21 july 2014
DESCRIPTION
Strengthening Mozambique’s District Health System to Improve Access and Quality of HIV Care and Treatment Services. 21 July 2014. Main Challenges. High HIV prevalence L ow ART coverage Scarcity and misallocation of resources Low managerial capacity at district level. Driving Question. - PowerPoint PPT PresentationTRANSCRIPT
Strengthening Mozambique’s District Health System to Improve Access and Quality of HIV Care and Treatment Services
21 July 2014
2
Main Challenges
• High HIV prevalence
• Low ART coverage
• Scarcity and misallocation
of resources
• Low managerial capacity
at district level
MozambiqueHealth Statistics at a Glance
Population (2014) 26 million
HIV Prevalence 11.5%
PLHIV(2014) 1.6 million
Nº of HFs with ART 644 of 1,445 (45%)
PLHIV Eligible for ART 865,877
Nº Active in ART 508,890
ART Coverage 59%
12 month ART retention 71%
% Below Poverty Line 55%
Ratio of doctors to pop 3/100,000
Access to healthcare 56%
3
Can strengthening health systems improve
access, quality and sustainability of HIV
services?
Driving Question
4
Health Systems and Clinical Services
The plan…
5
Health Systems and Clinical Services
The reality…
The plan…
The reality…
The Reality
The Plan
7
Intervention Response
Graduation Path Strategy• District focused• District assessment tool (DAT)• Integrated technical assistance (TA)
through Equipes Polivalentes• Support package (tutoring, subgrants,
equipment, minor renovations, and emergency funds)
2. Development of Standards and Sub-Criteria
6. Self-Assessment (Base Line)
1. Definition of Functions and Standards
5. Training of staff and external evaluators
7. Identification of Areas of Improvement
8. Action Plan
4. Development of an scoring system
9. Execution
10. Follow up Assessments(Self or External)
Design & Implementation Process
3. Development of assessment tool
District HSS Assessment Framework
Functions (8)
Standards (23)
Sub-Criteria (115)
Follow up & Progress Monitoring
Measurable Indicators Scoring System
10
Functions
Health Systems
Management Capacity
1. Planning Systems and Capacities
2. Information Systems and Capacities
3. Financial Management Systems
4. Human Resources Systems
5. Pharmacy Supply and Logistic Systems
Health Services
Management Capacity
6. Health Programs Management
7. Key Laboratory and Support Services
8. Community Mobilization
District Health System Functions
“Continuous QI is achieved by iterating through the cycle and consolidating achieved progress through standardization” (Johannes Vietze, 2013)
Time
Continous Improvement
Standards Consolidation through
Standardization
Quality Im
provement
StandardsPlan
Do1
Do2Study
Act
Plan
Do1
Do2Study
Act
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Baseline vs. Post-Baseline1. Planning Systems
2. Information Systems
3. Financial Management
4. Human Resources
5. Supply and logistics
6. Health Programs
7. Laboratory & Support
8. Community Mobilized
58% 74%
54%
40%26%
20%29% 27%
88%
79%
49%
37%
61%68%
72%
38%
Basline 2nd Measure
13
Preliminary Findings• Baseline:
– High variation across health system functions– Weaker areas: pharmacy supply & logistics, lab, health programs
mngmt– Stronger areas: HIS, Planning systems and capacities– Insufficient systems to track problems and implement solutions
• Post-Baseline– Highest improvement in weakest areas (pharmacy & health programs)– Strongest areas: HIS, planning, pharmacy & health programsBasline 2nd Measure Difference
1. Planning Systems 58% 88% 30%2. Information Systems 74% 79% 5%3. Financial Management 54% 49% -5%4. Human Resources 40% 37% -3%5. Supply and logistics 26% 61% 35%6. Health Programs 20% 68% 48%7. Laboratory & Support 29% 72% 43%8. Community Mobilized 27% 38% 11%TOTAL 36% 66% 30%
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Initial Lessons Learned
• District assessments increased MoH staff awareness of management standards
• Assessment-based action plans are effective tool for guiding quality improvement (PDSA cycle works!)
• Action plans owned by districts and used to guide activities
• Project staff support district health officers to implement action plans to improve results
15
Can strengthening health systems improve
access, quality and sustainability of HIV
services?
Driving Question
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Next Steps
• Quasi-experimental design to test hypothesis• Difference-in-difference approach• Regression-discontinuity design
Intervention Start Date Project End Date
Clin
ical
Out
com
e In
dica
tors
Experimental Group Experimental Group: High HSS
06/1612/1506/1512/1406/1412/132011-2012End of project
Baseline,First
measure
Start of project, Pre-Baseline
Second measure
t1 t2 t4t3 t5 t6t0
Comparison Group Experimental Group: Low HSS
17
Acknowledgements
