District and provincial health system capacity Working Group Update

1. District and provincial health system capacity Working Group Update Janna Brooks HIV Care and Treatment Branch Global AIDS Program U.S. Centers for Disease Control and Prevention

2. Background Project started as result of findings from Track 1.0 M&E meeting in November 2009 Many existing tools and frameworks for assessing capacity of ART sites and local partners’ organizational capacity Lack of existing analytical approaches for provincial and district health systems capacity to sustainably plan, organize and support delivery of HIV services

3. ConsensusCore Capacity Domains Strategic Planning for Integrated HIV Services Stakeholder Management and Coordination Human Resource Management for Clinical Services Financial Management of Funding for HIV Services Supervision of Clinical Services HMIS, M&E Systems Pharmacy Supply/Logistics Renovation/Maintenance/Equipment Laboratory Services Support Quality Management/Improvement Systems Community Linkages

4. Literature Review Findings Predominant conceptual framework is WHO Health System Building Blocks Existing approaches focus on health facility or national health system performance Lack of operationalization of WHO concepts at provincial and district capacity levels Validation of core domains, identification of gaps Review of assessment methodologies Annotated bibliography of sources reviewed

5. Core Domains and WHO Building Blocks

6. Objectives of the Provincial/District Capacity Assessment Identify strengths and weaknesses in organizational structures, managerial processes, and provision of support for HIV services Provide evidence for better planning and implementation of health systems capacity-building support to provincial/district health teams Measure baseline assessment of capacity & performance, and to measure improvements as a result of support Can be used flexibly—from structured discussions to formal capacity assessments

7. Capacity and Performance Capacity = ability of an organization to implement its mandated activities Performance = how effectively the organization actually implements its activities and achieves it objectives Relationship of capacity to performance is not simple Interdependent, but multidimensional and non-linear relationship

8. Capacity & Performance Measures • Capacity rating for the province or district for each of the capacity domains through checklists for compliance • interviews with the DHO, verified by supporting documentation; • the scoring is determined according to decision rules for each capacity area (i.e. whether a minimum threshold level is reached) • Performance ratingbased on key performance indicators for each of the capacity areas • quantifiable data from district health management information system records • performance scores = good (>80%), fair (50% -80 %), poor (< 50%) • Validationof ratings – random sample of facility level

10. Does Capacity Lead to Performance? Performance Capacity

11. Analysis and Results

12. Limitations vs. Benefits of Approach Limitations Offers only a rapid check on a limited number of capacity and performance areas Does not provide a comprehensive assessment of capacity or performance Not yet validated in field implementation Benefits Ease of implementation; consistent systemic approach Lean methodology — quickly focus effort on areas that need in-depth analysis and support Comparable assessment approach across domains and/or health system units

13. Next Steps Feedback process of first draft Field test/validation Development of User Manual Development of In-depth discussion guide in each technical area for follow-up actions

14. Acknowledgments…Jennifer Yourkavitch Eric Sarriot, Leo Ryan, Lela Baughman, Rozalin Wise , Joe Barker, Laura Porter, Nancy Fitch , Tshiwela Neluheni, Pat Bass, John Donahue, Kristen Stafford, Charity Alfredo, Jackie Sallot, Philippe Chiliade, Kjersti Schmitz , AngeliAchrekar, Jaime Butler-Dawson, Lanette Burrows, IlonaVarallyay Interested? Contact: Janna Brooks zir7@cdc.gov Josef Amann jua6@cdc.gov