q1 Q2 Q3 Q4 Total

I 4.3 Percent

of IUD and

OCs

discontinuers

during the first

year of use at

MOH PHC

centers

This is a quantitative indicator that measures

the percentage of IUD and combined oral

contraceptives discontinuers during the first

year of use. A client is considered a

discontinuer if she started the use of IUD or

COCs from an MCH center and

discontinued the method use during the first

year of use. A sentinel Surveillance Study is

conducted to follow up use of IUD and

COCs. Discontinuation is measured using

survival analysis for the collected data.

Sentinel

Surveillance

Study

Biannual (Results

will be available

in Y4)

28

14

IUD

42

COC

Y1 0

Y2 BL

14

IUD

42

CO

C

BL Baseline

Y3

13 IUD

40

COC

11.8

IUD

40

COC

- 7%

IUD

0%

COC

Y4 No data will be collected by HSS II in Year 4 and Year 5 for this

indicator, since it is being collected by another institutionalized

survey. Y5

Result 4.4: Family planning services are offered to post‐partum and post‐miscarriage women at MOH, RMS hospitals and JUH

4.4a Percent

of post-

miscarriage

clients

receiving

modern FP

methods

before

discharge at

selected public

hospitals


the percentage of post-miscarriage clients

receiving modern FP methods before

discharge from selected public hospitals.

MOH hospitals selected for this indicator

include those which mount to a total of 80-

85% of annual deliveries according to 2009

MOH statistical report.

Numerator: Number of post-miscarriage

clients receiving modern FP methods before

discharge at selected public hospitals during

6 months

Denominator: Total number of post-

miscarriage clients at selected public

hospitals during 6 months

Hospital

Logbooks

Semiannual

0

Y1 0

Y2 10% N/A 25.3

% 25.3% 153%

Y3 20% 18% 21.9

% 19% -0.3%

Y4 30% 23% 23.8

% 23.4% -22%

Y5 40% 26% 26% 26% -35%



71

Performanc

e Indicator Definition

Data Source,

Method &

Frequency

Base

Line Year Target

Results %

Deviation

from

Target


4.4b Percent

of postpartum

clients

receiving FP

counseling

before

discharge at

selected public

hospitals


measures the percentage of postpartum

clients receiving counseling for FP before

discharge from selected public hospitals.

MOH hospitals selected for this indicator

include those which mount to a total of 80-

85% of annual deliveries according to 2009

MOH statistical report.

Numerator: Number of postpartum

clients receiving FP counseling/information

before discharge at selected public hospitals

during 6 months

Denominator: Total number of

postpartum clients at selected public

hospitals during 6 months

Hospital

Logbooks

Semiannual

0

Y1 0 N/A

Y2 10% n/a 34.9% 34.9% +249%

Y3 20% 32.9

% 44.7% 38.8% +94%

Y4 30% 50% 51.8% 50.9% 69%

Y5 40% 63% 68% 65.5%

63.7%

Result 4.6: A functional FP supervision and monitoring system at Central and Health Directorate(health centers and hospitals) levels

4.6 Number

of HDs with a

functioning

FP/MCH

supervision

system

This is a quantitative indicator that identifies

the number of Health Directorates with an

active MCH supervision system. The

supervision system is considered active if it

meets all of the following criteria:

1- Annual supervision schedule is

submitted to WCHD.

2- At least 60% of scheduled visits are

completed in Y3 (65% in Y4 and 70% in

Y5).

3- The supervision visit is documented

using the MCH supervision reports

form.

4- Monthly supervision reports are

submitted to the WCHD by the HD.

WCHD

documentation

including HDs’

supervisory

reports

Semiannually

0

Y1 4 4 4 0%

Y2 8 3 3 3 -62.5%

Y3 12 5 9 7 -41.7%

Y4 12 8 11 10 -16.7%

Y5 12 6 - 6 -50%



72

Objective 5: Improved Community Health

Result 5.1: Community health committees are established and functioning in all 12 HDs with special emphasis on poor and underserved populations both in

rural and urban areas

Performance


Data Source,

Method &

Frequency

Base

Line Year Target

Results %

Deviation

from

Target

Status Q1 Q2 Q3 Q4

5.1 Percent of

active Community

Health

Committees in

HDs


the number of active community health

committees in Health Directorates. An active

community health committee should fulfill the

following criteria:

1. A demonstrated Scope Of Work, roles and

responsibilities and operational instructions

2. Updated annual work plans addressing

health issues

3. 60% of the activities in the annual work

plan implemented within the allocated

timeframe

CHCs’ and

HDs’

Documents

Annual

0

Y1 30 28 -6.7%

Y2 40 29 -27.5%

Y3 80%* 90 13%

Y4 80% 87% 8.75%

Y5 80% 78%

-2.5%

*Target changed to percent in Year 3.

5.2 Number of

HDs with active

HP program


the number of Health Directorates with an

active health promotion program. A Health

Directorate with an active health promotion

program should fulfill the following criteria:

1. Has a Certified HP trainer

2. At least 60% of health centers trained on

HP concept and practices

3. At least 60% of planned HP activities are

implemented at the health centers

4. At least 60% of HCs receiving training are

reporting on a monthly basis

5. HD supervising the HC/HP activities

HDs’

Documents

HP&P

Directorate

Documents

Project Reports

Annual

0

Y1 2 6 200%

Y2 6 10 67.8%

Y3 10 8 -20%

Y4 12 8 -20%

Y5 12 8 -20%



73

Objective 6: Renovate, equip, furnish and maintain health facilities

Result 6.1 Obstetric, neonatal and emergency departments in selected hospitals renovated and upgraded to comply with international standards R 5.2:

Information on the ESP, family planning, reproductive health, maternal, neonatal and child health are promoted at the community level

Performance


Data

Source,

Method &

Frequency

Base Line

Year

Target

(EOC,

NNC/ ER)

Results %

Deviation

from

Target


6.1 Number

of hospitals

with

renovated and

equipped EOC

and NNC

departments


the number of MOH & RMS hospitals

renovated and equipped. A hospital is

considered renovated and equipped if any or

all of the departments below have been

renovated/remodeled, equipped and furnished

according to the hospitals assessment done at

the beginning of the project. The departments

are: 1) obstetric wards, 2) delivery rooms, 3)

operating theaters for C/S, 5) Neonatal

Intensive Care Units, 6) Ob/Gyn and

neonatal outpatient clinics

Project

Reports

Annual

0

Y1 0

Y2

EOC/ NNC

= 4

ER = 2

EOC/

NNC = 1

ER = 2

-50%

Y3

EOC/ NNC5

= 4

ER =0

EOC/

NNC = 4 0%

Y4

EOC/ NNC

= 4

ER =3

EOC/

NNC = 3

ER = 2

-28.5%

Y5

EOC/ NNC6

= 1

ER = 1

EOC/NNC

= 1

ER = 1

0%

End of Project Total

EOC/

NNC = 9

ER =5

5 Target was modified to carry over uncompleted renovation works from the previous year 6 Target was modified to carry over uncompleted renovation works from the previous year



74

Performance


Data

Source,

Method &

Frequency

Base

Line Year

Target

(EOC,

NNC/ ER)

Results %

Deviation

from

Target


Result 6.3: Selected primary health training centers renovated, equipped and furnished

6.3 Number

of Training

Centers

renovated,

equipped and

furnished


the number of training centers renovated and

equipped. A training center is considered

renovated and equipped if it has been

renovated/ remodeled, equipped, furnished.

Renovated and fully equipped training centers

along with a MOH training plan will contribute

to strengthening technical skills at the facility

level especially improving FP/RH knowledge

and information and improve technical skills to

provide needed services such as IUDs,

voluntary surgical contraception, breast

feeding, PHC, EOC, NNC, IMCI and others.

Project

Reports

Annual

0

Y1 0

Y2 8 8 0%

Y3 2 2 0%

Y4 0

Y5 0

Result 6.4: IT equipment to strengthen/ expand / develop health information systems is procured installed and utilized

6.4 IT

equipment

procured,

installed and

utilized

This is a binary indicator. The procurement

and installation of IT equipment identifies that

the indicator has been met. The indicator will

be considered to be achieved once the IT

procurement plan is developed and approved

by USAID, and equipment is procured and

installed at MOH facilities.

Project

Reports

Annual

0

Y1

Y2 100% 100% 0%

Y3 100% 100% 0%

Y4

Y5

Result 6.5: A standardized and efficient facility maintenance system at central and hospital levels established, functioning and sustainable

6.5 Facility

maintenance

guidelines and

monitoring

tools

developed and

utilized

This is a binary indicator that measures

whether the guidelines and monitoring tools

have been finalized and disseminate or not.

The indicator will be considered to be

achieved once the guidelines and tools are

developed; providers received classroom and

hands-on training for implementing guidelines.

Project

Reports

Annual

0

Y1

Y2

Y3 100% 100% 0%

Y4

Y5



75

Indicator Summary

The above table presented the last available data for each indicator. Explanations for

deviations from target of more than 10% above are given below.

Objective 1: Knowledge management

Explanations for the cancelled Knowledge Management survey in Y3

HSS II and the MOH agreed to cancel the knowledge management survey in Y3 as HSS II

KM staff and MOH counterparts were engaged in the overhaul of the MOH website and

health information systems.

Objective 2: Quality Improvement

Explanations for percent deviations greater than 10 for Quality Improvement

indicators: 2.1

Indicator 2.1: The target of accredited HCs for Year 5 (end of project) was 50.

However, 75 HCs have been accredited year. This higher than expected success rate

demonstrates the effectiveness of the collaborative approach for improving quality at

primary health care level. More importantly, it highlights the commitment of the MOH

to implement the required quality improvement measures.

Indicator 2.2: Out of the target of 10 HDs, three HDs have not yet achieved satisfactory

referral performance: Tafilah, Madaba and Karak. The Health Director of Madaba has yet

to allocate a room for the referral and appointment unit. The HD plans to have the

referral and appointment unit located at the Outpatient Department. However,

outpatient clinics are located outside Nadeem Hospital in the Health Directorate

compound, where construction work is ongoing. The construction works at Karak (now

completed) led to a similar problem. And in Tafilah, the HD decided to accept walk-in

patients without referral in order to ease transportation costs on patients.

Indicator 2.3b: Diabetic patients are currently being monitored using Fasting Blood Sugar

tests, which are less reflective of long-term control as compared to HbA1c. Indicator

Performance for Objective

Objective 3: Safe Motherhood

Explanation for percent deviations greater than 10 for Safe Motherhood indicators:

Indicator 3.1d: Personnel in some hospitals are still hesitant to complete confidential

inquiry forms because of legal liability fears.

Objective 4: Family Planning

Explanations for percent deviations greater than 10 for Family Planning indicators

Indicator 4.1: HSS II and the MOH have made significant progress in increasing the

number of HCs that provide at least four modern FP methods. Nevertheless, this

indicator is still below target. HSS II has documented the reasons for this in the past.

Below is a summary of the main reasons:



76

Pre-service issues: There is disconnect between pre-service education and

certification requirements for physicians and midwives, and the actual skills needed

by the MOH from these cadres at various centers where FP services need to be

provided.

Deployment and job requirement issues: For family planning, the present

requirement that midwives can only insert IUDs at health centers if they are

supervised by physicians specifically trained to perform this role is limiting access to

this popular and reliable FP method. Because physicians assigned to health centers

typically stay less than a year at any one center, this results in many trained midwives

being unable to offer IUD services because the general practitioners (GPs) who are

supposed to supervise them are newly assigned and not yet trained to do this, or in

some cases refuse to perform this function.

On-the-job performance of staff: Currently midwives who agree to offer IUD services as part of their work in health centers do so on a voluntary basis – there is

no requirement that every midwife assigned to a health center perform this service,

and no specific recognition of the extra effort this requires.

Indicator 4.4a: The percentage of post-miscarriage patients receiving FP methods is

below target. With the MOH, the HSS II team revealed that a significant proportion of

the cases intend to become pregnant again in the immediate future.

Indicator 4.4b: The percentage of postpartum patients who receive counseling is above

target. HSS II, RMS and MOH are putting forth great effort in monitoring and supervising

the services provided at these hospitals. Several hospitals allocated devoted midwives to

provide counseling to postpartum women before discharge. HSS II is continuously

monitoring and supervising the services provided by these midwives through regular

field visits. Furthermore, the commitment of the Capital HD director, Dr. Lail Al-Fayez,

who assigned two midwives to work at Al-Bashir Hospital, which has average monthly

deliveries of 1200 (the highest in the Jordan), has made significant impact on postpartum

counseling numbers.

Indicator 4.6: The deviation from target is due to the Kingdom-wide vaccination drive in

the first quarter (October – December, 2013). In the first quarter, the system was only

60% functional (as measured by completion of scheduled visits). In the second quarter,

the system was 100% functional (i.e. all visit were completed). However, the indicator is

calculated over the first two quarters, which explains the current deviation.

Objective 5: Community Health

Explanation for percent deviations greater than 10 for Community Health indicators:

Indicator 5.2: The number of HDs with active health promotion programs (8) is below

the target of 12. One necessary criterion for an active HP program is having a certified HP trainer. Due to high turnovers at HDs, this has proven to be a difficult criterion to

maintain.



77

Annex 2: List of Counterpart Administrations and Directorates

MINISTRY OF HEALTH MINISTRY OF HEALTH

Administrations Central Directorates

1. Secretary General 15. Health Communication and Awareness

Directorate

2. Planning Administration 16. Director of Buildings and Maintenance

Directorate

3. Primary Health Care Administration 17. Directorate of Biomedical Engineering

4. Health Directorates Administration 18. Employee Affairs Directorate

5. Hospital Administration 19. Human Resources Development

Directorate

6. Services Administration 20. Outpatient Clinics and Emergency

Directorate

7. Administrative Affairs Administration 21. International and Public Relations

Directorate

Central Directorates Chiefs of Specialty

8. Directorate of Planning and Project

Management

22. Chief of Obstetrics and Gynecology

(Ob/Gyn) Specialty 9. Project Management Department

10. Performance Appraisal Department

11. Information Technology Directorate 23. Chief of Pediatrics Specialty

12. Quality Directorate

13. Non-Communicable Diseases

Directorate 24.

Chief of Midwifery and Nursing

Specialty 14.

Women and Child Health Care

Directorate

ROYAL MEDICAL SERVICES JORDAN UNIVERSITY

1. Planning & Information Department 1. University President

2. Chief of Ob/Gyn Department JORDAN UNIVERSITY HOSPITAL

3. Chief of Neonatology 1. Hospital Director

4. Nursing Director 2. Head of Ob/Gyn Department

5. Training Department 3. Head of Neonatology

HIGHER POPULATION

COUNCIL 4. Nursing Director

1. Secretary General 5. Head of Maintenance Department



78

Annex 3: List of 120 Health Centers Prepared for Accreditation

# Health Centers (HCs) Health Directorate (HD)

1. Balila HC

Jarash HD

2. Qadisiyyah HC

3. Marsaa’ HC

4. Souf HC

5. Sakeb HC

6. Barma HC

7. Qafqafa HC

8. Kufur Khal HC

9. Al-Kfeir HC

10. Al-Mastabeh HC

11. Deir Al-Liyat HC

12. Ain Jana HC

Ajloun HD

13. Rajeb HC

14. Ajloun Comprehensive HC

15. Al-Wahadneh HC

16. Arjan HC

17. Prince Hasan HC

18. Buweida HC

Irbid HD

19. Ibn Sina HC

20. Dahiyat Al-Hussein HC

21. Eidoon HC

22. Nuaymeh HC

23. Al-Razi HC

24. Ramtha Comprehensive HC

25. Al-Mazar HC

26. Al-Taybeh HC

27. Kufr Yuba HC

28. Huwwara HC

29. Al-Sareeh HC

30. Al-Kraymeh HC

31. Qumeim HC

32. Hartha HC

33. Deir Abi Sa’eed HC

34. Al-Farouq HC

35. Al-Husn HC

36. Manshiyat Bani-Hasan HC

Mafraq HD

37. Eidoon Bani-Hasan HC

38. Mansoora HC

39. Um Al-Sarb HC

40. Zaatari HC

41. Hosha HC

42. Al-Kom Al-Ahmar HC

43. Rehab HC



79


44. Lib CHC

Madaba HD

45. Faisaliyyah Al-Oula HC

46. East Madaba HC

47. Al-Areesh HC

48. Al-Areed HC

49. Dleilet Al-Hamaydeh HC

50. Al-Hilalieh HC

51. Al-Falah HC

Zarqa HD

52. Zarqa Jadida HC

53. Prince Abdullah HC

54. Shabeeb HC

55. Hay Al-Rasheed HC

56. Musherfa Comprehensive HC

57. Jabal Amir Hamza Comprehensive HC

58. Tatweer Hadari (Yajooz) HC

59. Jabal Tareq HC

60. Al-Bassa HC

Capital HD

61. Abu-Nseir Comprehensive HC

62. Al-Thira'a (Hai Nazzal) HC

63. Al-Awdah (Um-Tineh) HC

64. Wadi El-Seer HC

65. Al-Nasser HC

66. Sweileh Al-Shamel HC

67. Al-Hashimi Al-Shamali HC

68. Pr. Basma (Ras Al-Ain) HC

69. Marka Comprehensive HC

70. Sahab Comprehensive HC

71. Al Jwaideh HC

72. Khreibat Al-Souq HC

73. Um-Nuwara HC

74. Al-Jofeh HC

75. Um Al-Amad HC

76. Um Al-Basateen

77. Na’our HC

78. Tla’ Al-Ali HC (Um Al-Hussein)

79. Shafa Badran HC

80. Maghareeb HC

Balqa HD

81. Mahes HC

82. Al-Salalem HC

83. Al Nahda HC

84. Mubess Primary HC

85. Allan Primary HC

86. Sbeihi Comprehensive HC

87. Al-Ma’addi Primary HC

88. Yarqa Primary HC



80


89. Baqee’ Comprehensive HC

90. Abu-Nseir Primary HC

91. Ain Al-Basha HC

92. Wadil Hoor HC

93. South Shouneh HC

94. Nayef Bin-Asem HC (Swema)

95. Rama HC

96. Ader HC

Karak HD

97. Taybeh HC

98. Majra HC

99. Ayy Comprehensive HC

100. Mu’ab Primary HC

101. Mo’tah Primary HC

102. Al-Qasr Primary HC

103. Faqqou’ Comprehensive HC

104. Manshiat Abu-Hamour HC

105. Ghor Al-Mazra’a HC

106. Tafileh CHC - A July 2012

Tafileh HD

107. Ees HC

108. Bseira Comprehensive HC

109. Al-Ain Al-Baida HC

110. Eima HC

111. Al-Qadesiyyah HC

112. Taybeh HC

Ma’an HD

113. Ail HC

114. Ma’an Gharbi HC

115. Shobak HC

116. Petra Comprehensive HC

117. Aqaba Comprehensive HC

Aqaba HD 118. Pr. Basma HC

119. Al-Khazzan HC

120. Baldeh Qadima HC



81

Annex 4: List of Hospitals that Received the Safe Motherhood

Program

# Hospital Health Directorate Health Sector Entity

1. Al-Iman Ajloun Ajloun MOH

2. Al-Hussein Salt Balqa MOH

3. Princess Iman (Ma’addi) Balqa MOH

4. Prince Hussein (Baqa’a) Balqa MOH

5. South Shouneh Balqa MOH

6. Bashir Capital MOH

7. Dr. Jamil Tutanji Capital MOH

8. King Hussein Medical Center Capital RMS

9. Queen Alia Capital RMS

10. Jordan University Hospital Capital JU

11. Abu Obaida Irbid MOH

12. Muath Bin Jabal Irbid MOH

13. Princess Badia / Rahma Irbid MOH

14. Princess Raya Irbid MOH

15. Yarmouk Irbid MOH

16. Prince Rashed Irbid RMS

17. Jarash Jarash MOH

18. Ghor Safi Karak MOH

19. Karak Karak MOH

20. Prince Ali Karak RMS

21. Ma’an Ma’an MOH

22. Queen Rania Ma’an MOH

23. Nadeem Madaba MOH

24. Princess Salma Madaba MOH

25. Mafraq OBGYN Mafraq MOH

26. Ruwaised Mafraq MOH

27. Ramtha Ramtha MOH

28. Prince Zeid Tafila RMS

29. Prince Faisal Zarqa MOH

30. Zarqa Zarqa MOH

31. Prince Hashem Zarqa RMS



82

Annex 5: List of Hospitals that Were Upgraded through

Renovation and Expansion Works

# Hospital Upgraded

Departments

Area

before

Upgrading

in m2

Area

after

Upgrading

in m2

Health

Directorate

Health

Sector

Entity

1. Al-Hussein Salt

1) Obstetrics and Neonatal

820 2,670 Balqa MOH

2. Princess Iman

(Ma’addi)

2) Obstetrics

and Neonatal 270 1,060 Balqa MOH

3. South Shouneh


100 1,970 Balqa MOH

4) Emergency 256 991

4. Bashir 5) Obstetrics

and Neonatal 5,900 6,100 Capital MOH

5. Dr. Jamil

Tutanji 6) Emergency 1,150 1,250 Capital MOH

6. Queen Alia 7) Obstetrics

and Neonatal 1,720 2,480 Capital RMS

7.

Jordan

University

Hospital

8) Obstetrics

and Neonatal 0 6,250 Capital JU

8. Jarash 9) Emergency 440 1,140 Jarash MOH

9. Karak


755 1,910 Karak MOH

11) Emergency 810 1,275

10. Mafraq OBGYN


1,554 2,950 Mafraq MOH

11. Prince Zeid 13) Obstetrics

and Neonatal 1,360 2,060 Tafila RMS

12. Prince Faisal 14) Emergency 710 1,142 Zarqa MOH

Total 15,845 33,248



83

Annex 6: List of Hospitals that Received Medical Equipment,

Furniture and IT Equipment

# Equipment Item Quantity

Medical Equipment for Dr. Jamil Tutanji (Sahab) Hospital - Emergency Department

1. Blood gas analyzer 1

2. Vital Sign Monitor- Dash 4000 5

3. Defibrillator/Cardioverter (AED) 1

4. Defibrillator; Manual 1

5. ECG machine 3

6. End tidal CO2 monitor RespSence 1

7. Examination Light, mobile SE51FL 6

8. Hand Held Doppler (Vascular) Versalab SE BW 1

9. Laryngoscope (curved and Straight) 3

10. Magill forceps 3

11. Operating Surgical Light 1

12. Otoscope/opthalmoscope 2

13. Oxygen delivery set, wall unit, French 15

14. Plaster, cutter American Orthopedics cast cutter 1

15. Portable Ventilator 1

16. Pulse Oximeter- 9700 Avant 5

17. Resuscitation bag ( Ambubag), adult 3

18. Resuscitation bag ( Ambubag), Pediatric 3

19. Sphygmomanometer, mobile on a stand (adult, pediatric and thigh cuffs) 5

20. Sphygmomanometer, wall mounted (adult, pediatric and thigh cuffs) 20

21. Stethoscope 20

22. Stool, step 7

23. Suction unit (Mobile) 2

24. Syringe pump (Standard syringe set) 4

25. Ultrasonic Nebulizer 2

26. Ultrasound machine Logic P5 Pro 1

27. X-Ray viewing box 4

28. Fetal Heart Rate Detector (Sonicaid), Medsonics T334 1


30. Mnaual Resuscitation bag, neonatal 2

31. Operating table, General surgery Amsco 3085 1

32. Crash Trolley 239966MRD 4

33. Examination bed/ Couch with IV Pole 16

34. In patient bed/ Adult with IV Pole 14



84


Medical Equipment for Dr. Jamil Tutanji (Sahab) Hospital - Emergency Department

35. Instrument Cabinet 4

36. IV Stand 12

37. Medication trolley 6450 3

38. Spinal Immobilization board, Adult 2

39. Spinal Immobilization board, Pediatric 1

40. Trolley patient ambulating transport 0747 6

41. Trolley patient, radio translucent Trauma 3

42. Trolley, Plaster 6030 1

43. Wheel chair 8






49. IV Stand 12





54. Trolley patient, radiotranslucent Trauma 3


56. Wheel chair 8

Medical Equipment for Dr. Jamil Tutanji (Sahab) Hospital – NICU

57. Nasal Bubble CPAP, Manufacturer: Fisher & Paykel 1

Furniture for Dr. Jamil Tutanji (Sahab) Hospital - Emergency Department

58. 4 drawer metal cabinet 1

59. chair (guest, bedside) 25

60. Chair desk, adjustable height 10

61. Changing room lockers (4 doors, 2upper + 2 lower) 8

62. Coffee Table medium size 2

63. Doctor on call room (bed + cabinet + small side cabinet) 1

64. Filing cabinet/ half closed (wood) 4

65. Manager Desk Chair 9

66. Multi-purpose carts (instrument trolleys) 3

67. Office Desk: Approximate size 1200 x 600x720 mm 7

68. Trash basket 10

69. Waiting area chairs 2-Seats (perforated chrome or stainless steel) 3

70. Waiting area chairs 3-Seats (perforated chrome or stainless steel) 6



85


Medical Equipment for Prince Faisal Hospital - Emergency Department




4. ECG machine 3



7. IV Stand 12


9. Magill forceps 3

10. Operating Surgical Light 1


12. Oxygen delivery set, wall unit, French 12



15. Pulse Oximeter- 9700 Avant 5



18. Sphygmomanometer, mobile on a stand (adult, pediatric and thigh cuffs) 5


20. Stethoscope 20

21. Stool, step 7







28. Examination Lamp, Burtan-Phillips, Model: SN22FL 1

29. Swivel Stool, Manufacturer: Winco 1

30. Wheel Chair, Manufacturer: Invacare 2

Medical Equipment for Prince Faisal Hospital - NICU


32. Manual Resuscitation Bag, Neonatal, Ambu 2



86


Medical Furniture for Prince Faisal Hospital - Emergency Department














46. Wheel chair 8



87


Medical Equipment for Al-Bashir Hospital - Ob/Gyn Department and NICU

1. Anesthesia Cart Lakeside model 2915CBL 13

2. Anesthesia Unit, Avance care station 1

3. CTG Machine, FGL, Analogic 11




7. ECG machine 6


9. Examination Lamp Burtan model SE51FL 12


11. Fetal Heart Rate Detector Nicoet/carefusion 10

12. Manikin, AED-CPR Training 1

13. Manual Resuscitation Bag, Adult 3

14. Manual Resuscitation Bag, Neonatal Ambu 10

15. Gas blender 7

16. Phototherapy unit 19



19. Pulse oximeter- 9700 Avant 8

20. Pulse oximeter, infant/neonatal Nonin 7500 20



23. Sphygmomanometer Adult / Mobile on stand 35

24. Sphygmomanometer, mobile on a stand (adult, pediatric and thigh

cuffs) 10



27. Incubator , NICU, Drager model C2000 Isolette 21

28. CTG Unit GE central station : Trium CTG machine, and screen : with

8 monitors model Coro 259 CX 1


30. Oxygen Delivery Set British Type Connection 20

31. Pediatric ALS trainer 4

32. Infant Radiant Warmer/ resuscitator GE Panda 13

33. Stethoscope 30

34. Stethoscope Adult 35

35. Stool, step 10



88


Medical Equipment for Al-Bashir Hospital - Ob/Gyn Department and NICU

36. Stool, Swivel Winco 15

37. Suction Machine, gardner denver, Aspiration Thomas 7


39. IV Stand 24

40. Suture Cart 2364M 2

41. Transport Incubator, NICU 2




45. Jaundice Meter, Drager JM-103 1


47. Monitor GE 259 CX-A 8

48. Nasal Bubble CPAP/ Fisher&Pykel 10

49. TV Sharp LCD 40" Full HD 1920 X 1080 Pixels 1



52. Ventilator (NICU): Newport E360S 6

53. Vital Sign Monitor Pediatric Dash 4000 2


55. Vital sign monitor, GE Dash 4000 Operating room 1


57. Vital Signs Monitor GE Dash 4000 (NICU) 15

58. Magill forceps 6




62. Pulse Oximeter, Infant/Neonatal, Manufacturer: Nonin, Model: 9700 1


Medical Furniture for Al-Bashir Hospital - Ob/Gyn Department and NICU


64. Danger Drug Cabinet 6

65. Delivery bed 4

66. Digital Scale, Neonatal 13

67. Examination Bed (Coach) 9


69. Gynecological Examination table with stirrups 5



89


Medical Furniture for Al-Bashir Hospital - Ob/Gyn Department and NICU

70. In Patient bed pediatric 6


72. Infant examination table 3

73. Inpatient bed Adult Graham Field Alpha AX7114 120


75. Instrument Table , Lakeside model 8354 8

76. Medication Trolley 1



79. Operating table 2


81. Pediatric Examination/ treatment bed 4

82. Stainless steel table, small Lakeside model 8357 8

83. Stainless Steel table, Large Lakeside model 8350 4

84. Trash basket 15




88. Delivery Bed, Manufacturer: Hill-Rom, Model: Affinity 4 1

89. Inpatient Bed, Manufacturer: Hill-Rom, Model: 305 Manual Bed With

Foan mattress and IV Pole 25

90. Wheel chair 22


Furniture for Al-Bashir Hospital - Ob/Gyn Department and NICU

91. Chair (guest, bedside) 30

92. Chair desk, adjustable height 4

93. Chair desk, HON 2091PC 25

94. Changing room lockers 80

95. Manager Chair 4

96. Classroom Chair 100

97. Counter Chair 10

98. Doctor on call room furniture

(3 beds and mattresses and 3 comidone each) 6

99. Executive Desk with Side 1

100. Filing cabinet (wood local purchase) 5

101. Filing Cabinet, Vertical 5

102. Office Desk HON model P3251R 25



90


Furniture for Al-Bashir Hospital - Ob/Gyn Department and NICU

103. Guest Chair 30

104. Guest Chair / Black Leather 65

105. Guest Chair / High Back Black Leather 11

106. Training Room Table 25

107. DVD Sharp with Shelve 1

108. Waiting Area Chairs 2-Seats 6

109. Waiting Area Chairs 3-Seats 24

110. Waiting Area Chairs Stainless Steel 6

111. Counter Chair / Black Leather 36

112. Bed side cabinet 120



91


Medical Equipment for Al-Hussein (Salt) Hospital - Ob/Gyn Department and NICU

1. Anesthesia Cart, Manufacturer: Waterloo, UTGKU-41212 2

2. Anesthesia Unit, Manufacturer: GE, Model: Avance S5 1

3. CTG Machine, Manufacturer: Analogic 2

4. Digital Scale, Neonatal, Manufacturer: Detecto, Model: 8435KG 1


6. Gynecological Examination Table with Stirrups, NK Medical 2

7. Incubator, NICU, Manufacturer: GE, Model: Giraffe 10

8. Infant Radiant Warmer/Resuscitator, Manufacturer: GE, Model: Panda

Warmer 2



11. Operating Surgical Light (LED Technology), Manufacturer: Steris,

Model: Harmony V LED LK-05 1

12. Phototherapy Unit, Manufacturer: GE, Model: Lullaby PT 1


14. Vital Sign Monitor for Operating Room, Manufacturer: GE, Model:

DASH 4000 1

15. Vital Signs Monitor for NICU, Manufacturer: GE, Model: DASH 5000

with Neonatal Accessories 4

Medical Furniture for Al-Hussein (Salt) Hospital - Ob/Gyn Department and NICU

16. Danger Drug (DDA) Cabinet 1


18. Examination Bed (Couch), Winco, Color: Blue 3



20. Instrument Cabinet, Manufacturer: UMF, Model: SS7834 3

21. Movable Anesthesia Chair, Manufacturer: Winco, Model: 4380 1

22. Operating Table, Manufacturer: Steris, Model: 3085 SP System 1

23. Stainless Steel Mayo Table, Movalble, Manufacturer: Lakeside 2

24. Stainless Steel Table, Large, Manufacturer: Lakeside 1

25. Stainless steel Table, Small, Manufacturer: Winco 3

26. Stool, Swivel, Manufacturer: Winco, Model: 4350 2

27. Wheel Chair, Manufacturer: Invacare, Model: EX2 2



92


Furniture for Al-Hussein (Salt) Hospital - Ob/Gyn Department and NICU

28. Bed Side Cabinet, NK Medical, Model: IC711-MET 2

29. Changing Room Lockers 25

30. Counter Chairs 28

31. Doctor on call room (2 beds+cabinet+small side cabinet) 3

32. Filing Cabinet / Open (4 shelves wood) 6

33. Filing Cabinet/Half Closed 8

34. Guest Chairs for Offices 32

35. Lecture Room Chairs 25


37. Office Desk (120x70x72cm) 16

38. Staff Rest Chairs 24

39. Waiting Area Chair (3-Seats) 19



93


Medical Equipment for South Shouneh Hospital – Emergency, Ob/Gyn Dept. and NICU



3.

Defibrillator Automated (AED), Manufacturer: Phillips, Model:

Heartstart XL, Accessories include external paddles (Adult and

Pediatric), 10 packs of printing paper, one extra set of ECG cables for

adult and pediatric, 50 AED pads

1


5. ECG Machine, Manufacturer: Space Labs, Model: Cardio Express SL12 2





Warmer 2

10. Manual Resuscitation Bag, Adult Ambubag 3



13. Otoscope / Ophthalmoscope, Manufacturer: Wech Allyn, Model: 71142 1

14. Oxygen Flowmeter (British system with autoclavable humidifier) 20


16. Pulse Oximeter Adult/Pediatric, Manufacturer: Nonin, Model: 7500 2


18. Sphygmomanometer Mobile on Stand (adult, pediatric and thigh cuffs),

Manufacturer: Baum, Model: 250 2

19. Stethoscope Adult, Manufacturer: Viridian, Model: 32 10





24. Ultrasonic Nebulizer, Manufacturer: Drager, Model: Tropical Plus

MP01205 1

25. Vacuum Regulator (British system with safety jar for 500cc) 15

26. Vital Sign Monitor Adult (Emergency), Manufacturer: Space Labs,

Model: S12400 2

27. Vital Sign Monitor for Operating Room, Manufacturer: GE, Model: DASH 4000

1





94


Medical Furniture for South Shouneh Hospital – Emergency, Ob/Gyn Dept. and NICU


30. Crash Trolley (Red), Manufacturer: Waterloo, Model: UTRLA-333369-

RED Accessories included IV Pole Oxygen cylinder with flowmeter and

regulator

4

31. Danger Drug (DDA) Cabinet 1


33. Examination Bed (Couch), Manufacturer: Clinton Industries, Model:

3010 27 Accessories included IV Pole 17


35. Infant Examination Table, Manufacturer: Winco, Model: 8400-xx-IV

Unit includes IV Pole 1

36. Inpatient Bed, Manufacturer: Hill-Rom, Model: 305 Manual Bed With Foan mattress and IV Pole

31


38. Medication Trolley, Manufacturer: Harlof, Model: VL42BIN3 3




41. Operating Table, Manufacturer: Steris 1

42. Patient Trolley, Ambulating, Manufacturer: NK/Novum, Model: NK

8000 2

43. Patient Trolley, Radiotranslucent, Manufacturer: Stryker, Model: 1037 2

44. Wheel Chair, Manufacturer: Invacare, 5



Furniture for South Shouneh Hospital – Emergency, Ob/Gyn Dept. and NICU

46. Bed Side Cabinet, Manufacturer: NK Model: IC-711 11




50. 4 Drawer Metal Cabinet 1

51. Cupboard (Wardrobe) for Doctor-on-Call Room 1

52. Dixon Cabinets/Shelves 6


54. Filing Cabinet (Half Closed) wood 180 X 80 12






95


Furniture for South Shouneh Hospital – Emergency, Ob/Gyn Dept. and NICU

58. Manager Desk Chair, mesh/base fabric wih foam mash back/chrome

base adjustable height with full arms support, 5 casters base best quality

heavy duty, approximate dimension 82cm H X 50cm W

12

59. Meeting Room Table, wooden top with melamine or metal screen,

metal legs powder coated no rust, heavy duty design and finishing, size=

120 cm X 70cm

6

60. Metal Changing Room Lockers (4 doors: 2 upper + 2 lower)

approximate dimensions 180 X 60 X 50cm 14


62.

Office Desk, wood, top cover consists of minimum 1.8cm plywood

faced with laminated sheet from both sides heavy duty design,

w/screen/melamine or wood with metal legs powder coated no rust,

two drawers with lock, approximate size= 1200 X 700 X 720mm,

heavy duty frame design and finishing

12

63. Single Wood Bed with Mattress for Doctor-on-Call Room 1


65. Visitor Chair, chrome/base fabric upholstery/chrome legs and handles,

5 casters base best quality haevy duty design 50


67. Waiting Area Chairs (3-Seats): metal frame base and chair, made of

perforated chrome or stainless steel best quality 14

IT Equipment for South Shouneh Hospital

68. Dell E170SC 17"LCD Monitor; Monitor Stand; power cable 10a/125v 1

69. Dell Optilex 780 DT Base, 15a/250v Computer; power cable 10a/125v;

Optical Mouse USB, Keyboard, USB; Dell Drivers and Documentation

CD;

1

70. HP 3015dn 220v Printer; power cord 125v; power cord 220v; Print

CartridgeSN: 3027B001AA; Installation Software CD 1



96


Medical Equipment for Mafraq Ob/Gyn Hospital - Ob/Gyn Department and NICU








Warmer 2


9. Mnaual Resuscitation bag 2







DASH 4000 1



Medical Furniture for Mafraq Ob/Gyn Hospital - Ob/Gyn Department and NICU


















97


Furniture for Mafraq Ob/Gyn Hospital - Ob/Gyn Department and NICU




32. Doctor on call room (2 beds + cabinet + small side cabinet) 3

33. Filing Cabinet / Open (4 shelves wood) 8








41. 4 Drawer Metal Cabinet 1



98


Medical Equipment for Queen Alia (RMS) Hospital - Ob/Gyn Department and NICU








Warmer 4





11. Oxygen Flowmeter with humidifier 30



14. Scale for Incubator, Manufacturer: GE, Model: Giraffe 1

15. Vacuum Regulator with safety Jar 10


DASH 4000 1



Medical Furniture for Queen Alia (RMS) Hospital - Ob/Gyn Department and NICU


19. 4 Drawer Metal Cabinet


















99


Furniture for Queen Alia (RMS) Hospital - Ob/Gyn Department and NICU


34. Coffee Table 4












100


Medical Equipment for Jordan University Hospital - Ob/Gyn Department and NICU


2. CTG Machine, Manufacturer: Analogic, Model: Fetal Guard Lite FGL

Accessories included with each unit 9

3. Digital Scale, Neonatal, Manufacturer: Detecto 10



6. Fetal Heart Rate Detector (Sonicaid), MedaSonics Model: T345D 6

7. Incubator, NICU, Manufacturer: Drager, Model: Isolette 8000 13

8. Incubator, NICU, Manufacturer: Drager, Model: Isolette 8000 (with scale) 2

9. Infant Radiant Warmer/Resuscitator, Manufacturer: Drager, Model:

Resuscitaire 11


11. Manual Resuscitation Bag, Neonatal 2

12. Oxygen Regulator with Humidifier for Neonatal Department 35





16. Oxygen Regulator with Humidifier for Obstetric Department 45

17. Phototherapy Unit, Manufacturer: GE, Model: Lullaby LED 5


19. Vacuum Regulator with Bottle for Neonatal Department 25

20. Vacuum Regulator with Bottle for Obstetric Department 25

21. Ventilator, NICU, Manufacturer: Viasys, Model: Avea 2


DASH 4000 3




Medical Furniture for Jordan University Hospital - Ob/Gyn Department and NICU


25. Anesthesia Cart, Manufacturer: Waterloo, Model: UTGKU-43699 4

26. Birthing Bed for Labor, Delivery and Recovery, Manufacturer: Hill-Rom,

Model: Affinity 4 (P3700) 10


3010-27 accessories included IV Pole IV40 8



30. Gynecological Examination Table with Stirrups, Manufacturer: Clinton

Industries, Model: 8870 1



101


Medical Furniture for Jordan University Hospital - Ob/Gyn Department and NICU

31. Infant Examination Table, Manufacturer: Winco, Model: 8400-IV 3




34. Movable Anesthesia Chair, Manufacturer: NK/Novum, Model: NV2610B 2

35. Patient Trolley Ambulating, Manufacturer: NK/Novum, Model: NK8000 2

36. Stainless steel table Mayo 2

37. Stainless Steel Table, Large, Manufacturer: UMF, Model: SS8008 13


39. Stool, Swivel Winco 7



Furniture for Jordan University Hospital - Ob/Gyn Department and NICU


43. Chairs for Meeting Room at Neonatal Department 20



46. Filing Cabinet, Wood with Lock 30

47. Guest Chairs for Meeting Room 50


49. Manager Desk Chair HON 2091 High Back with Leather Fabric 15

50. Manager Desk Chair with Back Rest and Wire Mesh Fabric 12

51. Meeting Room Table 26


53. Single Wood Bed with Mattress for Doctor-on-Call Room 18

54. Waiting Area Chair 50

55. Wooden Cabinet (2 Doors) for Doctor-on-Call Room 2

56. Wooden Cabinet (3 Doors) for Doctor-on-Call Room 4

IT Equipment for Jordan University Hospital - Ob/Gyn Department and NICU

57.

Desktop Computer: Intel® Core i3,/Compatible with Win 7, XP/4 GB

1333 MHz DDR3 SDRAM/2 DIMM/Minimum 500GB 7200 rpm SATA 3.0

Gb/s min/ Integrated Intel HD/DVD/RW/ Sound line in, microphone / ALL

keyboards Arabic letters / 17 'inch/ 1366 x 768 / VGA and DVI-D connectivity

7

58. HP 19" LCD Monitor 1366x768 Resolution Monitor Stand and Power Cable 7

59. Network Printer: HP laserJet Pro P1606dn 2



102


Medical Equipment for Prince Zaid (RMS) Hospital - Ob/Gyn Department and NICU









Warmer 4

8. Manual Resuscitation Bag, Ambubag 2





12. Oxygen Regulator with Humidifier 40

13. Phototherapy Unit, Manufacturer: GE, Model: Lullaby LED 1



16. Vacuum Regulator with safety Jar 15


DASH 4000 1



Medical Furniture for Prince Zaid (RMS) Hospital - Ob/Gyn Department and NICU
















31. Stainless Steel Table, Small, Manufacturer: Winco 8





103


Furniture for Prince Zaid (RMS) Hospital - Ob/Gyn Department and NICU


35. Bedside Comidone 3



38. Doctor-on-Call Cabinet 4

39. Doctor-on-Call Single Bed (2m x 0.9m) with mattress 4



42. Meeting Room Table 16


44. Visitor Chairs 75




104


Medical Equipment for Jarash Hospital – Emergency Department

1.





1








9. Oxygen Flowmeter (British system with autoclavable humidifier) 20


11. Sphygmomanometer Mobile on Stand (adult, pediatric and thigh cuffs),

Manufacturer: Baum, Model: 250 2


13. Ultrasonic Nebulizer, Manufacturer: Drager, Model: Tropical Plus

MP01205 1

14. Vacuum Regulator (British system with safety jar for 500cc) 15


Model: S12400 2

Medical Furniture for Jarash Hospital – Emergency Department



regulator

4
















105


Furniture for Jarash Hospital – Emergency Department




31. Manager Desk Chair, mesh/base fabric with foam mash back/chrome



12



33.

Office Desk, wood, top cover consists of minimum 1.8cm plywood

faced with laminated sheet from both sides heavy duty design,

w/screen/melamine or wood with metal legs powder coated no rust,

two drawers with lock, approximate size= 1200 X 700 X 720mm,

heavy duty frame design and finishing

12

34. Visitor Chair, chrome/base fabric upholstery/chrome legs and handles, 5 casters base best quality heavy duty design

40





106


Medical Furniture for Karak Hospital – Emergency, Ob/Gyn Dept. and NICU



3.





1







Warmer 5




13. Operating Surgical Light, Model: Trilight 5300 1


15. Oxygen Flowmeter (French system with autoclavable humidifier) 40



18. Pulse Oximeter, Infant/Neonatal, Manufacturer: Nonin, Model: 9700

includes two sets of reusable leads, probes and accessories 2

19. Scale for Incubator, Manufacturer: GE, Model: Giraffe


21. Suction Jar, 2 Litre 2

22. Ultrasound Nebulizer, Manufacturer: Drager 1

23. Vacuum Regulator (French system with safety jar for vacuum regulator

500cc) 30


Model: S12400 2


DASH 4000 2





107


Medical Furniture for Karak Hospital – Emergency, Ob/Gyn Dept. and NICU




regulator

4











36. Operating Table, Model: Saturn select 3.01 1



39. Stainless Steel Cabinet, Manufacturer: UMF, Model: SS7834 8




43. Swivel Stool, Manufacturer: Winco 7

44. Wheel Chair, Manufacturer: Invacare 8

Furniture for Karak Hospital – Emergency, Ob/Gyn Dept. and NICU



47. Doctor on call room bed 8

48. Doctor on call room cabinet 4


50. Manager Desk Chair, mesh/base fabric wih foam mash back/chrome



26

51. Meeting Room Table, wooden top with melamine or metal screen,

metal legs powder coated no rust, heavy duty design and finishing, size=

120 cm X 70cm

12



53. Office Desk (120x70x72cm) 26/26

54. Training Room Chair, chrome/base fabric upholstery/chrome legs and

handles, heavy duty design 25

55. Visitor Chair, chrome/base fabric upholstery/chrome legs and handles,

5 casters base best quality haevy duty design 50





108


Medical Equipment for Pr. Iman (Ma’addi) Hospital - Ob/Gyn Department and NICU









Warmer 3

8. Inpatient Bed, Manufacturer: Hill-Rom, Model: 305 Manual Bed with

Foam Mattress 21







14. Oxygen Flowmeter (French system with autoclavable humidifier) 30




18. Vacuum Regulator (French system with safety jar for 500cc) 20

19. Vital Sign Monitor for Operating Room, Manufacturer: GE, Model: DASH

4000 1



Medical Furniture for Pr. Iman (Ma’addi) Hospital - Ob/Gyn Department and NICU



23. Doctor-on-Call Single Bed with mattress and side comidone 2






27. Movable Anesthesia Chair, Manufacturer: Winco 1









109


Furniture for Pr. Iman (Ma’addi) Hospital - Ob/Gyn Department and NICU









# Hospital NICUs that Received CPAP Units Quantity

1. Dr. Jamil Tutanji (Sahab) Hospital / MOH 1

2. Al-Bashir Hospital / MOH 10

3. Al-Hussein (Salt) Hospital / MOH 2

4. South Shouneh Hospital / MOH 1

5. Mafraq Ob/Gyn Hospital / MOH 2

6. Queen Alia Hospital / RMS 3

7. Jordan University Hospital (JUH) 3

8. Prince Zaid Hospital / RMS 2

9. Jarash Hospital / MOH 1

10. Karak Hospital 2

11. Princess Iman (Ma’addi) Hospital / MOH 1

12. Abi Obaidah Hospital / MOH 1

13. King Hussein Medical Center / RMS 2

14. Ramtha Hospital / MOH 1

15. Yarmouk Hospital / MOH 1

16. Zarqa Hospital /MOH 2

17. Al-Nadim Hospital / MOH 2

18. Muath Bin-Jabal Hospital / MOH 1

19. Prince Ali Hospital (RMS) 1

20. Prince Hashem Hospital / RMS 2

21. Prince Hussein (Baqa’a) Hospital / MOH 1

22. Prince Rashed Hospital / RMS 1

23. Princess Raya Hospital / MOH 1

24. Princess Salma Hospital / MOH 1

25. Ghor Al-Safi Hospital / MOH 1

26. Ma’an Hospital / MOH 2

27. Princess Badia Hospital / MOH 3

28. Queen Rania Hospital / MOH 1



110

Annex 7: List of Upgraded Training Centers including

Equipment and Furniture Provided

# Location of Training Center (TC) Governorate

1. Central Training Center in MOH Building Capital

2. Al-Qadesiyyeh Primary Health Center Jarash

3. Eshtafena Comprehensive Health Center Ajloun

4. Al-Sareeh Comprehensive Health Center Irbid

5. Jabal Amir Hamza Comprehensive Health Center Zarka

6. Mafraq Comprehensive Health Center Mafraq

7. Sahab Comprehensive Health Center Amman

8. Ein Al-Basha Comprehensive Health Center Balqa

9. Public Health and School Health Building Tafileh

10. Ma’an Health Directorate Ma’an



111

1. Equipment and Furniture Provided to the Upgraded Training Centers

#

Quantity per Training Center (TC)

Equipment & Furniture Sahab

TC

Ain Al-

Basha

TC

Mafraq

TC

Al-

Qadesiyya

TC

Al-

Sareeh

TC

Eshtafena

TC

Jabal

Amir

Hamza

TC

Tafilah

TC

Ma’an

TC

1. Training Room Table 14 12 14 14 14 14 12 12 12

2. Training Room Chair 60 60 64 64 70 60 50 55 55

3. Filing Cabinet/Half Closed 4 4 4 5 4 4 4 4 4

4. Manager Desk Chair with Arm 0 0 0 0 2 2 2 3 3

5. Office Desk (120x70x72cm) 1 2 1 0 1 2 2 3 3

6. Office Desk (140cm) 1 0 1 2 0 0 0 0 0

7. Round Table 4 4 5 4 5 4 4 4 4

8. White Screen 1 1 1 1 2 0 0 1 1

9. White Board 1 1 1 1 2 0 0 0 0

10. Flip Chart Stand 2 2 3 3 3 0 0 0 0

11. Desktop Computer 2 1 2 2 2 1 2 2 2

12. Printer 1 1 1 1 1 1 1 1 1

13. Digital Light Projector (DLP) 0 1 0 0 1 0 1 1 1

14. Air Conditioning (2-Ton) 2 2 5 2 0 2 2 5 4

15. Air Conditioning (3-Ton) 1 1 0 0 0 1 1 0 0

16. Photocopy Machine 1 1 1 1 1 1 1 0 0

17. Water Boiler (Kettle) 1 0 1 0 1 0 1 1 1

18. Water Cooler 1 0 1 0 1 0 1 1 1



112

2. Equipment and Furniture Provided to the Upgraded Training Center

at the Central MOH

# Equipment & Furniture Quantity

1. Training Room Table 18

2. Training Room Chair 60

3. Manager Desk Chair with Arm 5


5. Round Table 6

6. White Screen 3

7. White Board 2

8. Flip Chart Stand 4

9. Desktop Computer 2

10. Printer 1

11. Podium 1

12. Digital Light Projector (DLP) 1

13. Movable Trolley for Datashow 1

14. Column Speaker 15W @ 100V line with wall

bracket ASC-20T 8

15. Column Speaker 30W @ 100V line with wall

bracket ASC-40T 2

16. Power P.A. mixing amplifier 240W rms r max

GZ-240 UNIPEX 1

17. Wireless Microphone VHF band 2 channel one

set 1 receiver with 2 hand held mics 1

18. Wireless Microphone VHF band 2 channel one set 1 receiver with 2 Tai clip mics

1

19. Table Microphone Stand 2

20. Wired Microphone 600 ohm AUD-98XLR 2

21. Water Boiler (Kettle) 2

22. Water Cooler 2



113

Annex 8: List of Community Health Committees

# CHCs Health Directorate (HD)

1. Sahab

Amman

2. Jizeh

3. Naour

4. Bassah

5. Abu Nuseir

6. Al-Thiraa’ (Hai Nazzal)

7. Al-Nasser

8. Al-Hashimi Al-Shamali

9. Al-Jofeh + Al-Awdah (Um-Tineh)

10. Wadi El-Seer

11. Um-Nuwwara + Al-Qweismeh

12. Khreibat Al-Souq

13. Sweileh

14. Princess Basma

15. Jwaideh

16. Marka Al-Shamel

17. Amman

18. Um Al Basateen

19. Shafa Badran

20. Um Al Amad

21. Tlaa' Al Ali

22. Zarqa Jadida + Prince Abdallah

Zarqa

23. Dleil

24. Prince Hamza + Zawahreh

25. Tareq

26. Hai Al-Rasheed

27. Al-Musheirfeh Al-Shamel

28. Al-Tatweer Al-Hadari (Yajooz) + Al Falah7

29. Shbeib

30. Salalem

Balqa

31. Fuheis

32. Zai

33. Mahes

34. Al Maghareeb

7 Developed into a Community Based Organization (CBO)



114


35. Al-Baqee’

36. Abu-Nuseir + Mubes

37. Yarqa

38. Ma'addi

39. Al-Sbeihi

40. Al Nahda

41. Allan

42. Madaba El-Gharbi Madaba

43. Zaatari

Mafraq

44. Khaldieh

45. Mansheyet Bani Hasan

46. Eidoun

47. Mansoura

48. Sakhra

Ajloun

49. Ein Janna

50. Rajeb

51. Anjara

52. Prince Hasan (Ajloun)

53. Al Wahadneh

54. Balila

Jarash

55. Souf

56. Jarash + Al-Qadisiyya + Deir Al-Layat

57. Al Razi

58. Burma

59. Al-Kfeir

60. Sakeb

61. Kufur Khal

62. Qafqafa

63. Al-Mastabeh

64. Marsaa’

65. Beit Ras

Irbid

66. Huwwara

67. North Shouna

68. Kraymeh

69. Rayyan

70. Buweida

71. Deir Abi Saeed (Koura)



115


72. Barqash

73. Hartha

74. Dahiyat Al-Hussein + Al Razi + Ibn Sina

75. Aydoun

76. Al-Sareeh

77. Huson

78. Al-Mazar

79. Kufur Youba

80. Al-Nuaymeh

81. Qumeim

82. Ramtha

83. Taybeh

84. Al Farooq

85. Ader

Karak

86. Taybeh

87. Majra

88. Al-Qaser + Al Rubbeh

89. Faqqou’

90. Manshiat Abu Hammour

91. Mutah + Al-Mazar

92. Ay

93. Mouab

94. Al Eis

Tafila 95. Tafil

96. Bsaira

97. Eima

98. Petra

Ma’an

99. Ail

100. Ma'an

101. Manshieh

102. Husseinieh

103. Princess Basma

Aqaba 104. Al-Khazzan

105. Old City

106. Aqaba



116

Annex 9: List of HSS II Publications

# Publications 1. Best Practices for Implementing the Mother-Newborn Package of Services at

Hospitals 2011 - Maternal

2. Best Practices for Implementing the Mother-Newborn Package of Services at

Hospitals 2011 - Neonatal

3. The Evidence-Based Clinical Guidelines for Contraceptive Use 2013 - Arabic

4. The Evidence-Based Clinical Guidelines for Contraceptive Use 2013 - English

5. The Evidence-Based Clinical Guidelines for Contraceptive Use 2013 – References

6. Emergency Health Care Clinical Guidelines 2010

7. Emergency Nursing Procedures 2011

8. Emergency Department Service Standards For General Hospitals

9. Evidence Based Medicine Manual 2011

10. Family Planning Strategic Plan 2013-2017 – Arabic

11. Family Planning Strategic Plan 2013-2017 – English

12. Knowledge Management Strategy 2011

13. Long Acting Hormonal Contraceptives; Contraceptive Implants

Clinical Guidelines 2011

14. Long Acting Hormonal Contraceptives; Contraceptive Implants

Training Module 2011

15. Maintenance System Policies and Procedures Manual 2012

16. MOH Job Descriptions 2011

17. MOH Strategy 2013-2017 – Arabic

18. MOH Strategy 2013-2017 – English

19. Standards for Providing Postpartum and Post-abortion Family Planning Services 2011

20. Diabetes Mellitus Guidelines for PHC 2012

21. Hypertension Guidelines for Primary Health Care 2012



117

Annex 10: List of HSS II Studies

# Studies

1. Family Planning Sentinel Surveillance 2010

2. Missed Opportunities for Family Planning, Client Exit Interview Study Report 2010

3. Situation Analysis Report for Readiness to Provide Intrauterine Device Insertion

Services in MOH Health Centers Where Midwives are Not Currently Providing this

Service 2012

4. Maternal and Child Health Supervision System Assessment 2012

5. A Decade of Task Sharing in Jordan: Lessons for Policy and Service Delivery 2013

6. Family Planning Services Provided at Selected MOH Hospital Outpatient Clinics –

Situation Analysis Report 2013

7. Decision Makers’ Attitudes towards Family Planning Services –

Qualitative Research Report 2013

8. Users of Traditional Family Planning Methods Needs Assessment –

Qualitative Research Report 2014

9. Effect of Family Planning Counseling Provided to Postpartum Women before

Discharge from Al-Bashir Hospital on the Adoption and Continuation of Modern

Contraceptive Methods – Study Report 2014

10. Uses and Attitudes regarding Family Planning in Ma’an - Qualitative Research Report

2014

11. Missed Opportunities for Family Planning, Client Exit Interview Report, 2011

12. Pre-Intervention Report: Assessment of Community FP Uses and Attitudes - Irbid

Initiative, 2013

13. Post Intervention Report: Assessment of Community FP Uses and Attitudes - Irbid

Initiative, 2014

14. National Midwifery Core Competencies & Career Structure Framework, 2014

15. Family Planning Sentinel Surveillance Newsletter, 2013

16. Health Care Providers Practices and Beliefs towards FP Methods, July 2013

17. Users of Traditional FP Methods – Needs Assessment Report, 2014



118

Annex 11: List of Training Programs and Number of Trainees

# Component Training Title

Total

Male

Trainees

Total

Female

Trainees

Total

Trainees

1.

Knowledge

Management

ArcGIS I – Introduction to GIS 0 5 5

2. ArcGIS II – Essential Workflows 0 4 4

3. ArcGIS III – Performing Analysis 0 4 4

4. Building Web Application Using

the ArcGIS API for Silverlight 0 4 4

5. CISCO CCDA (Cabling &

Networking) 6 4 10

6. Computer Basic Skills 35 169 204

7. Creating & Publishing Maps with ArcGIS Desktop

0 4 4

8. Editing Data with ArcGIS for

Desktop 0 4 4

9. Migrating to ArcGIS 10.1 for Server 0 4 4

10. QIS Maintenance Troubleshooting 5 5 10

11. A+ (Micro 2000 A+ Course) 30 93 123

12. Advance Microsoft Access 3 7 10

13. Advanced MS Excel & Access 17 33 50

14. Basic Advance Excel 1 7 8

15. Basic Microsoft Access 3 7 10

16. CCNA 14 2 16

17. Cisco CCNP Switching 6 3 9

18. Cvoice 6 4 10

19. Designing, Deploying, and

Managing a Network Solution 10 38 48

20. Java Programming Language (J2EE) 4 5 9

21. Microsoft C# 3 7 10

22. Microsoft C# Development

Language Basic and Intermediate 3 7 10

23. Microsoft SharePoint 2010

Installation and Configuration 8 14 22

24. MS PMP 7 17 24

25. Network+ 30 111 141

26. Oracle DBA 5 4 9

27. Oracle DBA 1 & 2 7 5 12

28. PHP 1 6 7

29. SPSS 3 19 22

30. TOT for KM 11 20 31

Sub-Total 218 616 834



119

# Component Training Title Total Male

Trainees

Total Female

Trainees

Total

Trainees

31.

Primary

Health Care

& Quality

Improvement

PHC QI Collaborative Learning

Session 1035 2543 3578

32. Accreditation 607 2163 2770

33. Accreditation Collaborative

Initiative 118 266 384

34. Advanced TOT for QUHs and

QD 17 16 33

35.

Chronic Diseases Guidelines

Training (Hypertension &

Diabetes)

105 309 414

36. Coordinators’ Training

Workshop 9 8 17

37. Employee Engagement Model 29 86 115

38. Essential Services Packages 86 311 397

39. Infection Prevention 14 72 86

40. Management and Leadership

Skills 147 173 320

41. Monitoring & Evaluation 29 23 52

42. Operational Planning

(HC Annual Action Plans) 150 266 416

43. PHC Clinical Guidelines 20 11 31

44. PHC QI Cluster Specific Training

for HD Staff 44 100 144

45. PHC QI Collaborative 459 1445 1904

46. Referral 686 866 1552

47. Refresher Supervision Training 12 30 42

48. Strategic Planning 135 117 252

49. Supervision System 144 821 965

50. TOT for PHC 16 11 27

51. TOT for Quality 23 37 60

52. Training on Indicators including

MCH Indicators 331 1196 1527

53. TOT for Referral System 7 3 10

54.

Training on the Implementation

of HCAC PHC Medical Records

Standards

1 22 23

55. Updated Accreditation Standard 17 31 48

Sub-Total 4253 10932 15185



120


Trainees

Total Female

Trainees

Total

Trainees

56.

Safe

Motherhood

Best Practices for Implementing

the Maternal Mother-Newborn

Package of Services (MNPS) -

Clinical TOT

15 67 82

57. Best Practices for Implementing

Neonatal (MNPS) Clinical TOT 12 54 66

58.

Aseptic Preparation and

Administration for IV Medication

And Fluids Guidelines

5 15 20

59.

Breastfeeding & LAM Education

for Maternal & Neonatal Service

Providers

2 175 177

60. CPAP System Training 77 300 377

61.

Clinical Guidelines and Best

Practices for Mechanical

Ventilation

41 28 69

62.

Essential Maternal Care & its Best

Practices Training Workshop for

Midwives

1 247 248

63.

Essential Maternal Care & its Best

Practices Training Workshop for

Physicians

46 14 60

64.

Essential Neonatal Care & its

Best Practices Training

Workshop for Nurses

1 239 240

65.

Essential Neonatal Care & its

Best Practices Training

Workshop for Physicians

25 27 52

66. Midwifery Clinical Guidelines 0 54 54

67. NNC Clinical Guidelines for

Nurses 1 40 41

68.

Orienting HSMCs on

Postpartum/Post-abortion FP

services

33 72 105

69. HSMC Confidential Inquiries 43 81 124

70. HSMC Operational Planning 66 106 172

71. Supportive Supervision for

HSMCs 17 32 49

72. TOT for EOC and NNC trainers 12 58 70

73. OJT for Maternal Best Practices

for Implementing the MNPS 78 334 412

74. OJT for Neonatal Best Practices

for Implementing the MNPS 26 253 279

Sub-Total 501 2196 2697



121


Trainees

Total Female

Trainees

Total

Trainees

75.

Family

Planning

Breastfeeding & LAM Education

for the Maternal & Neonatal

Service Providers

2 175 177

76.

FP Counseling and Standards for

PP/PM for Head Nurses of

Obstetric Wards and Clinics

0 58 58

77. FP Services QI Initiative 184 587 771

78. Fostering Good FP Practices 37 390 427

79.

FP Counseling for Health

Providers at PHC and Hospital

Levels

7 1195 1202

80. FP Orientation for Non-MCH

Health Providers at PHC level 131 669 800

81. IUD Insertion for Physicians 8 61 69

82. IUD Insertion for Midwives 0 125 125

83. Logistics for Midwives 3 266 269

84. MCH Supervision 3 26 29

85.

Orientation of Universities on

the Integrated FP Information

within Curricula

0 16 16

86.

Orientation on FP PP/PM

Standards for Hospital Service

Providers

78 490 568

87. Orienting HSMCs on PP/PM FP

Services 33 72 105

88. Refresher TOT for RH/FP at

PHC and Hospital Levels 2 27 29

89.

Refresher Training for RH

Trainers on the Updated

Evidence Based Clinical Practice

Guidelines for Contraceptive Use

17 61 78

90.

Refresher Training on

Contraceptive Technology

Update, Including IUD Insertion

167 119 286

91. Refresher Training on FP for

Couples about to Marry 0 21 21

92. Refresher Training on IUD

Insertion for Midwives 0 44 44

93. Specific Counseling on Implanon 17 62 79

94. TOT for RH/FP at PHC and

Hospital Levels 6 56 62

95. TOT on LAHC; CI 5 6 11



122


Trainees

Total Female

Trainees

Total

Trainees

96.

Family

Planning

(continued)

LAHC; CI 86 101 187

97. TOT on the Updated FP

Counseling Curricula 0 17 17

98.

Training for RH Service Providers

on the Updated Evidence Based

Clinical Practice Guidelines for

Contraceptive Use

69 410 479

99. Training on the MCH Logbooks 4 98 102

100. Use of FP Educational Materials

for Midwives 1 393 394

Sub-Total 860 5545 6405

101.

Community

Health

HP Role in Case Management 209 637 846

102. Supervision Skills in HP 8 7 15

103. TOT for HP 7 9 16

104. Community Activation Cycle 712 794 1506

105. Participatory Rapid Assessment 517 576 1093

106. Arab Women Speak Out 0 715 715

107. Men Advocacy Groups 161 27 188

108. Youth Peer Education 177 482 659

109. Advanced BCC 19 30 49

Sub-Total 1810 3277 5087

110. Renovations OJT for Hospital Maintenance

Committees 211 173 384

Sub-Total 211 173 384

111.

Human

Resources

for Health

CPR TOT 19 2877 32

112. CPR for PHC Service Providers 730 2877 3607

113. Updated CPR Guidelines for

Emergency Care Providers 280 240 520

114. TOT on Evidence Based

Medicine 5 1 6

115. Evidence Based Medicine 83 38 121

116. TOT on Emergency Health Care 29 6 35

117. Emergency Health Care Clinical

Guidelines for Physicians 182 55 237

118. Emergency Nursing Procedures 112 215 327

119. Human Resources for Health 29 54 83

Sub-Total 1469 3499 4968

Total Number of Trainees 9322 26238 35560



123

Annex 12: Expenditure for Current Quarter (Year 5 – Quarter 4)

Budget Line Item Jul-14 Aug-14 Sep-14 Total

SALARIES $104,677.68 $70,300.20 $103,851.20 $278,829.08

FRINGE BENEFITS $43,964.63 $29,526.09 $43,617.51 $117,108.23

OVERHEAD $26,391.93 $17,151.80 $26,884.28 $70,428.01

CONSULTANT

Consultant fees $2,224.46 $906.44 $0.00 $3,130.90

Travel and Per Diem Consultant $0.00 $0.00 $0.00 $0.00

Consultant ODC's $0.00 $0.00 $0.00 $0.00

TRAVEL AND PER DIEM (Excluding Consultant) $7,398.26 $1,809.38 $3,165.50 $12,373.14

ALLOWANCES $18,595.01 $9,679.63 $10,310.57 $38,585.21

OTHER DIRECT COSTS $179,479.75 $37,244.09 $88,051.30 $304,775.14

EQUIPMENT/ GOVERNMENT PROPERTY

Equipment Procurement $452.88 $890.00 $0.00 $1,342.88

Office equipment $0.00 $0.00 $0.00 $0.00

SUBCONTRACTS

Subcontracts Renovation $56,563.44 $45,092.65 $1,514.83 $103,170.92

Subcontracts (Excluding Renovation) $101,694.91 $0.00 $12,711.86 $114,406.77

HANDLING CHARGE $3,540.59 $1,031.56 $312.99 $4,885.14

GENERAL AND ADMINISTRATIVE $72,969.08 $31,681.12 $52,476.71 $157,126.91

TOTAL ESTIMATED COSTS (Exclusive of Fee) $617,952.62 $245,312.96 $342,896.75 $1,206,162.33

FEE $38,622.03 $15,332.07 $21,431.04 $75,385.14

Burdened Salary Cap Adjustment -$790.52 -$701.09 -$1,210.62 -$2,702.23

ESTIMATED COSTS PLUS FEE $655,784.13 $259,943.94 $363,117.17 $1,278,845.24