Center for Global Health

1. The UN Secretary General’s Global Strategy for Women’s and Children’s Health: Getting it Done for Maternal and Newborn HealthInnovations in Health Systems Strengthening Pat Riley, CNM, MPH, FACNMNageshBorse, MS, PhD January 20, 2011 Center for Global Health Place Descriptor Here

2. Why a Health Systems Unit within DGHA? • PEPFAR II legislative mandate • GHI principles • Facilitate USG country teams plan cross-cutting HS interventions • Define and develop best practices in HSS with an eye toward a stronger public health approach to HSS • Ability to technically engage global stakeholders in HSS (WHO, GF, GAVI, WB, DFID) • Promote implementation science in HS

3. DGHA: Health Systems/Human Resource Team Overview of: • HRH Innovations • HRIS • African Regulatory Collaborative • HS Innovations • HS Research • HS Metrics Initiative

4. HR Innovations

5. Health outcomes Service Utilization Why Workforce MAtters

6. HRIS and Health Services Delivery: Enables appropriate selection of various HRH interventions

7. Supply Data: Includes: - Numbers of providers - Students in training - Licensure info Requests for out-migration - Professionals trained outside the country HRIS Linkage • Deployment Data: • Maintained by the MOH • Quarterly workforce census data collected at local facilities are entered into an electronic database system • Data is simultaneously transmitted to national office - thereby ensuring its accuracy and timeliness. Supply Data are linked with Deployment Data (e.g., satellite connections) creating one single database system.

9. Information Collected: Pre-service Data:Can be used to track students in pre-service training (from entry to graduation - including drop-outs) Registration Data:maintained by Regulatory Boards In-service Training:Continuing Professional Development (CPD) in EmOC, neonatal care, family planning update Out-migration Data:using proxy indicators Deployment Data:staff demographics, location of employment and ward, promotion hx & eligibility, in-service training, qualifications, reasons for attrition & placement of Emergency Hire staff Linked to HR Department’s Personnel Management

10. Kenya’s Provincial Health Indicators**KDHS 2003, KAIS 2007, Facts and Figures on Health and Related Health Indicators2008

11. Distribution of Kenya’s Midwivesby Provincen = 16,713 (May 2010)

12. Kenya Nurse Supply Data September 2009

13. HRH data rectified backlog promotions HRH data successfully advocated for increasing GoK civil service retirement age from 55 to 60 HRH data used to identify workforce maldistribution (e.g. nurse/population ratio) HRH data used to verify employment figures with regulatory data, resulting in the identification of genuine employees vs. “ghost workers”, non-credentialed clinicians Examples of HRIS Influencing Kenya Policy

14. REGULATION • African Regulatory Collaborative (ARC): South-to-South partnership with The Commonwealth Secretariat (UK) & the East, Central, and Southern Africa Health Community (ECSA) to convene nursing and midwifery leadership on a quarterly basis in order to: • Ensure quality standards of nursing and midwifery practice harmonized in the region • Ensure updated regulatory frameworks • Build capacity of nursing and midwifery councils in key regulatory functions • Establish a sustained consortia of nursing and midwifery leaders • Evaluation science

15. HS Innovations

16. Health System Framework

17. “It may simply not be possible to convince human beings rationally to take a long-term view. People do not focus on the long-term because they have to, but because they want to.” (Senge, The Fifth Discipline p. 210)

18. Health Systems Constraints in Africa • Limited availability of competent and effective health workers • Poorhealth information systems • Ineffectivehealth financing systems • Weakprocurement and supply chain management systems • Inadequate service delivery capacity/quality • Limited planning, policy-making, management and governing capacity • “Prioritization”

19. Clinical vs. Health Systems Research Clinical/ Traditional Problem >> Intervention >> Implementation >> Outcome Health Systems Research

20. Inputs/ Resources Outcomes Process Outputs PEPFAR & Other GHIs • Community Access to Health Services: • Distance • Quality • Perception • Cost • Income • Knowledge • Education Governance Health Financing Service Utilization Health Outcomes Country Existing Resources Health Workforce Information System Health Services Availability Non-HIV Donors –(GAVI, UNICEF, Other non-health) Supply Chain Management

21. Uganda Public Health Evaluation(Impact of HIV Investments on Maternal and Child Health) PEPFAR > $1 bn. (80% of HIV Investment) Impact on Mother and Child Health Outcomes 2004 2005 2006 2007 2008 2009 2010 2011 Study Period Health Management Information System (HMIS) Monitoring and Evaluation of Emergency Plan Progress (MEEPP) database

22. Decentralization and District Health Offices • DHOs are becoming autonomous, influential • Decentralization becoming the sine qua non • Controls Primary health care and referral hospitals “Poor understanding of these developments and failure to recognize the DHO’s vital role in decentralized health sector”

23. Interventions  Public Health System Sector-Wide Approach Norton 1998, Jeppsson 2001, Elsey 2005, Biesma 2009 and Okamoto 2009

24. Sub-national Institutional Capacity Gap Analysis REVIEW Existing Policies Conduct a Survey Understand Gaps and develop recommendations for MoH to develop DHO Capacity

25. Health Systems Metrics Initiative • CDC HQ funded activity ($100K per country) • CDC In-country team identifies a HS project • Short-term HSS Indicator/Intervention Projects • Impact of Supply Chain Management on Drug Availability at the facility • Impact of integration of MCH with PMTCT on utilization

26. Thank you! Center for Global Health Place Descriptor Here