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DISTRICT AND PROVINCIAL HEALTH SYSTEM CAPACITY

WORKING GROUP UPDATE

Janna BrooksHIV Care and Treatment Branch

Global AIDS ProgramU.S. Centers for Disease Control and Prevention

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Background

Project started as result of findings from Track 1.0 M&E meeting in November 2009

Many existing tools and frameworks for assessing capacity of ART sites and local partners’ organizational capacity

Lack of existing analytical approaches for provincial and district health systems capacity to sustainably plan, organize and support delivery of HIV services

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ConsensusCore Capacity Domains

Strategic Planning for Integrated HIV Services Stakeholder Management and Coordination Human Resource Management for Clinical

Services Financial Management of Funding for HIV Services Supervision of Clinical Services HMIS, M&E Systems Pharmacy Supply/Logistics Renovation/Maintenance/Equipment Laboratory Services Support Quality Management/Improvement Systems Community Linkages

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Literature Review Findings

Predominant conceptual framework is WHO Health System Building Blocks

Existing approaches focus on health facility or national health system performance

Lack of operationalization of WHO concepts at provincial and district capacity levels

Validation of core domains, identification of gaps

Review of assessment methodologies Annotated bibliography of sources reviewed

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Core Domains and WHO Building Blocks

WHO Building Blocks Provincial/District Capacity AreasGovernance

Health Workforce

Health Information System

Medical Products

Health Financing

Service Delivery

Community(Proposed 7th building block)

Strategic Planning for Integrated HIV Services Stakeholder Management and Coordination

Human Resource Management for Clinical Services Supervision of Clinical Services

HMIS, M&E Systems

Pharmacy Supply/Logistics

Financial Management of Funding for HIV services

HF Renovation/Maintenance/Equipment Laboratory Services Support Quality Management/Improvement Systems Integration of Service delivery

Community Linkages

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Objectives of the Provincial/District Capacity Assessment

Identify strengths and weaknesses in organizational structures, managerial processes, and provision of support for HIV services

Provide evidence for better planning and implementation of health systems capacity-building support to provincial/district health teams

Measure baseline assessment of capacity & performance, and to measure improvements as a result of support

Can be used flexibly—from structured discussions to formal capacity assessments

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Capacity and Performance

Capacity = ability of an organization to implement its mandated activities

Performance = how effectively the organization actually implements its activities and achieves it objectives

Relationship of capacity to performance is not simple

Interdependent, but multidimensional and non-linear relationship

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Capacity & Performance Measures

Capacity rating for the province or district for each of the capacity domains through checklists for compliance interviews with the DHO, verified by supporting documentation; the scoring is determined according to decision rules for each

capacity area (i.e. whether a minimum threshold level is reached) Performance rating based on key performance

indicators for each of the capacity areas quantifiable data from district health management information

system records performance scores = good (>80%), fair (50% -80 %), poor (< 50%)

Validation of ratings – random sample of facility level

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Health WorkforceCountry:Region:District: Label

Number of facilities overseen by district: D.Nfac

Number of facilities providing HIV/AIDS services:

Capacity Area Label QuestionVerbal

ResponseDocument

Review Performance IndicatorValue Quant Label

HR D.HR1 Do you have a listing of all sanctioned clinical positions in your district?

Number of sanctioned clinical positions in district: D.HRq1

COMMENT

HR D.HR2 Is there a listing of filled clinical positions?

Number of filled clinical positions in district: D.HRq2

COMMENT

HR D.HR3 Has the listing of filled clinical positions been updated within the last 12 months?

COMMENT

HR D.HR4 Do you have a training plan for district staff in HIV/AIDS prevention, care and treatment which details in-service trainings to upgrade staff skills and knowledge in HIV/AIDS?

Total number of HIV/AIDS trainings planned for the past 12 months: D.HRq3

COMMENT

Total number of planned HIV/AIDS trainings conducted in the past 12 months: D.HRq4

HR D.HR5 Do you have a listing of personnel trained ( such as through * refresher training; * on-the-job training; or * workshops on technical updates) in your district in HIV/AIDS prevention, care and treatment in the last two years?

Number of personnel trained (initial or refresher training) in HIV/AIDS prevention, care and treatment in the last two years: D.HRq5

COMMENT

Rapid District Assessment – District Office data collection form

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Does Capacity Lead to Performance?

Low CapacityHigh Performance

Why?

High CapacityHigh Performance

Low CapacityLow Performance

High CapacityLow Performance

Why?

Capacity

Perf

orm

ance

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Analysis and ResultsGovernance/ Leadership

Health Workforce

HMIS Pharmacy Finance Service Delivery

Community

Capacity Perform Capacity Perform Capacity Perform Capacity Perform Capacity Perform Capacity Perform Capacity Perform

District 1Good Fair Poor

District 2

District 3

District 4

District 5

District 6

District 7

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Limitations vs. Benefits of Approach

Limitations Offers only a rapid check on a limited number of

capacity and performance areas Does not provide a comprehensive assessment of

capacity or performance Not yet validated in field implementationBenefits Ease of implementation; consistent systemic approach Lean methodology — quickly focus effort on areas that

need in-depth analysis and support Comparable assessment approach across domains

and/or health system units

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Next Steps

Feedback process of first draft

Field test/validation

Development of User Manual

Development of In-depth discussion guide in each technical area for follow-up actions

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INTERESTED?Contact:

Janna Brooks zir7@cdc.govJosef Amann jua6@cdc.gov

Acknowledgments…Jennifer Yourkavitch Eric Sarriot, Leo Ryan, Lela Baughman, Rozalin Wise , Joe Barker, Laura Porter, Nancy Fitch , Tshiwela Neluheni, Pat Bass, John Donahue, Kristen Stafford, Charity

Alfredo, Jackie Sallot, Philippe Chiliade, Kjersti Schmitz , Angeli Achrekar, Jaime Butler-Dawson, Lanette Burrows, Ilona Varallyay