Health Systems Strengthening II Fostering sustainable quality health care

1. Health Systems Strengthening II Fostering sustainable quality health care 2009 -2014

2. PHCI HSS HSS II

3. HSSII Results Framework Knowledge Management Quality of Primary Care Safe Motherhood Family Planning Community Health Knowledge management promoted 200 HCs prepared for accreditation Reduced MMR & NMR Modern FP use increased Health committees in all HDs FP information and services increased Data used to improve services Functional referral system Postpartum FP counseling and care Health services promoted Long-term FP methods promoted Improved use of GIS Planning supervision monitoring Reliable data collected FP services in more facilities Improved human resource capacities FP services supervised and monitored FP included in HD plans Renovation and equipping of maternal, newborn, emergency and training facilities FP promoted in community

4. HSSII Results Framework Knowledge Management Quality of Primary Care Safe Motherhood Family Planning Community Health Knowledge management promoted 200 HCs prepared for accreditation Reduced MMR & NMR Modern FP use increased Health committees in all HDs FP information and services increased Data used to improve services Functional referral system Postpartum FP counseling and care Health services promoted Long-term FP methods promoted Improved use of GIS Planning supervision monitoring Reliable data collected FP services in more facilities Improved human resource capacities FP services supervised and monitored FP included in HD plans Renovation and equipping of maternal, newborn, emergency and training facilities FP promoted in community

5. Renovation and Equipment Emergency rooms • Strategies and Results • Improve physical appearance and patient flow • Improve safety, including infection prevention • Improve quality of care Maternal & newborn units Training facilities

6. Renovation and Equipment Emergency rooms expanded and improved at Dr JamilTutanji and Prince Faisal Hospitals Emergency rooms Maternal & newborn units Training facilities

7. Renovation and Equipment Emergency rooms Maternal & newborn units Training facilities

8. Renovation and Equipment Traininghealth care providers on emergency services Emergency rooms Maternal & newborn units Training facilities

9. Renovation and Equipment Obstetric and neonatal departmentsat Al-Bashir Hospital upgraded Emergency rooms (ER) Maternal & newborn units Training facilities

10. Renovation and Equipment Emergency rooms (ER) Maternal & newborn units Training facilities

11. Renovation and Equipment Training centers established in seven Health Directorates Emergency rooms (ER) Maternal & newborn units Training facilities

12. Renovation and Equipment Emergency rooms (ER) Maternal & newborn units Training facilities YEAR 3

13. HSSII Results Framework Knowledge management Quality of Primary Care Safe Motherhood Family Planning Community Health Knowledge management promoted 200 HCs prepared for accreditation Reduced MMR & NMR Modern FP use increased Health committees in all HDs FP information and services increased Data used to improve services Functional referral system Postpartum FP counseling and care Health services promoted Long-term FP methods promoted Improved use of GIS Planning supervision monitoring Reliable data collected FP services in more facilities Improved human resource capacities FP services supervised and monitored FP included in HD plans Renovation and equipping of maternal, newborn, emergency and training facilities FP promoted in community

14. Knowledge Management • KM Strategy Approved • by MOH Knowledge management promoted Reliable data collected • KM Tool Kit and Training Manual Developed • Knowledge Management strengthened within MOH • Training on • KM Practices • conducted • at all levels Data used to improve services • KM Team • and • Focal Persons • approved by MOH

15. Knowledge Management Knowledge management promoted Increased reporting of quality indicator data by HCs to HDs Reliable data collected % Data used to improve services

16. Knowledge Management • Knowledge • management • promoted • Electronic data dashboards used to improve MOH and HD planning. Reliable data collected Data used to improve services

17. Knowledge Management • Knowledge • management • promoted • Data usedby HC staff for monitoring and planning Reliable data collected Data used to improve services

18. Knowledge Management Ways Forward Rationalize data collection and reporting systems at HCs Enhance data presentation & analysis for decision making Support PHC quality improvement collaborative with IT equipment and information system training Support the Information Technology Directorate (ITD) • Knowledge • management • promoted Reliable data collected Data used to improve services YEAR 3

19. HSSII Results Framework Knowledge Management Safe Motherhood Family Planning Community Health Quality of Primary Care Knowledge management promoted 200 HCs prepared for accreditation Reduced MMR & NMR Modern FP use increased Health committees in all HDs FP information and services increased Data used to improve services Functional referral system Postpartum FP counseling and care Health services promoted Long-term FP methods promoted Improved use of GIS Planning supervision monitoring Reliable data collected FP services in more facilities Improved human resource capacities FP services supervised and monitored FP included in HD plans Renovation and equipping of maternal, newborn, emergency and training facilities FP promoted in community

20. PHC Quality of Care Increased compliance with HCAC PHC standards in health centers 200 HCs prepared for accreditation Functional referral system Improved planning supervision monitoring

21. PHC Quality of Care 200 HCs prepared for accreditation Decreased referralof patients from health centers to hospitals Functional referral system Improved planning Supervision monitoring January – August 2011

22. PHC Quality of Care 200 HCs prepared for accreditation • MOHStrategic Plan Updated • 7HD Quality Councils • 12HD Operational Plans • 90HC Annual Action Plans • 16Hospital Annual Plans Functional referral system Improved planning supervision monitoring

23. PHC Quality of Care 200 HCs prepared for accreditation Improved reporting culture shown by percentage of HCs reporting quality indicator data to HDs Functional referral system % Improved planning supervision monitoring

24. PHC Quality of Care 200 HCs prepared for accreditation Improved quality culture Functional referral system Improved planning supervision monitoring

25. PHC Quality of Care 200 HCs prepared for accreditation • Lessons & way forward • Measurable improvement (structure, process and culture) • Innovative structured approach • Sustainable enabling environment • HD involvement & capacity increased • Number of HCs expanded • Focus on high population areas Functional referral system Improved planning supervision monitoring YEAR 3

26. PHC Quality of Care 200 HCs prepared for accreditation HSSII HCAC Community Integration Organization and Leadership Management of Information Continuum of Care Client and Family Education Quality Improvement & Client Safety Client Care and Support Human Resources Functional referral system ESP Community Interventions Action Plans FP/RH Program Indicators Information Systems Referral System HP Program Training Improved planning supervision monitoring YEAR 3

27. PHC Quality of Care 200 HCs prepared for accreditation Functional referral system Improved planning supervision monitoring YEAR 3 Accreditation Preparedness Approach Comprehensive Quality Improvement Approach HSS II PHC Interventions

28. PHC Quality of Care 200 HCs prepared for accreditation Comprehensive Quality Improvement Approach Functional referral system Improved planning supervision monitoring YEAR 3

29. HSSII Results Framework Knowledge Management Quality of Primary Care Family Planning Community Health Safe Motherhood Knowledge management promoted 200 HCs prepared for accreditation Reduced MMR & NMR Modern FP use increased Health committees in all HDs FP information and services increased Data used to improve services Functional referral system Postpartum FP counseling and care Health services promoted Long-term FP methods promoted Improved use of GIS Planning supervision monitoring Reliable data collected FP services in more facilities Improved human resource capacities FP services supervised and monitored FP included in HD plans Renovation and equipping of maternal, newborn, emergency and training facilities FP promoted in community

30. Safe Motherhood Reduced MMR & NMR • 25hospitals established safe motherhood committees (HSMCs) • 16 hospitals promoted use of partograph and MgSO4 • 9 hospitals introduced CPAP (continuous positive airway pressure) for newborn resuscitation Postpartum FP counseling and care

31. Safe Motherhood • 25%survival of newborns on mechanical ventilation in 2009 • 50%survival of newborns on mechanical ventilation in 2010 • 100% survival of newborns using CPAP in 2009 & 2010 • Al Hussein Hospital, Balqa. 2009 N=452, 2010 N=415 Reduced MMR & NMR Postpartum FP counseling and care

32. Safe Motherhood Reduced MMR & NMR • 9 hospitals introduced postpartum and post-abortion counseling and services Postpartum FP counseling and care

33. Safe Motherhood Reduced MMR & NMR • Promote best practices • Expand and strengthen maternal care (partograph and MgSO4) • Expand advanced newborn care • - CPAP and improved mechanical ventilation • - Infection prevention, inc. IV fluid preparation • Expand postpartum FP counseling • Improve supervision through HSMCs • - Unified hospital medical records • - Better newborn referral • - Confidential death/near-miss Postpartum FP counseling and care YEAR 3

34. HSSII Results Framework Knowledge Management Quality of Primary Care Safe Motherhood Community Health Family Planning Knowledge management promoted 200 HCs prepared for accreditation Reduced MMR & NMR Modern FP use increased Health committees in all HDs FP information and services increased Data used to improve services Functional referral system Postpartum FP counseling and care Health services promoted Long-term FP methods promoted Improved use of GIS Planning supervision monitoring Reliable data collected FP services in more facilities Improved human resource capacities FP services supervised and monitored FP included in HD plans Renovation and equipping of maternal, newborn, emergency and training facilities FP promoted in community

35. Family Planning • Improved quality of FP services • 150 HCs trained to reduce missed FP opportunities • 122 HCs were assessed for quality of FP counseling • - 70rated “good” • - 37rated “acceptable” Modern FP use increased FP information and services increased Long-term FP methods promoted FP services in more facilities FP services supervised and monitored FP included in HD plans FP promoted in community

36. Family Planning Increased access to long-term FP methods Modern FP use increased FP information and services increased Long-term FP methods promoted 47 FP services in more facilities FP services supervised and monitored FP included in HD plans FP promoted in community

37. Family Planning Modern FP use increased • Better planning and supervision of FP • WCHD supervision tool developed • MCH supervisors supported • 12 HD operational plans updated to include FP FP information and services increased Long-term FP methods promoted FP services in more facilities FP services supervised and monitored FP included in HD plans FP promoted in community

38. Family Planning YEAR 3 • Build an enablingenvironment • Assist MOH to finalize National FP Strategy • Update FP & RH Clinical Guidelines • Recognize and reward FP providers and teams • Expand access to long-acting methods at hospital and health center levels Modern FP use increased FP information and services increased Long-term FP methods promoted FP services in more facilities FP services supervised and monitored FP included in HD plans FP promoted in community

39. Family Planning YEAR 3 • Integrate FP in PHC • QI collaborative • Assess FP services and needs • Ensure FP and breastfeeding counseling in 3rd trimester ANC • Improve FP knowledge and attitudes of GPs • Ensure adequate method mix (3-4 methods) at focal health centers Modern FP use increased FP information and services increased Long-term FP methods promoted FP services in more facilities FP services supervised and monitored FP included in HD plans FP promoted in community

40. HSSII Results Framework Knowledge Management Quality of Primary Care Safe Motherhood Family Planning Community Health Knowledge management promoted 200 HCs prepared for accreditation Reduced MMR & NMR Modern FP use increased Health committees in all HDs FP information and services increased Data used to improve services Functional referral system Postpartum FP counseling and care Health services promoted Long-term FP methods promoted Improved use of GIS Planning supervision monitoring Reliable data collected FP services in more facilities Improved human resource capacities FP services supervised and monitored FP included in HD plans Renovation and equipping of maternal, newborn, emergency and training facilities FP promoted in community

41. Community Health • 45 Community Health Committees • 12Women’s Advocacy Groups • 12 Youth Groups Health committees in all HDs Health services promoted

42. Community Health Health committees in all HDs • 100+community events reached • 9400women with FP messages Health services promoted

43. Community Health Health committees in all HDs • Three ongoing community mobilization campaigns initiated Health services promoted

44. Community Health Health committees in all HDs Health services promoted YEAR 3

45. HSSII Results Framework Knowledge Management Quality of Primary Care Safe Motherhood Family Planning Community Health Knowledge management promoted 200 HCs prepared for accreditation Reduced MMR & NMR Modern FP use increased Health committees in all HDs FP information and services increased Data used to improve services Functional referral system Postpartum FP counseling and care Health services promoted Long-term FP methods promoted Improved use of GIS Planning supervision monitoring Reliable data collected FP services in more facilities Improved human resource capacities FP services supervised and monitored FP included in HD plans Renovation and equipping of maternal, newborn, emergency and training facilities FP promoted in community

46. Human Resources Developed • “HSS II's efforts were successful… because they were built on global evidence and followed an extensive participatory approach with the MOH” • Secretary General Health HR management improved • 441 job descriptions revised and approved by the Minister of Health Trainings conducted

47. Human Resources HR management improved Trainings conducted

48. Human Resources Developed HR management improved • EBM (evidence-based medicine) approach introduced to MOH and RMS • Clinical decisions based on evidence • Systematic review of the literature • Apply in practice Trainings conducted

49. Health Systems Strengthening II Fostering sustainable quality health care Thank You!