Service Delivery Gaps Many areas of the country have low service access to MCH and other services due to a range of management, infrastructure, logistics and security barriers.
Program Coordination Gaps Lack of organizational capacity, guidelines and strategic framework on how to coordinate immunization, nutrition, environmental health and RH services is leading to fragmentation and inefficiencies in health service delivery
Human Resource Gaps There is lack of clarity in the roles and functions of basic health staff, and inequities in the distribution of staff, resulting in lack of access to health services in hard to reach areas.
Theme 1 Service Delivery Reaching communities with essential health system delivery components of MCH, nutrition, immunization and environmental health, with emphasis on hard to reach areas
Theme 2 Health Program Coordination and Capacity Building Strengthening coordination, management and organization of the health system at all levels with a focus on the Township Level
Theme 3 Human Resource Management and Development Improving distribution, skill, number and mix of health workers with emphasis on hard to reach areas
HSS Goal: Achieve improved service delivery of essential components of Immunization, MCH, Nutrition, Environmental Health by strengthening programme coordination, sub-national micro-planning, and human resources management and development in support of MDG goal 2/3 reduction in under 5 child mortality between 1990 and 2015.
Health Management and Planning, including Mapping hard to reach areas Human Resource Management Health Finance and Financial Management Community Participation Essential Drugs & Equipment Infrastructure Data Quality and Service Quality
• the focus will be on “system planning” for maternal and child health, immunization, nutrition and environmental health.
• the planning is therefore for the coordinated management and delivery of a “package of services,” and is not simply a collection of projects and programs.
• Once the system has been designed, tested and evaluated, consideration should be given to expanding the package of services to include communicable disease control, NCDs and hospital service
PROBLEMLack of coordinated planlack of management trainingInfrequent supervision and monitoring
RESPONSECTHP (costed)Financing of supervision of regular
supervision at all levelsQuarterly and annual review meetings
PROBLEMLow skilled birth attendanceLack of access in HTR area
PLAN RESPONSE FINANCING strengthening referral systems between
village and hospital (patient referral fund) - includes improved transport from village level and costs of treatment
MOBILITY increased TA/DA for midwives to move to additional villages more frequently (villages under her sub centres) plus Package service according to micro plan (MCH+Nutrition+ES)
COMMUNICATION regular meetings with local authority/ VHWS and advocacy to local authority
PROBLEM
Low midwife population ratio and incorrect skill mixPoor retention of staff in HTR
PLAN RESPONSE
Training of the auxiliary midwife and CHW Refresher training of the AMW and CHW Regular CME from BHS to VHW at RHC and sub RHC Renovation of RHC/construction of sub centers Per-diems for operations
PROBLEM
Lack of operational finance for providers and economic barriers in the community
RESPONSE
Costed CTHP with financial support for operations
Referral funds to solve economic barriers in the community
PROBLEMSome sub RHC have no building Each facility need with a delivery roomLimited housing for retention of staffLimited water and electrical supply (no power in
sub centres)
RESPONSEIncreased institutional delivery through improved
facility (constructions and renovations including delivery room at sub RHC and RHC)
Include water/sanitation/electrical supply in construction work
PROBLEM There is no ambulance at the Township
Hospital (100 bedded-Government support?)
Bicycles old and policy issues with motorcycles
RESPONSE Funding Request Procurement
PROBLEM Limitations in supplies of ED and equipment
(no replenishment for 10 years)
RESPONSE Essential Drugs to TH/SH/RHC/ sub center
level Equipment (RHC kit/HA kit/MW kit/CDK) Incremental for 4 years
PROBLEM Lack of training on management & research
RESPONSE Modified MEP training HSR training HSR grant
PROBLEM Lack of supervision check list
RESPONSE Supportive supervision TA for supervision Check-list is the RHC plan
HSS 180 townships in 4 years
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Health system analysis examines gaps in operations across health programmes and service delivery units
Making the transition from “management by project” to “management through systems” is a critical step in achieving:
Equity: in distribution
Efficiency through coordination and reduction of overlap of resources in favour of hard to reach areas
Effectiveness: improved health coverage
Sustainability: strengthening self reliance and management capacity
Yr 4 (60)Yr 4 (60)
Thank You