Coordinated Township Health Plan in (20) townshipsGAVI HSS

Contents of CTHP1. Conducting a health system assessment2. Establishing a Monitoring and Evaluation

Framework3. Developing RHC plans with sub RHC

participation4. Township Level Activity setting5. Analyzing Costs and Sources of Finance at

Township level6. Incorporating all of the above into a

Coordinated Township Health Plan

Scope of the Coordinated Health Plan (Package of Services)

• 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

Results of Package Service Delivery from Jan-June 2012 in (20) townships

Package of service from Jan-Jun 2012 in (20) Tspss/n Township Planned

packagePackage service from Jan-Jun

Percent

1 Bamaw 57 43 75.4

2 Shwegu 78 45 57.7

3 Demawsoe 88 46 52.3

4 Hlaingbwe 100 74 74

5 Hakkha 85 78 91.8

6 Ye Oo 159 81 50.9

7 Myeik 79 43 54.4

8 Mudon 132 64 48.5

9 Thaton 102 62 60.8

10 Lewe 137 82 59.9

11 Pyinmana 96 61 63.5

12 Htilin 142 77 54.2

13 Yedarshay 129 84 65.1

14 Thayarwaddy 163 93 57.1

Package of service from Jan-Jun 2012 in (20) Tspss/n

Township Planned package

Package service from Jan-Jun

%

15 Maungdaw 253 180 71.116 Kyaington 210 198 94.317 Nyaungshwe 180 75 41.718 Ngaputaw 92 38 41.319 Kawthmu 118 66 55.920 Hsipaw 101 95 94.1

Total 2501 1585 63.4

s/n Problem/Gaps Response Strengths Weaknesses

1 Lack of coordinated plan CTHP GuidelineCosted

Less coordination

2 Lack of access to health in HTR area

• Mapping HTR• Planned for Package of service tour together with BHS for the whole year• Provision of TA/DA for midwives + Supervisors + AMW/CHW to move to additional villages more frequently with package service (MCH+EPI Nutrition + ES)

•Increase in service delivery • Team work culture created• Good rapport with communitySpecific-•ANC -increased

• EPI- can give to missed case

•Nutrition assessment

• Env Sanitation

• HE- a lot can be done

• improper arrangement for health posts

-Delivery by SBA ??? -High vaccine wastage

-Corrective measures still needed-Need P&Pinfrastructure -IEC materials-Time-NCD?

s/n Problem/Gaps Response Advantage Disadvantage

3 Lack of coordination with local authorities/others

Quarterly and annual review meetings at RHC levels/Township level

• Successive packages-become smoothMore positive collaboration

CHW thou' motivated

4 Infrequent supervision and monitoring

Financing supervision Regular supervision at all levels

Motivated midwives

5 -Low midwife: population ratio-Incorrect skill mix

-Poor retention of staff in HTR

HR research

Training of AMW/CHWRefresher training

Evidence based policy making tools

6 Lack of operational finance for providers and economic barriers in the community

MCH Voucher Scheme(pilot in Yedarshay)

HEF for all hospitals

Increase access to MCH service

Save lives of poor mothers and children

Heavy workload for hospital staff

s/n

Problem/Gaps Response Advantage Disadvantage

7 Limitations in supplies of ED and equipment (no replenishment for 10 years)

Essential Drugs to TH/SH/ RHC/ sub center level Equipment (RHC kit/HA kit/MW kit/CDK) Incremental for 4 years

ED provided and used

Did not meet the needs- s/a Antibiotics, Multivitamins, Antacid , Anti - hypertensive

8 Lack of training on management & research

HSR trainingHSR grant

S/R level , TMO are equipped with training and funds –motivated

Still cannot give full time for research

9 Bicycles- old and inoperable Motorbikes provided Cannot give to all those in need

10 117 midwives are without sub centers

To build new SC/ refurbish old RHC- this year –program changed

MOH is building new RHC/SC

Way forward• With a national scale up of the HSS Strategy to (40,60,60 to a total of

180 townships) there is need for– a strong middle level of management in the health system – Provision of resources to S/R– A clear budget allocation for HSS to ensure adequate governance

mechanisms at the State/Regional levels• More collaborative actions at the central level to become comprehensive CTHP in future• More collaborative efforts with UN Agencies & Donors• Many space for improvement in HSS townships that can be filled by different agencies at township operational levels• Lessons learned can be inputs for sustainability issue of package of service delivery by group of BHS • Policy guidance from evidence based research ----

Thank You