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Integrated service components
Health Systems
Development
Interventions
Changes in service activities & content: (e.g.. Kangaroo mother, maternal health care, improving access to preventive health technologies etc)
Enabling sub-system inputs…
• Train frontline workers to provide evidence-based maternal and neonatal health services that are currently not being provided.
• Implement interventions that are proven to reduce under-five mortality by increasing the capacity of providers at community, sub-district, and district-level service points.
• Coordinate community and clinic-based activities to standardize access to anti-malarial preventive measures and therapeutic regimes.
Health workforce size, composition
& training
• Strengthen referral systems to reduce maternal and neonatal mortality.
Information for decision-making
Essential drug supply & logistics
Health financing and planning
Leadership & governance
Pillar #1: Strengthening of referral services GEHIP services to be added as…a
…CHPS doorstepOutreach
Level A
…Community Health
Compound careLevel A
Sub-district referral services
Level B
Pillar #1 Referral System Inputs:Organization for emergency management: Community engaged training for
emergency recognition and response?Yes=1, zero otherwise
Community Health Officer resident and trained for emergency management?
Yes=1, zero otherwise
Yes=1, zero otherwise
Sub-district emergency response system developed?
Yes=1, zero otherwise
Yes=1, zero otherwise
Communication systems for emergency management: Emergency obstetric & child care
referral system functional?Yes=1, zero otherwise Yes=1, zero
otherwise Community recognition of emergencies
training completed?Yes=1, zero otherwise
Logistics systems for emergency response: Community-based cost sharing for
emergency services functioning? Yes=1, zero otherwise
Ambulance or equivalent available and functioning?
Yes=1, zero otherwise
Pillar #1 Referral System OUTPUTS: • Referral case volume by type Continuous variables Continuous variables
Information for decision-making
Essential drug supply & logistics
Leadership & governance
Health Systems
Development
Interventions
Health financing and planning
Enabling sub-system inputs…
Health workforce size, composition
& training
Integrated service components
Changes in workforce inputs (investment in staff, staff
composition, and in-service training on essential services
to address gaps in service delivery)
A strategy of Pillar 2: Retraining the frontline workers of the Community-based Health Planning and Services (CHPS) Initiative in doorstep service delivery
Pillar #2: Training for strengthening primary Healthcare services
GEHIP services to be added as…a
Community service capabilities
Level A
Sub-district clinical capabilities
Level B
Pillar #2 INPUTSPillar #2: Promotion and prevention inputs:• Post partum outreach and care: “Four visit
package” training completed for workers in this area?
Yes=1, zero otherwise Yes=1, zero otherwise
• Post natal care for newborns (Promotion of skin-to-skin contact, other interventions) introduced?
Yes=1, zero otherwise Yes=1, zero otherwise
• Community Health Officer resident & comprehensive reproductive health services fully functioning?
Yes=1, zero otherwise
Pillar #2 Curative health service inputs:• IMCI services fully functioning? Yes=1, zero otherwise Yes=1, zero otherwise
• Directly Observed Therapy, Short-course (DOTS)fully functioning?
Yes=1, zero otherwise
Pillar #2 OUTPUTS• HMIS case volume for IMCI treatable
illness/catchment area populationContinuous Continuous
• Kangaroo Mother Case volume/catchment area population
Continuous Continuous
• HMIS caseloads for seven leading causes of morbidity/population of catchment area.
Continuous variables Continuous variables
• HMIS immunizations by antigen Continuous variables Continuous variables
Pillar #3: Easing information capture for community-based healthcare workers and providing supportive information feedback
Pillar #3: Strengthening Primary Healthcare Management Information
Systems
GEHIP services to be added as…a
Community-based capabilities
Level A
Sub-district clinic capabilities
Level B
Input indicator: Simplified record keeping introduced and
functioning?Yes=1, zero otherwise
Output indicators:
Data feedback received in the past three months?
Yes=1, zero otherwise Yes=1, zero otherwise
Data used for decision-making in the past three months?
Yes=1, zero otherwise Yes=1, zero otherwise
Information for decision-making
Leadership & governance
Health Systems
Development
Interventions
Health financing and planning
Enabling sub-system inputs…
•Strengthen the operation of the essential medicine distribution system in GEHIP districts.
Integrated service components
Health workforce size, composition
& training
Essential drug supply & logistics
Pillar #4: Develop a supply monitoring
system for essential drugs and equipment.
Pillar 4: Strengthening Primary Healthcare Supply and Logistics Capabilities
GEHIP services to be added as…a
Community-based capabilities
Level A
Sub-district clinic capabilities
Level BPillar #4 INPUTS: Stock flow monitoring capabilities developed:• Stock flow monitoring system introduced and
fully functionalYes=1, 0=otherwise Yes=1, 0=otherwise
Pillar #4 OUTPUTS: Indicators of effective stock flow management:
Number of essential (“tracer”) drugs missing among 21 possible drugs…
0, 1, 2, 3…. 21 0, 1, 2, 3…. 21
Number of essential (“tracer”) drugs missing among 21 possible drugs…
0, 1, 2, 3…. 21 0, 1, 2, 3….. 21
Information for decision-making
Essential drug supply & logistics
Leadership & governance
Health Systems
Development
Interventions
Enabling sub-system inputs…
• Adapt Tanzania’s PlanRep tool for allocating healthcare resources according to burden of disease to facilitate rational healthcare planning and decision-making at the district level: District Health Planning, Analysis, and Reporting Tool (DiHPART)
• Utilize DiHPART for informing resource allocation at Levels A, B, and C
• Add $0.75 per year to the Common Fund
Integrated service components
Health workforce size, composition
& training
Pillar #5Adapting Tanzania’s district
planning and reporting toolkit to Ghana: PLANREP.
The District Health Planning and Reporting Tool (DiHPART)
Health financing and planning
DiHPART as a Tool…….. allows plans and budgets to be aligned to
Intervention addressable shares of the disease burden or health needs of the population, using district health intervention profile developed from DSS sites.
• Monitoring the effect of DiHPART on health systems strength involves assessing the discrepancy between the actual pattern of expenditure and expected pattern, based on the district Burden of Disease profile.
Translating the desired profile Into an index of DiHPART action:
An index of system strength at any service point is the sum of the discrepancies between actual HMIS registered services over a 90 day period and the district profile for the 8 categories of the Burden of Disease…
An indicator of district
system strength point is the
sum of the discrepancies
between the district disease
profile and the budget
profile for 8 intervention
categories
Pillar 5: Strengthening Primary Healthcare Planning and Resources Inputs
GEHIP services to be added as…a
Community-based capabilities
Level A
Sub-district clinic capabilities
Level B
DiHPART planning inputs:• For each service point, the sum of the HMIS
case volume (by intervention) minus the expected case volume (based on the district profile for 8 classes of interventions)
Continuous variable Continuous variable
GEHIP Incremental resource inputs:
• Total GEHIP revenue expended this quarter: Cumulative 90 day contribution
in US Dollars per capita
Cumulative 90 day contribution
in US Dollars per capita
• Engagement of other sectors in health: Total District Assembly Revenue invested in implementation (as a Health Common Fund Supplement)
Cumulative 90 day contribution
in US Dollars per capita
Cumulative 90 day contribution
in US Dollars per capita
• Engagement of other investors in health: Investments of international partners in health in implementation (by pillar)
Cumulative 90 day contribution
in US Dollars per capita
Cumulative 90 day contribution
in US Dollars per capita
Information for decision-making
Essential drug supply & logistics
Health Systems
Development
Interventions
Health financing and planning
Enabling sub-system inputs…
Integrated service components
Health workforce size, composition
& training
Leadership & governance
Changes in leadership
capabilities at each level in the
system. Strengthen the health system by team training that promotes leadership for integrated health care at each operational level.