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Country Team Action Plan

Yemen

Second Draft

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1. Where are we now?1. Accomplishment/Progress

since Bangkok 2007 • 5 BP started in 7 governorate (out of

23)• Protocols developed and adopted • Improvement Collaborative set up

and replicated• Service Providers’ training is on

going • Three new Best Practices were added

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1. Where are we now?1. Accomplishment/Progress

since Bangkok 2007 • Best Practices integrated in the pre-

service Community Midwives curriculum

• Best practices integrated in the in-service training

• Linked with quality improvement efforts

• Facilitated logistics improvements• Facilitated MIS

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1. Where are we now?1. Accomplishment/Progress

since Bangkok 2007 • About 500 service providers trained

(25 trainers and 12 for Newborn resuscitation)..

• Scaling-up is now part of MOPHP Plan• MOPHP and development partners

within RHTG established subgroup for quality and best practices

• Other donors now supporting scale up in new governorates

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1. Where are we now?2. Challenges since 2007

• Shortage of personnel (especially female) for 24 hour shifts

• Extremely short hospital stay after normal deliveries; maximum two hours

• Providers not convinced that delivery is a good time to talk about Family Planning

• Stock outs (Vit A, vaccines, IC supplies)

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1. Where are we now?2. Challenges since 2007

• Poor motivation• weakness in the documentation and

monitoring• Weak coordination between

management and service providers• Men’s involvement in RH/FP is not

cultural norm and not considered in service set up

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2. Where do we want to be? 1. Desired levels of

accomplishment• Scale up of the 8 Best Practices (BPs)

to 5 Health Centers per year in the governorates where the best practices have already started

• Scale up the BPs to at least 3 health facilities including the main governorate hospital in each of the remaining 16 governorates

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2. Where do we want to be? 2. Country Team Goal

• To strengthen services in the implementation of the 8 BPs in the current program sites.

• To scale up the 8 best practices nation wide to reduce maternal and newborn mortality and morbidity

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2. Where do we want to be? 3. Best Practice Chosen for

Scale-Up and Its Components

The 8 best practices to be strengthened and scaled up in targeted health facilities in 23 governorates

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3. What are the gaps?1. List gap between current status and desired levels of

accomplishment

• In the 7 governorates, where the BPs started, implementation is still localized in the main governorate hospitals and the desire is to spread to at least 5 health facilities each year.

• In 16 governorates BP activities have not been yet started and the desire is to have at least 3 health facilities including the main governorate hospital

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3. What are the gaps?2. List reasons for the gap

• Limited Resources (financial & human)

• Limited leadership capacity.• Absence of the BPs in the service

delivery system of the health facilities

• Shortage of staff, particularly the female staff.

• Weakness in supervision and monitoring system

• Poor staff motivation

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4. What interventions can we use to close the gap?1. List best practices and key interventions that can close

the gap1. Immediate and Exclusive Breast Feeding

2. Neonatal Infection Prevention3. Vitamin A for Women After Delivery 4. PP/PA Family Planning/HTSP5. KMC for LBW infants6. PPH managment/AMTSL7. Neonatal Resuscitation8. Immunization of newborn

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4. What interventions can we use to close the gap?

2. Describe how the interventions will address the gap

• Scaling up the BPs to at least 5 five health facilities in each of the 7 current governorates where the BPs have been established to ensure more coverage.

• Scaling up the BP to at least 3 health facilities including the main governorate hospital in each of the remaining 16 governorates, will help scaling up in the future to the rest of the facilities in these governorates

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4. What interventions can we use to close the gap?

3. List activities to carry out the interventions

• Resource mobilization• Increase the number of Improvement

Collaboratives teams• Training of public and private health

staff• Involvement of the health offices and

hospital directors in the process of BPs planning, implementation & evaluation.

• Mainstream implementation of BP in the service delivery system.

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5. What are the possible challenges to the

intervention?

• Limited financial and human resources

• Shortage of personnel (especially female) for 24 hour shifts

• Extremely short hospital stay after normal deliveries; maximum two hours

• Providers not convinced that delivery is a good time to talk about Family Planning

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5. What are the possible challenges to the

intervention?

• Stock outs (Vit A, vaccines, IC supplies)

• Weak supervision & monitoring system

• Poor motivation• weakness in the documentation

and monitoring

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6. Who are the possible partners, allies, and

stakeholders?• MoPHP: - Governorates health offices -Hospitals, Health centers• Universities and health institutes• Other government institutions: -Ministry of information - Ministry of endowment

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6. Who are the possible partners, allies, and

stakeholders? - Ministry of local Authority - Ministry of civil services• Developmental partners (Donors,

Social Fund for Developments,…)• Private sectors • NGOs ( e.g. NESMA,YMA,…..)

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7. What are the modifications needed to

improve the intervention’s scalability?• Mesopristol( facilities-community)

• Partograph• Magnisum sulphate • Post abortion management• Infant Nutrition• Establish recognition mechanism for

the best performance health facility

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1.8. Who will be involved

in scaling-up?1. List of organization (s) responsible for scaling-up

• Mainly MoPHP-Governorate Health Offices and health facilities with the support of interested donor organizations

• Private health facilities under the guidance of the MoPHP and it’s health offices

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2. Capacity of the organization to scale up & implications this has

for scaling up• It has the standards and regulations• It can assist in coordination among

donors and targeted health offices.• Increase capacity of staff • It has control over logistics• It provides qualified staff through

training• Coordinates between services and

education• Supervise the quality of the training

and services

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2. Capacity of the organization to scale up & implications this has

for scaling up• Leadership• Mainstreaming of BP in the health

system• Over all supervision and monitoring

of the whole process• TOT of 20 on BP team,3 IC teams.• BHS team• Ready manuals and guidelines for

the training and implementation.22

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3. Who will be part of the team to support the process of

scaling- up • Director of health offices and RH

directors• Director of the health facility

involved in the scale-up • IC Team• Logistics• Health information system, statistics• Supervisor, coach• Donor representative• Representative of the expert health

facility

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4. What needs to be done to ensure that the team is large enough and has the resources

to support scale-up?• More training for the team involved

in scale up.• More support to the interventions of

the best practices.• More establishment of IC teams• Translate the commitment to action• Follow up and support the process of

scale up

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9. What are the opportunities & constraints for Scaling-up?

1. opportunities:

• Strong commitment of the MoPHP and health offices.

• Willingness of interested health facilities for

scaling-up• Willingness of developmental

partners agencies to support introduction and scaling-up

• Development efforts of RH services

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9-What are the opportunities & constraints

for Scaling-up? 1. opportunities:• Availability of successful experiences

in implementation of best practices• Well trained trainers• 3 Improvement collaberatives teams• Support and readiness of institutions

like endowment and information to advocate

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9. What are the opportunities &

constraints for Scaling-up?2-Constraints

• Difficulties in changing behaviors of service providers towards better performance in PP counseling.

• weak supervision to improve performance

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9. What are the opportunities &

constraints for Scaling-up?2-Constraints

• Low Leadership capacity at level of health facility management staff

• Sustainability of logistics• Shortage of female staff• Rotation of staff trained in BP • Poor monitoring and

evaluation system28

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10. What policy, regulatory, budgetary, or other

institutional steps are needed?

• Best practices are part of the development efforts for the improvement of RH/FP and MNH service delivery. Therefore, policies, regulatory and budgetary steps are already set.

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10. What policy, regulatory, budgetary, or other

institutional steps are needed?• MDGs

• National Health Strategy 2010-1025• National RH/FP strategy 2006-2010• Ministerial Decree of free family

planning services• Republican and ministerial Decree of

free of charge delivery at public health facilities

• National standers of MNH services• Update of job description of midwives 30

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11. Where, when and how will the best practice be

expanded? • The expansion is to new geographic

sites and to more health facilities targeting more population .

• The scale up will be in about 2-3 years

• Dissemination of the PP to new areas of population by learning the strengths and weakness if the previous governorates

• Experiences of the Improvement Collaboratives

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12. What will be the costs of expansion and how will

needed resources be mobilized?

• The cost is mainly for the training of staff in different skills for implementation of BP.

• For IEC materials, meetings and supporting visits

• Some of developmental partners are committed to support by different levels

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13. How will the process, outcomes and impacts be

monitored? • Through regular reporting• Quarterly IC meetings• Field visits• Monitoring of the indicators

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14. How will results be fed into decision-making?

• Reporting of all reports to the governmental institutions, donors and local authorities.

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15. What are our action steps?

Action Step Responsible Person

Timeline

1.Meeting of the team of Bangkok 2010with the RHTG members to share information and more resource mobilization

Population sector RHTG coordinator

April 2010

2.Proposals for expansion in the targeted governorates for 2010

Pop sector /Health offices/

BHS team

April 2010

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15. What are our action steps?

Action Step Responsible Person

Timeline

3. Practical steps to solve the challenges of the implementation

Bangkok team 2010/Pop sector /Health offices/ BHS team

April 2010

4..Opertinalized POA of the scale up of BP for 2010-2011

Pop sector /Health offices/

BHS team

May 2010

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