High Impact Rapid Delivery approach for MDG4,5

1. High Impact Rapid Delivery approach for MDG4,5 Dr George Amofah Director Public Health Ghana Health Service

2. OUTLINE • Policy Context • Current Situation • Response (HIRD: principles, process) • Progress • Challenges • Way Forward

3. POLICY CONTEXT • Millenium SUMMIT IN 2000 • 147 world leaders agreed to a global compact to reverse poverty, hunger, illiteracy, environmental degradation, discrimination and disease • UN SPECIAL SESSION ON CHILDREN IN 2000 DREW ATTENTION TO URGENCY TO REDUCE CHILD HEALTH • AU ASSEMBLY THRO TRIPOLI DECLARATION TO ACCELERATE ACTION FOR CHILD SURVIVAL IN 2005 • PRIOROTIZATION OF CHILD SURVIVAL IN NEPAD • AFRICAN PEER REVIEW MECHANISM CALLS COUNTRIES TO MONITOR MDGS, ESP 4

4. Current situation • Under-five mortality rate as of 2003 (DHS) was 111 per 1000 live births. • Worsening indicators in Upper West, Northern, Central regions. Still high in Upper East though making progress. • No apparent change in maternal mortality • At current pace Ghana may not achieve MDGs • Calculated that we need to reduce mortality by 8.2% annually instead of current 0.6% in Africa if MDGs are to be achieved

5. Childhood mortality levels-2003

7. Current Situation-2 • Majority of deaths in children due to small number of common, preventable and treatable conditions • The paradox is that a set of cost-effective and affordable interventions (esp for MDG4,6) known and can prevent 63% of current childhood mortality • Sadly most of these interventions have been applied in only a few places with low coverage • For public health impact you need not less than 60% district wide coverage for most interventions

8. Phases of PH interventions in relation to coverage Maintenance 60 coverage Scaling up Initiation 20 0 Time period

9. Response (HIRD principles) • Urgent need to do things differently and do different things. • Complex factors involved therefore no single MDA can achieve goals hence need for multi-agency action working in partnership • A partnership for Achieving MDG4&5 using the High-Impact Rapid Delivery approach (HIRD) therefore proposed and initiated by MOH/GHS and all our partners in 2005 • Involves moving proven known cost-interventions to scale through fast track approach by multiple actors • Package of key interventions delivered in integrated manner as part of MTEF/Health development plans of regions/districts (cf Part of strategic RCH plan) • Aim at high district wide coverage over short timeframe • Use lessons drawn from other projects e.g ACSD and Wassa experience • Focus at community and household levels • USE OF LOCAL COMMUNITY STRUCTURES (CBAs, WOMEN’S SUPPORT GROUPS, NGOs, other MDAs etc) • Includes system wide strengthening and addressing larger socio-cultural and economic factors • Sources of funding: GOG, health fund, Global fund, GAVI, other earmarked funds, district assemblies etc • Regular systems for monitoring, review, support and evaluation

10. Process • Strategy was to Implement HIRD first in UWR, NR, UER and CR up to Dec 2006, then to remaining six regions in 2007 • Based on finding answers to the following district by district: • Where do we want to get to? Vision • Where are we now? Current situation • Why are we at current situation? Situation analysis using ‘but why’ approach • What do we want to do? Goal, objectives and targets • How do we get there? Strategies and key actions and activities • Where and when? • What resources do we need and from where?

11. PROGRESS SO FAR • Regional Planning workshops completed in all 4 regions from Dec 2005 to Feb 2006 • District specific plans developed and shared with partners (see excel planning templates) • Using plans as basis for implementation and support and funding by all stakeholders, including developmment partners • MOH/GHS accepted HIRD as basis for achieving MDG4&5 and reflecting same in priorities and budget, especially concerning commodity security • DANIDA funds to districts • JICA support to expand CHPS and provide basic equipment for all health facilities in UWR • UNFPA funding of aspects of RCH • UNICEF extending ACSD-like support to 3 northern regions • Church of Christ Latter Day Saints support to train hospital staff in neonatal resuscitation in the 4 regions • Child health promotion week in May 2006 • Nationwide mass Measles/polio/VAC/ITN campaign in November 2006 • Review in December 2006 in Tamale

12. Key Challenges • Late release of additional funds • Poor involvement of other MDAs at district • DHMTs not involving District hospitals • Tendency to projectise HIRD by managers • Funding for huge capital investment required esp for EOC/BOC for MDG5 • Weak M&E component so far

13. Way Forward • Extension of HIRD to six remaining regions (ASR, WR, ER by end of June 2007; BAR, VR and GAR by Dec 2007) based on lessons learnt so far • Consolidating gains made in 4 original regions • Strengthening M&E component • Ensuring that HIRD is integrated as part of District Health Development Plans • Improving inter-sectoral linkages and community based systems • Contract out certain interventions (esp community based) to others (MDAs, NGOs) with comparative strength • Begin investing in health systems esp EOC now esp for MDG5

14. Conclusion • HIRD is an attempt to scale up known priority cost-effective interventions for MDG4,5 in line with policy of ministry and international community while at same time ensuring strengthening of health systems to support interventions • Based on districts’ own defined strategies with enough flexibility for district managers to make a difference