early lessons learned and promising practices: supporting provincial health departments and...

Early lessons learned and promising practices:

Supporting Provincial Health Departments and Districts in

MozambiqueDr. Antonio Mussa

8th Annual Track 1.0 ART Program Meeting Maputo - ICAP MozambiqueAugust 11th, 2010

OVERVIEW

• TRANSITION APPROACHES IN MOZAMBIQUE

• ACTIVITY UP-DATE• LESSONS LEARNED• NEXT STEPS


TRANSITION APPROACHES IN MOZAMBIQUE

• To augment sub agreements with the Government of Mozambique (GOM) at provincial & district level to include some of the activities previously directly supported by ICAP

• To ensure sustainability and to directly strengthen health system capacity

• To strengthen role of civil society by facilitating transfer of key activities to existing or new local NGOs


HISTORY OF SUB AGREEMENTS ICAP - GOM

• HUMAN RESOURCES FOR HEALTH (HRH) / STAFFING WITH 5 PROVINCIAL HEALTH DEPARTMENTS (DPS), 1 CENTRAL HOSPITAL, MINISTRY OF INTERIOR & MINISTRY OF DEFENSE SINCE 10/2008

• PROVINCIAL HEALTH SCIENCES INSTITUTE (NAMPULA): 3 PRE-SERVICE TRAINING COURSES SINCE 9/2008

• NEW PRE-SERVICE TRAINING SUB AGREEMENTS WITH INHAMBANE PROVINCE & MINISTRY OF DEFENSE FOR 5 COURSES IN 2010


HRH/STAFFING


Professional Category

1 Basic Level Nurse2 Biologist3 Cleaners/ Support staff4 Counselor5 Data Clerk (Admin. Technician) 6 Driver7 Lab Technician8 Maternal Child Health Nurse9 Medical Doctor

10 Mid-Level Clinical Officer11 Mid-Level Nurse12 Pharmacy Technician13 Psychologist14 Recepcionist (Admin. Assistant.)15 Stock Clerk

Maputo City 93

Gaza Province 49

Inhambane Province 28

Zambezia Province 48

Nampula Province 96

TOTAL 314

Staff by Province - 2010

EXPENSES ON HRH STAFFING


2005 2006 2007 2008

DSCM 18,631 106,526 192,104 150,920 468,182

Maputo City MCH 1,421 13,175 15,343 11,451 41,390

MoD 19,335 81,820 106,016 51,680 258,851

Maputo Province MoI 28,040 48,123 39,472 115,636

Gaza Province 15,939 20,721 31,081 67,741

Inhambane Province 26,565 44,275 47,971 118,811

Zambezia Province 13,432 55,653 98,238 84,578 251,901

Nampula Province 14,371 95,560 202,327 158,719 470,976

TOTAL 67,191 423,278 727,147 575,871 1,793,486

EXPENSES in USD ON HRH STAFFINGPROVINCE TOTAL

SUB AGREEMENTS


2009* 2010 **

DSCM 159,208 505,395HCM HR 90,959 136,768MoD 92,615 324,411MoD PreService 167,837

GAZA 139,091 504,741115,390 618,303

PreService 252,129 ZAMBEZIA 146,082 702,539

358,556 784,344PreService 156,122 165,316

TOTAL 1,258,023 4,161,783* 2009 refers to expenses on HRH Staffing

** 2010 budget consider expanded scope of work beyond HRH staffing

MAPUTO

BUDGET in USDSUBAGREEMENTS

NAMPULA

INHAMBANE

Step IExpand SOW of Provincial and District subcontracts to further

transition responsibilities for greater sustainability and strengthening of health systems

• CONSENSUS BUILDING MEETINGS WITH EACH DPS

• DISTRICT PLANNING SESSIONS: ICAP provincial teams discussed facility reports (checklists and programmatic data), Standards of Care (SOC) Continuous Quality Improvement (CQI) instruments with the Districts as a basis for District planning:

Indicators with low performance were prioritized & analyzed

Solutions identified have been transformed into activities for the District plans


Step IITransition responsibility to Provincial & District level to ensure

sustainability and strengthening of health systems

PROVINCIAL PLANNING MEETINGS

• Participants: District Director, Chief Medical Officer & admin/finance staff from each District where ICAP is operating, representatives from DPS & ICAP team

Presentation of transition objectives, planning process and tools to be used

Districts & DPS present their plans which include activities, time line and the resources needed

Compilation and final revision of an overall plan by Districts & DPS


LESSONS LEARNED- I

• Transition is a new approach for all stakeholders (CDC, ICAP, MOH) “learning by doing”

• Time constrains of DPS that impede participation in scheduled meetings & review and release of documents lead to slowing of process; a focal point person could facilitate progress

• Limited planning and administrative/finance management capacity at DPS level indicates need for increased capacity building activities


LESSONS LEARNED II

• More guidance from central level MOH to DPS would facilitate planning and implementation process

• More consensus building needed among central level MOH & CDC to better define indicators and targets; strengthen M&E system to monitor transition

• Need for better harmonization of tools used by Track 1.0 transition implementers (planning, finance training, funding proposal writing) to standardize the USG approach for DPS support


NEXT STEPS- I

Finalize and obtain CDC approval for DPS subcontracts

Build operational capacity of the DPS through:additional staffing & program management

training of existing staffbuilding financial management capacity


NEXT STEPS- II

Build programmatic capacity of DPS in:data collection and reportingsupportive supervisionpartner coordination activitiesprogram management in technical areasadherence support & patient empowerment

Monitoring & Evaluation of the successful implementation of sub agreements and

plans


CONCLUSION

Plan to support and monitor the process from the administrative/financial perspective as well as from its potential impact on achievement of targets and on quality of care


THANK YOU !


early lessons learned and promising practices: supporting provincial health departments and...

Documents

annual track

icap provincial teams

districts dps

government of mozambique

provincial district

district planning

p rovincial h ealth

district director