Post on 17-Feb-2016
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DISTRICT AND PROVINCIAL HEALTH SYSTEM CAPACITY
WORKING GROUP UPDATE
Janna BrooksHIV Care and Treatment Branch
Global AIDS ProgramU.S. Centers for Disease Control and Prevention
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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
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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
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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
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Core Domains and WHO Building Blocks
WHO Building Blocks Provincial/District Capacity AreasGovernance
Health Workforce
Health Information System
Medical Products
Health Financing
Service Delivery
Community(Proposed 7th building block)
Strategic Planning for Integrated HIV Services Stakeholder Management and Coordination
Human Resource Management for Clinical Services Supervision of Clinical Services
HMIS, M&E Systems
Pharmacy Supply/Logistics
Financial Management of Funding for HIV services
HF Renovation/Maintenance/Equipment Laboratory Services Support Quality Management/Improvement Systems Integration of Service delivery
Community Linkages
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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
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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
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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 rating based 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%)
Validation of ratings – random sample of facility level
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Health WorkforceCountry:Region:District: Label
Number of facilities overseen by district: D.Nfac
Number of facilities providing HIV/AIDS services:
Capacity Area Label QuestionVerbal
ResponseDocument
Review Performance IndicatorValue Quant Label
HR D.HR1 Do you have a listing of all sanctioned clinical positions in your district?
Number of sanctioned clinical positions in district: D.HRq1
COMMENT
HR D.HR2 Is there a listing of filled clinical positions?
Number of filled clinical positions in district: D.HRq2
COMMENT
HR D.HR3 Has the listing of filled clinical positions been updated within the last 12 months?
COMMENT
HR D.HR4 Do you have a training plan for district staff in HIV/AIDS prevention, care and treatment which details in-service trainings to upgrade staff skills and knowledge in HIV/AIDS?
Total number of HIV/AIDS trainings planned for the past 12 months: D.HRq3
COMMENT
Total number of planned HIV/AIDS trainings conducted in the past 12 months: D.HRq4
HR D.HR5 Do you have a listing of personnel trained ( such as through * refresher training; * on-the-job training; or * workshops on technical updates) in your district in HIV/AIDS prevention, care and treatment in the last two years?
Number of personnel trained (initial or refresher training) in HIV/AIDS prevention, care and treatment in the last two years: D.HRq5
COMMENT
Rapid District Assessment – District Office data collection form
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Does Capacity Lead to Performance?
Low CapacityHigh Performance
Why?
High CapacityHigh Performance
Low CapacityLow Performance
High CapacityLow Performance
Why?
Capacity
Perf
orm
ance
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Analysis and ResultsGovernance/ Leadership
Health Workforce
HMIS Pharmacy Finance Service Delivery
Community
Capacity Perform Capacity Perform Capacity Perform Capacity Perform Capacity Perform Capacity Perform Capacity Perform
District 1Good Fair Poor
District 2
District 3
District 4
District 5
District 6
District 7
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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 implementationBenefits 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
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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
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INTERESTED?Contact:
Janna Brooks zir7@cdc.govJosef Amann jua6@cdc.gov
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 , Angeli Achrekar, Jaime Butler-Dawson, Lanette Burrows, Ilona Varallyay