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Project HEART Transition Monitoring
Challenges and Successes of Monitoring Health System
Capacity August 12, 2010
Rozalin Wise
Transition Monitoring System: Goals
• Document capacity of health system to meet HIV/AIDS Prevention, Care and Treatment needs pre, during and post transition
• Increase monitoring of systems and processes to guide program interventions focused on health systems strengthening beyond site level
• More uniform monitoring system across countries
Transition Monitoring System:Design Overview
• Capacity assessment of each Result area proposed in Transition Plan• Assessment scores transformed to same scale allowing plotting on spider diagram • Capacity assessments repeated annually at minimum
1. Health Outcomes
2. Health Service Provision
3. District Health Office Capacity
4. Main Local NGO Capacity
5. Community Capacity
6. Enabling Environment
0
40
80
BaselineFinal
The Transition Vision: A strong house!
Enabling Environment (“the foundation”)Policies, political stability, human rights,
gender equality, etc.
Operational Capacity of
Government or Local
Organizations managing
health system
RESULT 3
Health Outcomes (“the roof”)
Client and Community Engagement
RESULT 2
Health Outcomes (“the roof”)
Health Service
Provision
(Quality & Access)
RESULT 1
Enabling Environment (“the foundation”)Policies, political stability, human rights,
gender equality, etc.
Enabling Environment (“the foundation”)Policies, political stability, human rights,
gender equality, etc.
Health Service
Provision
(Quality & Access)
RESULT 1
Enabling Environment (“the foundation”)Policies, political stability, human rights,
gender equality, etc.
Health Service
Provision
(Quality & Access)
RESULT 1
Enabling Environment (“the foundation”)Policies, political stability, human rights,
gender equality, etc.
Operational Capacity of
Government or Local
Organizations managing
health system
RESULT 3
Health Service
Provision
(Quality & Access)
RESULT 1
Enabling Environment (“the foundation”)Policies, political stability, human rights,
gender equality, etc.
Operational Capacity of
Government or Local
Organizations managing
health system
RESULT 3
Health Service
Provision
(Quality & Access)
RESULT 1
Enabling Environment (“the foundation”)Policies, political stability, human rights,
gender equality, etc.
Client and Community Engagement
RESULT 2
Operational Capacity of
Government or Local
Organizations managing
health system
RESULT 3
Health Service
Provision
(Quality & Access)
RESULT 1
Enabling Environment (“the foundation”)Policies, political stability, human rights,
gender equality, etc.
Client and Community Engagement
RESULT 2
Operational Capacity of
Government or Local
Organizations managing
health system
RESULT 3
Health Service
Provision
(Quality & Access)
RESULT 1
Enabling Environment (“the foundation”)Policies, political stability, human rights,
gender equality, etc.
Health Outcomes (“the roof”)
Client and Community Engagement
RESULT 2
Operational Capacity of
Government or Local
Organizations managing
health system
RESULT 3
Health Service
Provision
(Quality & Access)
RESULT 1
Enabling Environment (the “foundation”)Policies, political stability, human rights,
gender equality, etc.
Health Outcomes: Clients have continuous high quality HIV care and treatment delivered by
local partners (the “roof”)
Client and Community Engagement
(active civil society, high
demand)
RESULT 2
ManagementCapacity of
Government, NGOs &
Private Sector managing
health system
RESULT 3
Health Service
Provision
(Quality & Access)
RESULT 1
Transition Monitoring System:Design Overview
Result Area Unit of Measure Assessment Tool/Process
RESULT 1:Services Provision
Health Facilities Site Capacity Profile (SCP)
RESULT 2:Health System Management
- District Health Authorities- Primary local NGO (transition partner) supporting systems strengthening
- SCP/MoH Capacity Assessment- Organizational Capacity Assessment (OCVAT tool)
RESULT 3:Community Linkage
Key informants in health facility catchments areas
SCP/Structured Interviews with CBOs and Support Groups
Enabling Environment(policy, political stability, corruption, etc.)
National Existing development/ policy indexes
Transition Monitoring Timeline
Assessment First Implementation
OCVAT June - Sep 2010
Site Capacity AssessmentSep - Oct 2010 pilotNov 2010 – Feb 2011 First Implementation
Community Capacity Assessment Same as Site Capacity
MOH Capacity Assessment
Pending finalization of CDC H-CAT 2
Organizational Capacity: The OCVAT(Organizational Capacity and Viability Assessment Tool)
• Semi-quantitative: Each indicator scored on 1-5 scale, representing stages of capacity
• Implementation: Two phases– External Assessment – conducted by EGPAF Global– Self-Assessment – facilitated workshop w/ staff representing
all departments/functions• External evaluators give scores• Participating staff give scores, median = official score • Results presentation: Compare scores, highlight
strengths, weaknesses, discussion• External facilitator decides final scores if no consensus
Service Provision: Site Capacity Profile (SCP)
• Capacity Areas: ART, PMTCT, Peds, Treatment Support, Pharmacy, Laboratory Services, M&E/Reporting, Quality Improvement Program, Finance
• Measures infrastructure, staffing and management/provision of services for each capacity area
• Coupled with existing Quality of Care measures• Score generated per capacity area• Implementation: Program Officers complete using
existing routine data, visit site to collect the rest OR use as QI activity with site QI Committee
MOH Capacity Assessment
• Will be based on CDC MOH Capacity Assessment tool
• Working Group with representation from all EGPAF Project HEART countries will adapt ensuring necessary country context specification and comparability to extent possible
Community Capacity Assessment
• Focused on provision of support services• For key support services, measures core
competencies:– Availability, Quality, Linkage (referral process),
Utilization Barriers– Rapid – each competency, a few key questions
• Informants: Site Staff, CBO Leaders, Support Groups
• Countries decide which support services to focus on (modules developed for all)
Conclusion
• Series of capacity assessments capture health system’s capacity to provide continuous quality HIV/AIDS care and treatment
• Demonstrates relationship of key components and their contribution to the whole
Thank you!
