MAISHA: Mothers and Infants, Safe Healthy Alive

1. MAISHA: Mothers and Infants, Safe Healthy Alive Dr Muthoni Magu-Kariuki Jhpiego Mbeya Region Advocacy Meeting 13-14 JuLY 2011

2. Presentation Outline • Jhpiego • Background – MAISHA Program • Program Objectives • Program Strategies • MAISHA Program Model • SBM-R and QI • Program geographic rollout • Planned program activities • Challenges and Lessons Learnt

3. Jhpiego An affiliate of Johns Hopkins University A nonprofit organization primarily funded through USAID, international donors and private foundations Currently working in more than 50 countries with about 500 USA and host country staff 3

4. Jhpiego’s Work What do we do? Strengthen the performance of health workers and health systemsto provide quality health care services for women and families How do we do it? Build service delivery and health workforce capacitythrough global and local partnerships Working with doctors, midwives, nurses and health educators Performance and quality improvement and human resources for health Translating research  practice 4

5. Jhpiego’s Global Presence

6. MAISHA Program Background • Associate award with funding from USAID • 5 year program: Oct 2008 to Sept 2013 • Implemented in partnership with: • Ministry of Health and Social Welfare : RCHS, NMCP, NACP, HSIU, HRDD including ZTCs. • Local Government: Regional and Districts levels • Save the Children, IMA World Health, Futures Group (White Ribbon Alliance) and TCCP (Tanzania Capacity and Communication Project)

7. MAISHA Partners’ Roles • MOHSW: Policy formulation and guidance • Save the Children: Kangaroo Mother Care • IMA World Health: working with FBO • Futures Group (White Ribbon Alliance) : Advocacy at all levels • T-MARC: Communication and demand creation (for the first 2 years) • TCCP Tanzania Capacity and Communication Project (IEC development) • Jhpiego: Capacity building in FANC, BEmONC, IP and QI

8. Project Objectives • Reduce maternal mortality due to major direct causes of mortality • Reduce newborn mortality due to infection, hypothermia and asphyxia through immediate newborn care • Reduce low-birth weight, stillbirth and newborn mortality due to malaria and congenital syphilis • Reduce transmission of HIV infection from mother to child and increase HIV-free survival

9. Program Strategies • Improve policy environment for FANC, basic emergency obstetric and newborn care (BEmONC), kangaroo mother care (KMC) and PMTCT through advocacy • Improve skills of providers for FANC, BEmONC, KMC and PMTCT through inservice and preservice training, supervision and quality improvement • Improve availability of equipment and supplies for FANC, BEmONC, KMC and PMTCT • Increase demand for quality services through behaviour change communication and community mobilization

10. Implementation • Visit to region to introduce MAISHA support to RHMT • Identification of facilities to be strengthened • Assessment of facilities • Advocacy meeting to share results and discuss program with all regional stakeholders • Site strengthening – training (BEmONC, FANC, supervision), equipment/ supplies, QI efforts • Monitoring

11. MAISHA Program Model • Strengthen the regional hospital as a BEmONC training site in each region, to also provide KMC • Strengthen 2-3 health centers/dispensaries per district for BEmONC/FANC service delivery • Training • Equipment and supplies • Quality improvement (standards-based management and recognition (SBM-R), facilitative supervision) • Develop regional BEmONC mentors from pool of trained providers

12. QI model for MAISHA (1) • Facility-based (regional hospitals) • “Classic” standards-based management and recognition (SBM-R) – series of modular trainings and meetings • Facility-based (health centers and dispensaries) • Performance standards, introduced during FANC and BEmONC service provider training • Baseline and follow-up assessments • External verification visits • Recognition by MoHSW

13. QI model for MAISHA (2) • Facilitative supervision • Based on use of standards • Training of regional RCH coordinators, district RCH coordinators and district nursing officers in facilitative supervision skills (including use of standards, recording/reporting, coaching, etc.) • Support for supervision visits in each region to the MAISHA-targeted sites

14. M&E under MAISHA • Sentinel sites (quarterly visits) – currently up to 40 sites nationwide. In Mbeya the facility is Itumba Hospital (Ileje) • In future sentinel will be the MAISHA selected facilities • Facility-level QI data • Clinical observations in order to capture those MNH and ENC indicators that MTUHA does not capture, (twice over LOP) • Training Information Management System (TIMS)

15. Program geographic rollout (BEmONC) • Year 1 – developing resources to support program implementation (guidelines, curricula, trainers) and necessary advocacy work; commencement of program in Lindi, Mtwara and Zanzibar • Year 2 – expansion to Arusha, Iringa, Kigoma, Kilimanjaro, Morogoro, Manyara, Pwani, Ruvuma, Tabora • Year 3 – expansion to Dar es Salaam, Mbeya, Rukwa, Shinyanga, Tanga • Year 4 - expansion to Dodoma, Kagera, Mara, Mwanza, Singida • Year 5 – continued support to all regions

16. Broad Plans for Year 3 – FANC/BEmONC • Activities for all regions: • BEmONC site strengthening and supervision • FANC provider training, and follow-up of FANC trainers • Collaboration with regional PMTCT partners for scale up of BEmONC, FANC, PNC and CECAP efforts

17. Human resource shortages, lack of appropriately skilled providers at lower level facilities Recordkeeping (current registers, high volumes, staff shortages) Inability of national HMIS to capture and report data for regular monitoring of program progress and effectiveness CHALLENGES

18. CHALLENGES cont… • Weak Health system: Poor infrastructure, inconsistent supply of necessary equipment, supplies and drugs; poor referral, transport • Delay in/continued ANC attendance • Inadequate community involvement • Inadequate supportive supervision • Ensuring quality during a relatively rapid expansion/scale up effort

19. LESSONS LEARNT • Importance of advocacy at all levels • Capacity building through cascade approach • Training is not the only answer – quality improvement efforts are key (wider systemic issues affecting equipment, supplies and transport that training in itself cannot address)

20. LESSONS LEARNT cont… • Importance of effective/efficient systems for monitoring program progress • Visibility of leveraging resources to address broader BEmONC and ANC package • Partnerships

21. Ahsanteni sana….