Transcript Country Team Action Plan

Country Team Action Plan
Yemen
Second Draft
Tracks 1 & 2
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1. Where are we now?
1. Accomplishment/Progress
since Bangkok 2007
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5 BP started in 7 governorate (out of 23)
Protocols developed and adopted
Improvement Collaborative set up and replicated
Service Providers’ training is on going
Three new Best Practices were added
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1. Where are we now?
1. Accomplishment/Progress
since Bangkok 2007
• Best Practices integrated in the pre-service
Community Midwives curriculum
• Best practices integrated in the in-service training
• Linked with quality improvement efforts
• Facilitated logistics improvements
• Facilitated MIS
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1. Where are we now?
1. Accomplishment/Progress
since Bangkok 2007
• About 500 service providers trained (25 trainers and
12 for Newborn resuscitation)..
• Scaling-up is now part of MOPHP Plan
• MOPHP and development partners within RHTG
established subgroup for quality and best practices
• Other donors now supporting scale up in new
governorates
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1. Where are we now?
2. Challenges since 2007
• Shortage of personnel (especially female) for 24
hour shifts
• Extremely short hospital stay after normal
deliveries; maximum two hours
• Providers not convinced that delivery is a good time
to talk about Family Planning
• Stock outs (Vit A, vaccines, IC supplies)
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1. Where are we now?
2. Challenges since 2007
• Poor motivation
• weakness in the documentation and monitoring
• Weak coordination between management and service
providers
• Men’s involvement in RH/FP is not cultural norm
and not considered in service set up
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2. Where do we want to be?
1. Desired levels of accomplishment
• Scale up of the 8 Best Practices (BPs) to 5 Health
Centers per year in the governorates where the best
practices have already started
• Scale up the BPs to at least 3 health facilities
including the main governorate hospital in each of
the remaining 16 governorates
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2. Where do we want to be?
2. Country Team Goal
• To strengthen services in the
implementation of the 8 BPs in the
current program sites.
• To scale up the 8 best practices nation
wide to reduce maternal and newborn
mortality and morbidity
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2. Where do we want to be?
3. Best Practice Chosen for Scale-Up and
Its Components
The 8 best practices to be strengthened
and scaled up in targeted health
facilities in 23 governorates
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3. What are the gaps?
1. List gap between current status and
desired levels of accomplishment
• In the 7 governorates, where the BPs started,
implementation is still localized in the main
governorate hospitals and the desire is to spread to
at least 5 health facilities each year.
• In 16 governorates BP activities have not been yet
started and the desire is to have at least 3 health
facilities including the main governorate hospital
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3. What are the gaps?
2. List reasons for the gap
• Limited Resources (financial & human)
• Limited leadership capacity.
• Absence of the BPs in the service delivery system of
the health facilities
• Shortage of staff, particularly the female staff.
• Weakness in supervision and monitoring system
• Poor staff motivation
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4. What interventions
can we use to close the gap?
1. List best practices and key
interventions that can close the gap
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Immediate and Exclusive Breast Feeding
Neonatal Infection Prevention
Vitamin A for Women After Delivery
PP/PA Family Planning/HTSP
KMC for LBW infants
PPH managment/AMTSL
Neonatal Resuscitation
Immunization of newborn
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4. What interventions
can we use to close the gap?
2. Describe how the interventions will address
the gap
• Scaling up the BPs to at least 5 five health facilities
in each of the 7 current governorates where the BPs
have been established to ensure more coverage.
• Scaling up the BP to at least 3 health facilities
including the main governorate hospital in each of
the remaining 16 governorates, will help scaling up
in the future to the rest of the facilities in these
governorates
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4. What interventions
can we use to close the gap?
3. List activities to carry out the interventions
• Resource mobilization
• Increase the number of Improvement Collaboratives
teams
• Training of public and private health staff
• Involvement of the health offices and hospital
directors in the process of BPs planning,
implementation & evaluation.
• Mainstream implementation of BP in the service
delivery system.
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5. What are the possible challenges to
the intervention?
• Limited financial and human resources
• Shortage of personnel (especially female) for
24 hour shifts
• Extremely short hospital stay after normal
deliveries; maximum two hours
• Providers not convinced that delivery is a
good time to talk about Family Planning
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5. What are the possible challenges to
the intervention?
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Stock outs (Vit A, vaccines, IC supplies)
Weak supervision & monitoring system
Poor motivation
weakness in the documentation and
monitoring
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6. Who are the possible partners,
allies, and stakeholders?
• MoPHP:
- Governorates health offices
-Hospitals, Health centers
• Universities and health institutes
• Other government institutions:
-Ministry of information
- Ministry of endowment
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6. Who are the possible partners,
allies, and stakeholders?
- Ministry of local Authority
- Ministry of civil services
• Developmental partners (Donors, Social Fund
for Developments,…)
• Private sectors
• NGOs ( e.g. NESMA,YMA,…..)
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7. What are the modifications needed
to improve the intervention’s
scalability?
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Mesopristol( facilities-community)
Partograph
Magnisum sulphate
Post abortion management
Infant Nutrition
Establish recognition mechanism for the best
performance health facility
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8. Who will be involved
in scaling-up?
1. List of organization (s) responsible
for scaling-up
• Mainly MoPHP
-Governorate Health Offices and health facilities
with the support of interested donor organizations
• Private health facilities under the guidance of the
MoPHP and it’s health offices
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2. Capacity of the organization to scale up &
implications this has for scaling up
• It has the standards and regulations
• It can assist in coordination among donors and
targeted health offices.
• Increase capacity of staff
• It has control over logistics
• It provides qualified staff through training
• Coordinates between services and education
• Supervise the quality of the training and services
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2. Capacity of the organization to scale up &
implications this has for scaling up
• Leadership
• Mainstreaming of BP in the health system
• Over all supervision and monitoring of the whole
process
• TOT of 20 on BP team,3 IC teams.
• BHS team
• Ready manuals and guidelines for the training and
implementation.
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3. Who will be part of the team to
support the process of scaling- up
• Director of health offices and RH directors
• Director of the health facility involved in the scaleup
• IC Team
• Logistics
• Health information system, statistics
• Supervisor, coach
• Donor representative
• Representative of the expert health facility
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4. What needs to be done to ensure that
the team is large enough and has the
resources to support scale-up?
• More training for the team involved in scale up.
• More support to the interventions of the best
practices.
• More establishment of IC teams
• Translate the commitment to action
• Follow up and support the process of scale up
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9. What are the opportunities & constraints
for Scaling-up?
1. opportunities:
• Strong commitment of the MoPHP and health
offices.
• Willingness of interested health facilities for
scaling-up
• Willingness of developmental partners agencies to
support introduction and scaling-up
• Development efforts of RH services
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9-What are the opportunities &
constraints for Scaling-up?
1. opportunities:
• Availability of successful experiences in
implementation of best practices
• Well trained trainers
• 3 Improvement collaberatives teams
• Support and readiness of institutions like
endowment and information to advocate
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9. What are the opportunities &
constraints for Scaling-up?
2-Constraints
• Difficulties in changing behaviors of service
providers towards better performance in PP
counseling.
• weak supervision to improve performance
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9. What are the opportunities &
constraints for Scaling-up?
2-Constraints
• Low Leadership capacity at level of health
facility management staff
• Sustainability of logistics
• Shortage of female staff
• Rotation of staff trained in BP
• Poor monitoring and evaluation system
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10. What policy, regulatory, budgetary,
or other institutional steps are needed?
• Best practices are part of the
development efforts for the improvement
of RH/FP and MNH service delivery.
Therefore, policies, regulatory and
budgetary steps are already set.
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10. What policy, regulatory, budgetary,
or other institutional steps are needed?
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MDGs
National Health Strategy 2010-1025
National RH/FP strategy 2006-2010
Ministerial Decree of free family planning services
Republican and ministerial Decree of free of charge
delivery at public health facilities
• National standers of MNH services
• Update of job description of midwives
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11. Where, when and how will the best
practice be expanded?
• The expansion is to new geographic sites and to
more health facilities targeting more population .
• The scale up will be in about 2-3 years
• Dissemination of the PP to new areas of population
by learning the strengths and weakness if the
previous governorates
• Experiences of the Improvement Collaboratives
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12. What will be the costs of expansion
and how will needed resources be
mobilized?
• The cost is mainly for the training of staff in
different skills for implementation of BP.
• For IEC materials, meetings and supporting
visits
• Some of developmental partners are
committed to support by different levels
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13. How will the process, outcomes and
impacts be monitored?
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Through regular reporting
Quarterly IC meetings
Field visits
Monitoring of the indicators
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14. How will results be fed into
decision-making?
• Reporting of all reports to the governmental
institutions, donors and local authorities.
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15. What are our action steps?
Action Step
Responsible Person
Timeline
1.Meeting of the team
of Bangkok 2010with
the RHTG members
to share information
and more resource
mobilization
2.Proposals for
expansion in the
targeted governorates
for 2010
Population sector
RHTG coordinator
April 2010
Pop sector /Health
offices/ BHS team
April 2010
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15. What are our action steps?
Action Step
Responsible Person
3. Practical steps to
Bangkok team
solve the challenges of 2010/Pop sector
the implementation
/Health offices/ BHS
team
4..Opertinalized POA
Pop sector /Health
of the scale up of BP
offices/ BHS team
for 2010-2011
Timeline
April 2010
May 2010
6.
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