CORE Global Health Practitioner Conference, Fall 2014

1. Integrated Systems Strengthening (ISS)
Minal Rahimtoola, MPH
Joseph Petraglia, Ph.D

2. WHY INTEGRATED SYSTEMS STRENGTHENING?
•Pathfinder International recognizes that health services cannot be strengthened in isolation of the community needs.
•The Integrated Systems Strengthening (ISS) approach focuses on influencing how public and private sector health systems and communities work together to improve sexual and reproductive health outcomes.
•The ISS puts community and health systems interaction – which happens within what we call the “zone of interaction” - at the nexus of systems strengthening

3. ISS APPROACH
Formal Health
System
Formal and Informal Community
System
Zone of
Interaction

4. OUR APPROACH
The integrated systems strengthening (ISS) approach supports the development of an informed, competent and engaged group of stakeholders within the “zone of interaction”, where health systems and community intersect. This interaction is grounded on principles of rights based programming, quality of service delivery and treatment of health users, and meaningful engagement of communities in decisions about their health.

5. WHO DO WE WORK WITH IN THE ZONE?
•Community actors
–Hard to reach populations
–Population subgroups
•Adolescents, men and women, boys and girls
•People with disabilities
–Community leaders
–Religious leaders
–Community based organizations
–Non governmental organizations
–Advocacy groups
•Health systems actors
–Public health sector stakeholders at the national, regional and district levels
–Private health sector stakeholders
–NGOs delivering health services
–Private practitioners
–Community health workers

6. PATHFINDER’S CLINICAL AND COMMUNITY ACTION TO ADDRESS MATERNAL AND NEWBORN HEALTH (CCA- MNH) MODEL
•Pathfinder’s CCA-MNH model involves working closely with the health system and community to ensure that a whole package of interventions that address post partum hemorrhage (PPH) are ready for action when the need arises.
•The model creates strong community-facility linkages along the continuum of care that are the result of an integrated approach to systems strengthening.

7. PATHFINDER’S CLINICAL AND COMMUNITY ACTION TO ADDRESS MATERNAL AND NEWBORN HEALTH (CCA-MNH) MODEL

8. COMMUNITY SCORECARDS ARE ONE WAY OF ENSURING THAT COMMUNITY MEMBERS ARE OFFERED THE CHANCE TO ENGAGE MEANINGFULLY IN ASSESSMENT OF CLINIC PERFORMANCE.

9. NHSDP IN BANGLADESH
•From Pathfinder’s implementation science perspective our ISS frequently faces significant real-world barriers which are important to acknowledge.
•A project in Bangladesh (The NGO Health Service Delivery Program– or NHSDP) :
Supports the delivery--through a network of NGOs--of an essential service package of primary health care
Serves over 22.2 million people, (14%) of total population.
Complements GOB’s efforts to reaching poor and underserved with quality services at an affordable or no fees.
•NHSDP is one in which nicely illustrates the kinds of challenges we and other implementers face in bringing the C into HSS.

10. COMPLEX COMMUNITY BENEFICIARIES
NHSDP Beneficiary
Poor
Community
Indigenous Population
Elderly peoples
Youth
High risk population
Eligible Couple
Adult Male
Adolescent boys & Girls
Under 5 Child
Physically Challenged

11. COMPLEX STAKEHOLDERS
NHSDP Stakeholders
Development Partners: USAID, DFID, Chevron
USAID Funded NGOs
GOB:
MOHFW, MOHT, MOLGRD, MOWCA, Public Reps
Local NGOs
Local Influential
CSR Organizations
Private Organizations
Civil Society Organizations
Partner Consortium Members
Community People
Non-USAID payable Customers
Right Based Organizations
NHSDP & NGOs, NMC Staffs, CSPs

12. CHALLENGES TO COMMUNITY ENGAGEMENT IN SYSTEMS STRENGTHENING
•Heterogeneity of the community. Urban/rural, “poorest of the poor” vs. low income, etc. Competing agendas and, of course, huge power differentials within communities.
•Government-supported “Community agents” often illiterate and uneducated in comparison to NGO Service Promoters. Creates an impression that NGOs are marketing to the community instead of the community organizing to articulate their own needs.
•Very developed and stratified stakeholder landscape creates a very confusing Zone of Interaction from the perspective of the community member.
•Scale of the project makes dealing with informal community structures especially difficult, leading to an over-emphasis on formal structures which are frequently less impactful or able to contribute to normative change.
•Cultural barriers to community members collaborating with providers as equals.

13. twitter.com/PathfinderInt
facebook.com/PathfinderInternational
Youtube/user/PathfinderInt
Thank you
mrahimtoola@pathfinder.org
jpetraglia@pathfinder.org