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HEALTH SYSTEMS STRENGTHENING

T he Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) recognizes that elimination of pediatric HIV/AIDS cannot

be achieved and sustained without strong health systems. Effective and locally owned leadership at the national, sub-national, and community levels is critical to ensuring a viable and efficient health system that delivers quality services and improves the health of women, children, and their families.

The World Health Organization has defined six building blocks of a strong health system: 1. Health service delivery; 2. Health workforce; 3. Health information systems; 4. Access to essential medicines; 5. Health system financing; and 6. Leadership and governance. EGPAF programs support all six

building blocks, while also supporting local governments to increase coordination amongst the six health system areas.

EGPAF is committed to working within the systems of government programs, in close cooperation with Ministries of Health and other local service providers. EGPAF works to strengthen local health systems through in-country capacity building which supports ministries of health and other local organizations to deliver services, fill short-term expertise gaps, manage the sub-granting of donor funds, and help develop evidence-based policy.

photo: Olivier Asselin

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AREAS OF EXPERTISE

blood pressure machines, weighing scales, and other maternal and child health equipment. Where possible, EGPAF assures strong local property management and maintenance systems.

HEALTH WORKFORCE

STRENGTHENING HUMAN RESOURCE PRACTICES AND MANAGEMENTEGPAF works with ministries of health and regional health authorities to strengthen HR processes by developing management systems that allow ministries of health to track staff trainings, salaries, and retention. EGPAF supports pre-service and in-service training and develops job aids to ensure all healthcare providers have the most up-to-date technical knowledge and skills for providing quality services to clients. EGPAF also engages in innovative methods to support ministries of health to attract and retain health workers such as performance-based incentives and ongoing supportive supervision, mentoring, and training. In Mozambique, EGPAF is working with the MOH to develop and roll-out its national HR management manual and accompanying standard operating procedures, has seconded human resources for health (HRH) professionals to the MOH and supported provincial and district health authorities with performance management systems.

HEALTH INFORMATION SYSTEMS

IMPROVING COLLECTION, ANALYSIS, AND USE OF DATAEGPAF supports health information systems at the national, district, and site levels. EGPAF works to ensure that district- and site-level reporting activities are robust, value-added, and locally owned and that all data is of high quality. EGPAF provides TA to improve clinical patient records, registers, and electronic clinical information systems. EGPAF trains local and national M&E staff, engages in supportive supervision, and supports local stakeholders to use data for evidence-based decision-making and care provision. In Zambia, EGPAF is working in partnership with the MOH and CDC to roll-out the national electronic patient records system, SmartCare, by providing strategic and programmatic input, financial management, information technology, staff, training, and procurement of computer equipment and hardware.

HEALTH SERVICE DELIVERY

PROVIDING A STRONG FOUNDATIONEGPAF works through local government in cooperation with ministries of health and other local service providers to strengthen maternal, newborn, and child health (MNCH), antenatal care (ANC), TB and primary care platforms, and to integrate HIV services into these platforms to provide quality, cost-effective, comprehensive services. In Lesotho, EGPAF supported the Ministry of Health (MOH) through targeted technical and operational assistance to successfully integrate HIV/AIDS services within broader MNCH services at every health facility across the country.

QUALITY IMPROVEMENTEGPAF strives to improve clinical care by integrating quality improvement (QI) processes into all facets of programming using the Plan-Do-Study-Act model. QI efforts are facilitated through staff supportive supervision and mentoring, frequent site visits to assess performance, regularly scheduled meetings for staff to discuss and share successful activities, and utilization of standardized tools designed to improve performance. At the national- and district-levels, EGPAF works with ministries of health and local partners to share experiences, identify best practices, and contribute to the development of a well-coordinated approach to QI.

IMPROVING THE EFFICIENCY OF HEALTH CARE SERVICESEGPAF works directly with district and site level staff to review practices related to the planning, management, and implementation of health services. EGPAF works hand-in-hand with local staff to identify bottlenecks and implement changes with the goal of streamlining processes and increasing program efficiencies. In Kenya, Lesotho, Malawi, Rwanda, Swaziland, Zambia, and Zimbabwe, EGPAF supported the MOH to establish systems and services that immediately enroll HIV-positive clients in care and treatment in MNCH, ANC, and TB services, thereby reducing delay in referrals and the number of patients who are lost-to-referral.

IMPROVING FACILITIESAdequate space and equipment is essential to improving the quality of health services. EGPAF has supported the renovation of many hospitals and clinics and provided crucial equipment including CD4, biochemistry, and hematology machines, as well as, delivery beds,

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AREAS OF EXPERTISE

service delivery at more than 130 HIV care and treatment sites, and approximately 700 PMTCT sites.

STRENGTHENING MANAGEMENT CAPACITY OF GOVERNMENT STAFF EGPAF programs work to increase the capacity of national and decentralized health authorities to effectively plan and to manage services, human resources, and funds while increasing accountability and local ownership. In Lesotho and Swaziland, EGPAF supports management, leadership, and planning of training for public-sector health managers.

BUILDING THE CAPACITY OF LOCAL ORGANIZATIONSEGPAF has led the way in efforts to build local capacity for HIV service delivery, with the ultimate goal of transition of program implementation responsibility to national governments and local NGOs. EGPAF is committed to strengthening civil society organizations (CSOs), and has contributed to building CSO organizational capacity across a broad spectrum of organizations from large, national nonprofits to very small, community-based organizations. EGPAF utilizes a comprehensive organizational development approach including baseline assessments, management and leadership training, resource mobilization, governance, coordination, and technical expertise.

In 2010, EGPAF supported the development of three independent, local affiliates in Mozambique, Côte d’Ivoire, and Tanzania. EGPAF provides on-going support to ensure that each organization has the capacity to grow and lead efforts in the elimination of pediatric HIV.

EGPAF is a leader in supporting implementation of the district approach, a locally-owned and locally-driven method for supporting the decentralized delivery of district-based health services and capacity building, in several country programs.Through this strategy, EGPAF provides technical, financial, and operational assistance to help districts coordinate and manage all partners and HIV services.

ACCESS TO ESSENTIAL MEDICINES

STRENGTHENING THE SUPPLY CHAINTo ensure a consistent supply of drugs and other commodities to health facilities, EGPAF provides both national and local TA, always ensuring that parallel supply chains either reinforce or are integrated into national logistics systems. In Tanzania, EGPAF developed a pharmacy mentorship program designed to improve forecasting, quantification, and timely ordering of drugs and other commodities, greatly reducing the number of stock outs in country.

HEALTH SYSTEM FINANCING

UTILIZATION OF GRANTS TO STRENGTHEN CAPACITY OF REGIONAL AND DISTRICT TEAMSEGPAF provides small sub-grants directly to regional and district health authorities to finance HIV services and activities, which, when coupled with EGPAF assistance, empowers local health authorities to gain experience budgeting, managing, and reporting on funds per international accounting standards, thus, increasing accountability for services and results, and addressing local health system priorities.

IMPROVING QUALITY OF CARE THROUGH PERFORMANCE-BASED FINANCING (PBF)EGPAF has been at the forefront in the use PBF of HIV funds to improve the quantity and quality of HIV and other priority services. EGPAF’s experience with PBF in Mozambique, Rwanda, and Côte d’Ivoire has resulted in improved quality of care, and reinforced district-level accountability and service management capacity. With increased motivation, districts are more receptive to capacity building for financial planning, management, monitoring and evaluation, and strengthened HR systems.

LEADERSHIP AND GOVERNANCE

BUILDING CAPACITY OF MINISTRIES OF HEALTHTo assist MOHs to meet their mandates, EGPAF provides technical and operational assistance to ministries of health. EGPAF also serves on national technical working groups that provide technical guidance and policy recommendations, as well as, national training curriculums for ministries. In Kenya, EGPAF is building capacity of healthcare workers and district level health management teams to support

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