Transcript Phlebotomy practices before the start of the Tanzania

Tanzania Ministry of Health and Social Welfare
Health Quality Assurance Division
“Quality assurance
and service integration”
Edwin Mkwama (BSc. N, MSc. Epidem.)
MNCH/HIV integration stakeholders’ Annual meeting
Giraffe Hotel, DSM 24th -25th September, 2014
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Presentation Outline
• Background of HQA
• Integration definition
• Policy environment on integration
• Benefits of integration
• Frameworks of integration of health services
• Role of HQAD in integration of health services
• Challenges of integration
• Way forward
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Background of HQA (1/2)
• Provision of Quality Health Care is one of the
top Priority in the National Health Policy
• Ministry established Health Services
Inspectorate Unit ( HSIU) in 1998.
• HQAD was established in 2012 (and HSIU
promoted to be one of the four sections)
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Background of HQA (2/2)
• Realizing MNCH and HIV are areas of concern;
the Directorate oversees all issues related to
quality of health services
• It encourages services integration where/when
the client is point of interest
• It encourages Coordinated services integration
to ensure quality is highly appreciated as well
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Integration definition (1/2)
• “The organization and management of
health services so that people get the care
they need, when they need it, in ways that
are user friendly, achieve the desired
results and provide value for
money.”(WHO, 2008)
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Integration definition (2/2)
• Two main types of integration (MoH, 2003):
• Horizontal integration means “fusion” of care, as
much as possible when the user is reached.
• Vertical integration means assuring the
indispensable linkage between the different
levels of care, from the national level to the
community and individual through the district
level.
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Policy environment on integration
• National Health Policy 2007
• TQIF second edition (2011-2016)
• Enhancing integration, sustainability and equity in
health care
• National Health and Social Welfare Quality
Improvement Strategic Plan (2013-2018)
• Integrated supportive supervision and mentoring
guidelines and tools
• Integrated QI implementation guidelines and
harmonized tools
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Benefits of
integration
• Integrating services,
strategies and plans can
improve not only equity,
access and coverage, but
may also enhance the
quality and efficiency of
care.
• Services can be costeffective,
• E.g. experience from
Northern Tanzania by
Evjen-Olsen et al., (2009)
• Limited health resources
available can be used as
efficiently as possible.
• Clients receive more
comprehensive services
for overlapping health
needs.
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Frameworks of integration of
health services (1/2)
Four core elements emphasized:
• CLIENT CENTRED SERVICES
• At facility and community level
• HEALTH OPERATIONS
• Planning at organization or agency level
• HEALTH SYSTEM
• Coordination at national level
• INTERSECTORAL INITIATIVES
• Across development sectors
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(Source: PATH 2011)
Frameworks of integration of
health services (2/2)
Elements to consider for successful integration:
• Planning and
• Logistics
budgeting
• Community
• Organization of
outreach
health services
• Referral services
• Staffing
• Monitoring,
• Training
evaluation, and
research
• Supervision
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Role of HQAD in integration of health
services
• Prepare and coordinate implementation of the
integration of health services guidelines;
• Coordinate and conduct joint health services
inspection and supportive supervision to
RHMTs/CHMTs;
• Monitor and evaluate implementation of joint
health services inspection and supportive
supervision;
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Challenges of Integration
• Funding for reproductive health services often
comes separately from funding for HIV
services.
• Health care workers need training in multiple
disciplines.
• Perceived loss of autonomy
• Lack of agreement as to who is in charge
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Way forward
• Ministry will review the Strategic Plan for
Integration of health services draft -2003
• Integration will be one the common agenda in
the TWG-Quality
• Generate evidence base of value and extent of
integration of various health interventions
• Need to take advantage of existing frameworks for
analysis of integration of health interventions in
health systems
• e.g. Atun et al., 2010 conceptual framework
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REFERENCES
• Atun, R., Jongh, T., Secci, F., Ohiri, K. and Adeyi, O. (2010). Integration of
targeted health interventions into health systems: a conceptual
framework for analysis. Health Policy and Planning 25:104–111
• Olsen, B. E., Olsen, Ø. E. and Kvåle, G. (2009). Achieving progress in
maternal and neonatal health through integrated and comprehensive
healthcare services – experiences from a programme in northern
Tanzania. International Journal for Equity in Health 8:27
• PATH (2009). PATH’s framework for health services integration
• URT-MoH (2003). Strategic Plan For Integration Of Health Services In
Tanzania Final Draft
• World Health Organization (2008). Integrated Health Services: What and
Why. Geneva: WHO Technical Brief No. 1.
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