Presented byJohannes van Dam Sr. Director, Program Sciencesand Theresa Hoke, Scientist II

January 10, 2012

FHI 360 – Program Sciences and Health Services Research (HSR)

Introduction

Frank Beadle de Palomo Senior Vice President and Director, GHPN

Presenters

Johannes van DamDirector, Program Sciences

Theresa HokeScientist III

Program Sciences

Presented by Johannes van Dam Sr. Director, Program Sciences

Overview

• New organizational structure - ??• New opportunities• Collaboration between country programs and US-

based programs

Global Health and Development (effective Oct. 1 2010)

Chief Operating Officer

Global Portfolio Management

Health and Development Sciences

Operations Support (OS)Information Technology (IT)

(includes Knowledge Management)

Behavioral and Social Sciences

Science and Technical Learning Services

Clinical Sciences

Quantitative Sciences

Product Quality and Compliance

Practice Areas

Science Facilitation

Program Management

Program Sciences

...

Global Research Services

Science to Practice Sites Country Office 1

Country Office 3

Country Office 2

Country Office N

Africa Team 1, including Haiti

Global ProjectsAPRO Team Africa Team 3Africa Team 2Global Systems

Support

Program Sciences

• Africa Regional Technical Team• Health Services Research• Health Systems Strengthening• Strategic Information/M&E• Technical Support• Laboratory Services• PROGRESS

Program Sciences – interface of science and programs

• Health Services Research (HSR)– To follow

• Strategic Information– M&E, HMIS and surveillance– Data Quality Assessment tool– BBSS

Program Sciences - continued

• PROGRESS– Expanded access to quality FP services (R to P)– Task shifting: e.g. CBA2I– Increase method mix: post-partum IUD, sino-implant, LNG

IUS– Non-health sector: MF institutions; environmental groups;

agriculture sector (LOL)• Health Systems Strengthening (HSS)

– HSS strategy – Rapid assessment tool– QA/QI and CQI model to go to scale

Program Sciences - continued

• Laboratory Sciences– Lab quality improvement (incl. international accreditation)– Medical waste management– Expand in Africa and Asia

• Technical Assistance and Support– A global network, with a hub in the Africa Regional

Technical Team– Provides TA in program design and implementation– Support for research & builds research capacity

FHI 360 Global TA System

• Push and pull system, meeting program needs (“pull”) and quality assurance (“push”)

• Linked to Technical Quality Assessment tool, currently being field-tested

• Seeks to make optimal use of technical expertise in FHI 360, regardless of location

• Africa Technical Team well positioned to identify, nurture and broker regional TA

• Track and monitor quality of TA provided

New Funding Environment

• Country ownership• Responsive to national priorities• Better M&E, more operational research• Better value for money:

– Costing– Efficiency– Outcomes and impact

• Sustainability• From implementation to capacity building

New and Old Priorities

• Increase efficiency of ART programs• Chronic/non-communicable diseases (CVD,

hypertension, diabetes, lung disease, cancers)• Health Systems Strengthening• HIV prevention (PrEP, male circumcision, microbicides)• Prevention for Positives• Strengthen PMTCT• FP/RH, including maternal health• Other infectious diseases (TB, malaria)

Programs and Program Science

Program Science in support of Country Programs

HEALTH SERVICES RESEARCH (HSR)

Presented by Theresa Hoke, Scientist II

Who We Are

Specialists in…• Public health• Maternal and Child Health• Economics• Statistics• Epidemiology• Health behavior• Health policy • Engineering• Medicine

What we do

• Conduct APPLIED RESEARCH

• Focus on optimizing – Access– Quality– Effectiveness– Cost

• Build capacity in research and evidence-based programming

Why applied research is useful

Through applied research we…• Evaluate programs• Identify and diagnose

service delivery problems • Develop and test

programmatic solutions • Examine costs and cost-

effectiveness• Investigate determinants of

intervention effectiveness

Traditional research contexts

• Family planning

• HIV prevention, care and treatment

• Maternal and newborn health

• Post-abortion care

• Reproductive health services & education for youth

• Male circumcision for HIV prevention

Moving into new sectors

• Agriculture

• Environment

• Micro-finance

• Waste management

• Behavioral economics

• Health systems research

Who we work with

• Host country government partners

• NGOs• Grassroots

organizations/ CBOs• FHI360 Country

offices• USAID CAs

Where we work

• National, regional and district levels

• Facilities– clinics– schools– program sites

• Communities• Sub-group populations

– postpartum women

– PLWHA– youth – MARPs

Selected examples of recent HSR research

Increasing access to family planning services

•Is it feasible and effective to strengthening linkages within health services?•Does task shifting/task sharing increase access to services?• What are the alternatives to public sector services?

Increasing access: Facilitated referrals in Tanzania

AimDevelop & test a facilitated referral

model to integrate FP and HIV services

Approach• Trained providers• Introduced service delivery guidelines

& job aids• Evaluated service delivery process &

measured impact of contraceptive uptake by Care & Treatment clients

Key Findings• Modern FP use increased from 78%

to 93%• Service quality improved

Improving quality

• How is service quality affected – by integration?– by task shifting?

• What is the effect of trainings and job aids on provider performance?

• Does client satisfaction increase with service innovations?

• How can systems be strengthened to ensure technical and material resources are in place to permit high quality service delivery?

Improving Quality: Emergency Obstetric & Newborn Care

AimTo identify gaps in delivery of essential emergency obstetric and newborn care (EmONC)

ApproachProvide TA to MOH and UN partners in conducting national facility-based surveys

Assess availability of “signal functions” for EmONC service delivery

Improving effectiveness

• How can we encourage full use of available technologies?

• Is integration of family planning into the work of other sectors an effective approach to achieving mutual programmatic goals?

Improving effectiveness: Integrating Family Planning Promotion into the Green Belt Movement

Aim• Assess the feasibility and effect

adding FP promotion to the duties of Green Volunteers

Approach• Design and implementation of

multi-component intervention• Collect post-intervention data

collection to assess Green Volunteers’ success with incorporating the innovation into their duties.

Cost Issues: Improving efficiency & increasing sustainability

• Estimating the cost of service delivery • Estimating cost of scaling-up interventions• Assessing cost-effectiveness of alternative

approaches to service delivery• Documenting resources required to support

transition to local ownership• Preparing costed implementation plans to support

resource mobilization• Linking resources used to outputs produced (value

for money assessments)

Capacity Building

Africa Regional Technical Team is strengthening FHI360 staff capacity to:• Identify challenges and knowledge gaps• Articulate research questions • Integrate evaluation and research into program proposals• Conduct programmatic research and evaluation

PROGRESS Project: Building programmatic research skills with local partners• National University of Rwanda School of Public Health• National Institute of Medical Research – MMRC (Tanzania)

How we can collaborate

Transferability• Our skills in applied research /

program evaluation are transferable to programs outside the health sector.

Complementarity• Skills in study design,

operations research, data collection and analysis, and results interpretation and dissemination complement program implementation capabilities.

Conclusion

• Donors/programs in all sectors are increasingly concerned about issues of access, quality, effectiveness, and cost.

• Opportunities to conduct applied research continue to arise.

• We are seeking mutually beneficial opportunities to collaborate and learn more about the programs you support.

Discussion

THANK YOU!!!