Technical quality and standards session: What is my … · Technical quality and standards session: ... - Taking care of Emergency and Relief wherever the need ... Technical quality

Technical quality and standards session:

What is my agency doing?

Global Health Cluster Partner Meeting 17-19 June 2015

Geneva, Switzerland

GHC Partners: CDC (Richard Garfield) ERA/AMU (Ossama Rasslan) [by email] IMC (Jill John Kall) IOM (Teresa Zakaria) Malteser (Marie-Therese Benner) Medair (Trina Helderman) SC (Francesco Checchi) UNHCR (Allen Maina) Unicef (Heather Papowitz) WVI (Ando Raobelison)

Ground rules

• About 5 min per agency

• About 2 min questions per agency

• Some space at the end for any other contributions

• Main idea is to map initiatives, not discuss in depth their merit / details

CDC Related Methods and Measurement


Geneva, Switzerland

Richard Garfield

SMART

EWARN

Special Surveys

• Mortality

• Injury

• Disability

• WASH

• Vaccine campaign coverage

• MISP

Quality Improvement in ERA/AMU Performance


Geneva, Switzerland

Prof. Ossama Raslsan, Secretary General, AMU

Supervisor, ERA

Who we are

• Arab Medical Union (AMU) is the union of medical syndicates, professional societies and organizations in the Arab World.

• It was established in Egypt 1962, for the purpose of fortifying the efforts to enhance medical practice and health status in the Arab world, as well as coordinating efforts in humanitarian work world wide.

Objectives To become a leading organization in the whole region AMU

aimed at: - Promoting medical profession, building capacity of medical personnel and improving health status in the Arab world. - Taking care of Emergency and Relief wherever the need calls - Supporting Vulnerable, Migrants and Refugees . - Achieving professional integration between Arab Countries

in medical fields - Building and exchanging Medical expertise among AMU countries. .

Main Functioning Bodies of AMU

I- The Arab Institute for Continuing Professional Development (AICPD)

AICPD is a non for profit institute affiliated to AMU.

It aims at raising the standards of healthcare practice through the provision of vocational training programs in various medical, surgical and health-related specialties.

These programs equip physicians and other healthcare professionals with core competencies needed to practice as specialists in their respective field.

II- Emergency And Relief Agency ERA

• ERA is the biggest AMU committee , established in early nineties.

• Whatever the nature of a crisis affecting a population - natural disaster, political crisis, armed conflict, etc. - ERA intervenes.

• Our emergency response aims to satisfy emergency needs especially medical ones.

• Taking into account the material needs that are essential for survival, is at the heart of our emergency response programs.

Improving Performance How did we do that with our

very limited resources?

1- Capacity Building • To facilitate adoption and implementation of

accountability and transparency measures to respond to donors, clients, governmental agencies and the community.

• To support and promote the implementation and/or improvement of ERA performance measures.

• To promote research that contributes with new knowledge, best practices, and innovative strategies to strengthen ERA, their operations, image and public trust.

• To promote the integration of evaluation as part of the institutional control system.

Capacity building comprised two main functions:

Medical Staff capacity building

Admin staff capacity building

Medical Staff capacity building

How did we use AICPD in Capacity Building?

We created a Professional Diploma in Disaster Management

Curriculum Contents Disaster cycle phases and the appropriate management Specific Multiple Casualty Treatment Research in Disaster Medicine Disaster Mental Health Education and Training in Disaster Medicine Leadership During Disasters Humanitarian Emergencies Media Management during disasters Communications during disasters Transport during disasters Trauma Management

AICPD Partners

Admin Staff Capacity Building • Proposal writing training

• Many training courses and workshops have been conducted to build the capacity of our staff;

• The proposal does not stand alone. It must be part of a process of planning and of research on, outreach to, and cultivation of potential foundation and corporate donors.

• Raising funds is an investment in the future. It takes time and persistence to succeed.

2- Strategic Planning • Strategic planning guided by experts was approved as

a corner stone in improving ERA performance.

• A clear strategic plan strengthens the idea behind the organization and how it can move forward.

• Establishing an organization with a mission and objectives is just one part of the work; running it in the right direction is equally important.

• A strategic plan really did that; it has guided the organization to move towards the same mission and objectives for which it was developed.

3- Initiatives • Ibsar ( Fighting Blindness Centre )

• It’s a committee for fighting blindness all over the Globe

• Managed to do over 25.000 operations to date bring back the hope to those who have lost it

• Succeeded in cutting down the cost to almost 20%

• All its work is based on donations and all the operations were completely for free

• Maak ( Disability limitation Centres )

• With over 7 centres across Egypt, Maak is helping daily hundreds of mentally disabled and neglected children

• Providing support for both the children and the families, Maak has issued a manual to be used as a guide for how to deal with cases, creating a success story for others to be inspired.

Motadaminon ( Psycho-social support Centre )

• A committee specialized in providing psycho-social support for those who need it

• A lot of sessions were conducted in refugee camps where families, especially children, were severely traumatized after they have lost everything because of war (e.g. Syrian Refugees )

Future initiatives

• There are increasing calls from crisis-affected communities, governments of disaster-prone countries, donor foundations, as well as the general public, for a fair global system, which will help objectively verify the impact and quality of humanitarian aid agencies; regardless of their origin or size.

• Better understanding of the impact of these interconnected trends and approaches

• Share best practices and find innovative ways to make humanitarian action more effective

• Transformation through innovation

• Serving the needs of people in conflict.

Thank You

Presentation Title ©2012 International Medical Corps

Improving Quality of Emergency Health Programs

From Relief to Self-Reliance

Dr. Jill John-Kall Health Advisor

All content in this document is the property of International Medical Corps and should not be reproduced without prior written consent. This material is protected by copyright. ©2015 International Medical Corps. Materials may not be reproduced without International Medical Corps’ prior written consent.


Approaches

Country teams and HQ staff work together to improve assessments and program design: • Regional outlook • Adaptability in remote management programs • Sector advisors (Health, SRH, WASH, MH, GBV, PSCM, DRR, M&E) provide

assistance and help integrate various programs • Technical learning sessions • Sharing of lessons learned from similar contexts (emergency response,

early recovery and HSS) • Continue to work with Ministries of Health, donors and other partners to

address needs across emergency, early recovery and development phases • Continue to provide capacity building to local staff and partners


Assessments

• M&E technical workshop on needs assessments for 17

countries which will be replicated in country • Focused on overcoming realities on the ground, sector

specific issues and standardized tool kits but to maintain flexibility to adapt tools on the ground in real time as needed

• Explore mHealth options for more efficient data collection and analysis

• Continue to work with all stakeholders and input to assessment processes


Technical Capacity Building

• Training of health care workers in all contexts; training needs are met with in country training sessions, eLearning modules, overseas training, etc.

• Provide support to Ministries to develop training curricula for health workforce, support national level hospitals in clinical care and management; support verification of suspected communicable diseases especially in conflict areas with limited access

• Sector specific training (M&E, SRH, GBV)

• Non technical training (English, computer skills, leadership/managerial skills)


Health Information Management

• Emergency Response Information System (ERIS)

• DHIS 2

• Data quality audits

• Exploring mHealth modalities for common issues: digitizing data at the point of service delivery to improve patient information and reduce errors; using available apps for reporting purposes, especially for inaccessible areas


Pharmaceutical Supply Chain Management

• Train field staff on tools for quality assurance and quality to manage the flow, storage and distribution of medical commodities (PSCM manual)

• Use National, WHO and/or donor specific essential drug lists to support the rational selection of medicines and treatment guidelines to support RUD

• Utilize a transparent procurement system- only WHO/donor prequalified suppliers are openly bidding on our tenders

• Member of QUAMED consortium and participate in trainings and supplier assessment surveys


END

Health Management at Borders Lessons Learnt and Opportunities

International Organization for Migration

GHC Meeting, 19 June 2015

West Africa EVD Outbreak How Human Mobility Exacerbates Infection

Transmission

“Even if you have a contact tracing system, what do you do when your contact picks up

and moves 60 km away one morning without telling you? If Ebola moves from location A to

location B, suddenly you need to duplicate everything…This explains a large part of why the control systems were overrun so quickly” – A. Petherick (2015), Ebola in West Africa: learning

the lessons. The Lancet, 385 (9968), 591-592.

Understanding mobility for better prevention, detection and response

to health threats

• The importance of mobility

– A known social determinant of health

– Direct contribution of spread of diseases

– A special skills set not possessed by many…

• Displacement vs mobility tracking

• The added value of integrating mobility pattern mapping with other sectors

The

Mo

bility C

on

tinu

um

And everything outside

the border

Understanding mobility for better prevention against health threats

• Better targeting of preventive measures

• Better targeting of resource allocation

• Working with otherwise unidentified vulnerable communities

• The role of transit points and destinations in prevention actions

Understanding mobility for better detection of health threats

• The border buffer zone and the importance to identify mobility hotspots – 20 km radius?

• Screening at the market places and the mines?

• Alert to important spots along the mobility continuum

Understanding mobility for better response to health threats

• Strategic stock-piling

• Proper referrals from hotspots

• Contact tracing

• PHC strengthening along the vulnerable corridor

Arising Opportunities & Challenges

• The tripartite cooperation (IOM-WHO-CDC)

• “A new science in the making”

• How to document knowledge rapidly?

• Validity of the approach, tools, SOPs?

Thank you!

Quality Initiatives


Geneva, Switzerland

Marie T Benner, Malteser International

Warehouse in a Box

Pilot Test in refugee setting in Thailand to control medicine stock outs and expiry:

• Increase awareness for the role of inventory management

• Reduce time spent on administrative tasks

• Increase visibility in consumption patterns and inventory status resulting into better forecasting

• Ensure better decision making through availability of information at various levels of the organization

• Equipment: tablet, solar charger and wirless barcode

COMBI=Communication for behaviour change impact

The COMBI method is a strategic and targeted communication approach based on concepts from marketing and includes different Behaviour Change Communication (BCC) theories/models.

•“The way how we make decisions buying a bottle of water, the same way people make decisions regarding

i.e. health issues”

COMBI Process

Connectdness and listening to the community is most important; think of the ‚competitor‘.

State the behavior to be changed (behavior change objective) – using 4W‘s and SMART

4 W’s: Who, What, Where, When, ….and, by the way, Why?

MANTRA 1: do nothing….(no pamphlets, no shirts or caps, no videos…until one has set up a precise specific behavioral Objective.

NYU/WHO IMC/COMBI - Doc #4 –Page 3 of 4

HICDARM : Needs and Goals Priority Market Segmentation

H I

C

D

A R

M

Have yet to Hear about family

planning

Have heard but now need to

be Informed

Now need to be

Convinced

Need to be encouraged to

Maintain their

family

planning behaviour

Need to be prompted to Act

Need to be triggered or

encouraged to

Decide to do

something about

family planning

Have acted and now

need to have action

Re-

confirmed

54

Afghanistan © Medair/Paul Hageman

Quality Initiatives GHC

June 2015

Country Program Sphere Audits

• Measures individual program and country level compliance against relevant, measurable Sphere indicators

• Quarterly

• Able to demonstrate improvement and areas where additional work is required over time

Country and Global QPI

Exit Criteria/Thresholds

services

services

Ebola Dashboard

• Utilized partnership with private sector to develop dashboard to follow the ebola outbreak

• Data currently limited to public data and Medair facility and quarantine data

• Final product soon to be completed

Technical quality and standards session:

What is my agency doing?


Geneva, Switzerland

Francesco Checchi, Save the Children

What is Save the Children doing?

Assessment Macro (population-level) Micro (facility-level)

Decision-making Which beneficiaries? Which package of services? What delivery modalities?

Implementation Staff and job descriptions Work planning Training and supervision Audit Pharma. management

Project design Logframe MEAL + indicators/targets Programmatic budget

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MEAL Health information system Specific MEAL activities

Mainstreaming vulnerabilities (HIV, gender, disability,

age)

Health system support practices

Integration with other sectors

Early recovery provisions






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Technical staff recruitment and retention

• Expanded global humanitarian health advisory team – 10 generalist health advisers

– 11 specialists (1 HIV, 5 RH, 1 neonatal, 1 epidemics / vaccination, 1 health policy, 3 HMIS-MEAL)

– 10 roving advisers

– 8 pharmacists

– 3 cluster support staff

• Five times larger than 2012

– Delay between investment and effect






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Staff capacity building

• Distance-learning modules for HIV in emergencies – HIV in emergency preparedness

– PMTCT in emergencies

– Mainstreaming HIV vulnerabilities

• DL and face to face modules for family planning and post-abortion care in emergencies

• Extensive CMAM and IYCF toolkits – Inspiration for health & HIV

• 6-month Humanitarian Health & Nutrition Diploma

About the Diplomas

2-week Residential

5-month Distance Learning + Mentoring

Closed book exam +

Critical Report

3-week Residential

5-month Distance Learning + Mentoring

Field placements

Closed book exam +

Critical Report

OVERALL AIM: Equip national humanitarian health and nutrition staff in key regions with

the required skills, knowledge and experience to a) organise and deliver, and b) design and lead field health and nutrition interventions in emergencies

a) Professional Diploma

in ‘Humanitarian Health

& Nutrition for

Practitioners’

b) Professional Diploma

in ‘Humanitarian Health &

Nutrition for

Managers’

Modules * Humanitarian Context

* (Rapid) Assessment & Surveillance

* Key Health & Nutrition Interventions

* Programme Cycle Management

* Emergency Health/Nutrition Operations

accreditation

Both Diplomas are accredited as Professional Diplomas by Liverpool School

of Tropical Medicine.

This partnership with LSTM means:

Quality Assurance

Professionalisation

Certification

“It motivated me to work harder in order to excel”

“It is an internationally recognised Diploma attesting to the high level

of the training” [Participant from 3rd cohort]

Gender

Female

Male

Specialisms Health

Nutrition

Health &Nutrition

HIV

68 participants

based in 14 countries in East Africa and West

and Central Africa.

Outputs

57% said they had been

engaged in a

humanitarian response

since starting the Diplomas

15% have been promoted 6 months later...

68% said their

responsibilities

had increased

after receiving the

Diploma

“Before the training I was

a Nutrition Officer, I am

now Health & Nutrition

Coordinator. Colleagues

and managers

acknowledge this new

integrated dimension of

my work. I now feel

entirely legitimate.” Graduate from Mali

“I am now

regularly consulted

for advice on

humanitarian

issues”

“I really developed my capacity and

confidence to lead an emergency

response. I gained important hands-on

skills that I was able to utilise (…) in

the Puntland Cyclone” Graduate from Somalia






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Assessment and decision-making

• Reviewing emergency health assessment tools

• Developing consolidated assessment tool to be used at macro and micro levels

• Guidance for decision-making (late 2015?)






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Project design and implementation

• Establishing various pharmaceutical management systems – Quality procurement

– Gifts in kind

– Supply chain and ordering

– Field-level forecasting and drug management

• Specific guidance on thematic priorities – Newborn health in emergencies guide

– FP/PAC guidance and toolkits

– PMTCT in emergencies

• Medical risk management project

• COMPASS project


COMPASS

• Complete Operational Modules of Public health Activities and Standardised Systems

• Software application pre-loaded with evidence / best practices / tools

• Designed to streamline work of field health managers

• Conduit for evidence and best practices


COMPASS

COMPASS Tips for implementation

Tips for inter-sector integration, vulnerability mainstreaming

Menu of indicators, how to interpret them

Training and supervision materials and schedule

Audit tools, protocols and schedule

HR lists and job descriptions

Programmatic budget

Drug lists and quantification

Operational library

Specify which services ~15-25 other input parameters






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MEAL

• Health Management Information System roll-out

• Defined indicators by module (service)

• DHIS-2

• 2 pilot countries this year

• Expanding to 60 countries by 2018






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Cross-cutting issues

• Mainstreaming and integration tip sheets

• Reviewing evidence to write practical “how to” guidance on best practice for health system support in emergencies

– Health financing / user fee removal

– Human resources for health

– District health team support package

THANK YOU!

Francesco Checchi

[email protected]

mailto:[email protected]

PUBLIC HEALTH IN REFUGEE

EMERGENCIES

GHC Partner Meeting

19th June 2015

On June 20, the world commemorates the strength, courage, and resilience of millions of refugees.

English student. Brother. Footballer. “I am alive thanks to my sister.”

UNHCR Global Public Health Strategy

83

Public Health

HIV & Reproductive Health

Food Security

Nutrition

WASH

2014 - 2018

How to reach results:

• Integrate services into national systems whenever feasible

• Robust contingency planning and emergency response that focuses on integration and sustainability of services

• Reinforce partnerships specifically with government line ministries

• Create synergies with other sectors from onset

• Develop and implement standard operating procedures for public health areas

How to reach results:

• Use data from TWINE, SENS and WMS systems to make evidence-based decision

• Promote and use innovative and appropriate technologies for diagnosis, treatment and monitoring

• Capitalise on health financing opportunities to address needs

• Increase HCR and partner expertise

Refugee camps

• Primary health care programs

• Aim for integration/synergies with national programs

• Referral for 2̊ and 3̊ care

• Capacity building

• Health information systems easier

Urban & Out of Camp

• Alternative to camps, including PHC and Referral care

• Legal / protection access to services

• HI schemes where feasible

• Challenges to monitor health status and health access

Monitoring tools refugee camps

Refugee camps

• HIS

• Disease outbreaks

• WMS

• Nutrition Survey

• Balanced score card

• Laboratory evaluation

• Referral care

• Maternal death review

• Neonatal death review

Monitoring tools out of camp

• HIS ONLY where there are vertical clinics outside MOH,

(some countries disaggregation by nationality)

• HAUS

• Nutrition survey (either included in national or separate)

• Balanced score card

• Referral care

Regular order

What to improve

• Integration with MOH – legal status/dilemma

• Too often establishment of vertical systems in

refugee camps, rather than working towards integration from emergency phase onwards.

• UNHCR limited accepted role in supporting MoH on quality improvement and health systems strengthening.

• Media hype emergencies versus no media emergencies

• Donor and funding fatigue (protracted nature of refugee operations)

• Challenges to find quality partners in protracted situations

• Beneficiaries not fully involved

• Empowering communities

Technical Quality and Standards UNICEF 2015

Content

1

2

3

UNICEF Core Commitments for Children in Humanitarian Emergencies (CCC)

Humanitarian Performance Monitoring

Capacity Building

UNICEF

UNICEF’s core humanitarian

policy to uphold the rights of

children affected by humanitarian

crisis

Promote predictable, effective

and timely collective

humanitarian action

A framework based on norms and

standards, around which UNICEF

seeks to engage with partners

What are the CCCs?

UNICEF 95

CCCs: Core Commitments for Children

Strategic Result

Commitments – the first

commitment in each sector

refers to coordination or

cluster lead (when relevant)

aligning UNICEF’s

commitments in humanitarian

reform with the CCCs.

Benchmarks – aligned with

globally accepted standards

including SPHERE and INEE

Content: Hierarchy of Results

UNICEF 96


Content: Technical Justification and

Programme Actions

Technical Justification

Programme Actions: UNICEF has identified key

preparedness,

response and early recovery

actions to contribute to each sectoral

commitment, based on evidence

available and best practice,

recognizing that partners will employ

diverse strategies to work towards

global benchmarks for children in

humanitarian action.

UNICEF 97


Content: Operational Commitments

Operational commitments now also

include defined

preparedness and

response actions

Some operational commitments also

include early recovery actions


1. Does response have adequate resources? e.g. tracking % funding by sector, % staffing filled, % supplies from allocation to delivery

Informs management of HQ-RO support to CO

2. Are we making progress/ enough progress? e.g. tracking children <5 with SAM enrolled in TFPs

• # and estimated coverage as % of target

• by UNICEF / by Cluster

Decisions to allocate more resources -- advocacy, $, human


3. Is the quality of the response as expected? e.g. % sites visited where issues identified related to – use of supplies; services functioning; equity of access….

Feedback to specific site/partners; changes to strategy

4. Are we meeting Cluster Lead Agency accountabilities?

e.g. tracking key milestones--TORs, IM systems, strategy, technical standards

Increase in management resources, advocacy

• Few key progamme indicators

• Few key operations indicators

• Cluster milestones

VISION – Supply, Human Resources & Funding Data

SitRep

High frequency coverage estimates -- partner reporting

• 2-3 key programme indicators per sector

Cluster coordination milestone

monitoring

• UNICEF CLA accountabilities

Field monitoring to check quality

• Implementation

bottlenecks • Equity

• Do no harm • Engagement local

capacities

Key Components of Humanitarian Performance Monitoring

SitRep feeds into CO management

team review

Monitoring of Results for Equity System (MoRES) adapted in Emergencies

Level 1 Needs assessment draws on prior Situation Analysis, and re-assesses same key determinants: • enabling environment; services and support; access and use

of services

Level 2 High frequency internal SitReps cover monitoring of availability and use of key UNICEF resources (narrative report and VISION management reports on resources for selected IRs)

Level 3 In major emergencies (e.g. Appeals > $15 million), country offices prioritize/redirect resources to scale up monitoring • Monitoring aligns to new priority results in line with CCCs • Indicators and methods systematically include:

― Key output indicators for coverage estimates (supply) through partners

― Quality issues (access, use) through field monitoring ― Cluster process milestones (coordination) through self-

reporting • Monitoring feeds higher frequency management review

Monitoring of Results for Equity System (MoRES) adapted in High Emergency-Risk Contexts

Level 1 Emergency-risk informed analysis entails:

• Examining impact of emergency threats and likely humanitarian consequences on equity gaps;

• Which can lead to identification/prioritization of different key result areas; geographic focus; or bottlenecks;

• And to equity-focused programming with specific risk prevention/reduction/mitigation focus.

Level 2

Level 3 Choice of indicators and data collection methods influenced by potential use in monitoring humanitarian response

Level 4

CAPACITY BUILDING

Humanitarian Learning Strategy

• Three tiers: Junior, Mid – level and Senior Management;

• Four phases: Induction, Pre-deployment, During Employment and End of Deployment

• Seven topic areas: Security, Well-Being, Humanitarian Action, UNICEF in Humanitarian Action, Leadership and Management, Technical and Simulations/ Team Building;

Health in Emergencies training

• Train all health staff globally (development staff): move capacity to the country level – Basics of IASC systems and Health Cluster

– Operational/technical issues

– UNICEF procedures

• Resources: compilation of resources and tools

• Process – Review of existing training: start now

– Mixed methods, modules, hands on, mentoring

eLearning and Resources

• http://www.unicefinemergencies.com/

• Health Resources for Emergencies: http://www.unicefinemergencies.com/downloads/eresource/Health.html

http://www.unicefinemergencies.com/

http://www.unicefinemergencies.com/

http://www.unicefinemergencies.com/downloads/eresource/Health.html




Assuring Quality in WVI Emergency Health Response

Operations


Geneva, Switzerland

Dr Ando Tiana Raobelison

International Standards: Emergency and Humanitarian Accountability Framework

– Do No Harm

– Code of Conduct

– Sphere Standards in Health Action

– HAP

– Convention on the rights of children

Own Quality Standards : LEAP approach (Learning, Evaluation, Accountability and

Planning)

Joint Assessment/ Health

Cluster/Community Participation PRIORITY INTERVENTIONS

Health HIV Nutrition DADDs

(Do Don’t Assure) DELIVERY MECHANISMS

HEA Disaster Management Standards OPERATIONAL ROLES

Own Quality Standards (ctd)

Pharmaceutical Management Policy Drug procurement

Orientation/Mentoring/Coaching Staff Capacity Building

Feedback from the

beneficiaries/Updates to the

community

Inform decision-making, Ensure Mutual

Accountability

Real-time Learning Evaluation process Improve current programming

Post –response Learning Event Inform future response

Operational Audit Measure quality of the Response

Own Quality Standards (ctd)

Documents

Technical quality and standards session: What is my … · Technical quality and standards session: ... - Taking care of Emergency and Relief wherever the need ... Technical quality