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21 July 2014

Strengthening Mozambique’s District Health System to Improve Access and Quality of HIV Care and Treatment Services. 21 July 2014. Main Challenges. High HIV prevalence L ow ART coverage Scarcity and misallocation of resources Low managerial capacity at district level. Driving Question.

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21 July 2014

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  1. Strengthening Mozambique’s District Health System to Improve Access and Quality of HIV Care and Treatment Services 21 July 2014

  2. Main Challenges • High HIV prevalence • Low ART coverage • Scarcity and misallocation of resources • Low managerial capacity at district level

  3. Driving Question Can strengthening health systems improve access, quality and sustainability of HIV services?

  4. Health Systems and Clinical Services The plan…

  5. Health Systems and Clinical Services The reality…

  6. The Reality The plan… The Plan The reality…

  7. Intervention Response Graduation Path Strategy • District focused • District assessment tool (DAT) • Integrated technical assistance (TA) through Equipes Polivalentes • Support package (tutoring, subgrants, equipment, minor renovations, and emergency funds)

  8. Design & Implementation Process 1. Definition of Functions and Standards 7. Identification of Areas of Improvement 8. Action Plan 2. Development of Standards and Sub-Criteria 3. Development of assessment tool 9. Execution 4. Development of an scoring system 5. Training of staff and external evaluators 6. Self-Assessment (Base Line) 10. Follow up Assessments (Self or External)

  9. District HSS Assessment Framework Measurable Indicators Scoring System Follow up & Progress Monitoring

  10. District Health System Functions

  11. “Continuous QI is achieved by iterating through the cycle and consolidating achieved progress through standardization” (Johannes Vietze, 2013) Standards Continous Improvement Quality Improvement Standards Consolidation through Standardization Time

  12. Baseline vs. Post-Baseline

  13. Preliminary Findings • Baseline: • High variation across health system functions • Weaker areas: pharmacy supply & logistics, lab, health programs mngmt • Stronger areas: HIS, Planning systems and capacities • Insufficient systems to track problems and implement solutions • Post-Baseline • Highest improvement in weakest areas (pharmacy & health programs) • Strongest areas: HIS, planning, pharmacy & health programs

  14. Initial Lessons Learned • District assessments increased MoH staff awareness of management standards • Assessment-based action plans are effective tool for guiding quality improvement (PDSA cycle works!) • Action plans owned by districts and used to guide activities • Project staff support district health officers to implement action plans to improve results

  15. Driving Question Can strengthening health systems improve access, quality and sustainability of HIV services?

  16. Next Steps Intervention Start Date Project End Date Clinical Outcome Indicators • Quasi-experimental design to test hypothesis • Difference-in-difference approach • Regression-discontinuity design t1 t0 t2 t3 t4 t5 t6 Experimental Group: High HSS Experimental Group: Low HSS Comparison Group 2011-2012 12/13 06/14 12/14 06/15 12/15 06/16 Startofproject, Pre-Baseline Baseline, First measure Second measure End of project Experimental Group

  17. Acknowledgements

  18. Daniel D. Lee dlee@chasssmt.com OBRIGADO

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