1. Stronger health systems. Greater health impact.
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater 1

2. HSS and its relation to L+M+G
1. HSS models
2. MSH approach to HSS
3. Contributions of L+M+G to building blocks
4. Measuring HSS
5. Experiences from the Field improving L+M+G
practices and their effects on performance and
health outcomes
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 2

3. HSS Models
• Forty-one HSS conceptual frameworks
• Great variety of ways in which health systems
are understood
• Large number of conceptual issues for which
greater research and deliberation is necessary
• Continued need for diversity in health systems
• Context specific, opportunities for health
systems research
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 3

5. Aim of HSS Models
Health Outcomes Health Goals
 Coverage
 Access &
 Health status
Availability
 Responsiveness
 Quality
 Fairness in
 Demand
financing
 Safety
 Efficiency
 Enabling social &
policy environment
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 5

6. The WHO Health Systems Framework
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 6

7. Six Steps to Achieving Greater Health
Impact
Step 6. Select the most appropriate
M&E indicators.
Step 5. Identify the critical health systems
interventions that address bottlenecks.
Step 4. Determine health systems requirements and
bottlenecks to achieve coverage levels.
Step 3. Identify and select high impact interventions.
Step 2. Identify the health challenges, their causes and risk factors.
Step 1. Identify the health outcome or impact goal.
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 7

8. MSH HSS Results Model
Step 4
Step 1
Step 2
Step 3 Step 5
Step 6
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 8

9. Contribution of L+M+G to HSS
Building Blocks
Building Evidence of an Effective Health How L+M+G support performance
Block System Building Block and effectiveness
Human • A well-performing workforce • Development of HRH policies
Resources achieves positive health and procedures
for Health outcomes given available
resources and circumstances • Support the implementation of
HRH policies and procedures at
• There are sufficient staff that are various levels of the system
appropriately distributed who are
competent, supported, motivated • A HRMIS supports and informs
and productive HRH management decision-
making
• Build leadership and
management capacity to
motivate providers and
managers to perform and/or
excel standards
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 9

10. Contribution of L+M+G to HSS
Building Blocks (cont.)
Building Evidence of an Effective Health How L+M+G support performance
Block System Building Block and effectiveness
Health • The system facilitates the • Develop in-country capacity to
Info. production, analysis, strengthen the HIS
System dissemination of reliable and
timely information on health • Leaders and managers use
determinants, coverage, system health data and information for
performance and health status performance assessment and
improvement at various levels
• Healthcare managers and
providers use the information to • Information and M&E practices
make informed management facilitate effective problem-
decisions solving, informed decision
making and policy formulation
• Information about health
systems performance is made
available to the public
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 10

11. Measuring HSS
IHP+
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 11

12. HSS and Measurement Implications
• Implementation processes and outcomes
• Three major technical areas to develop better
ways to measure success:
• Leadership practices
• Management systems
• Effective governance models for health
• Systems thinking approach
• Health systems research – OR studies
• National and sub-national levels
• Decentralized vs. centralized health systems
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 12

13. LMG Project and HSS Research
• Four country-specific OR studies
• Solving implementation challenges through L+M+G to
address health systems bottlenecks
• Two cross-cutting OR studies
• Contribution of gender equality, country ownership, and
sustainability through HSS to improve performance and
achieve health outcomes
• Country-driven applied research
• Aligning with country priorities to address systemic
bottlenecks
• Focus on local-capacity development
• Developing in-country capacity for M&E and applied
research in health systems
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 13

14. LMG Project and HSS Research (cont.)
• Reviewing and developing performance indicators for
L+M+G
• Within MSH: existing portfolio of leadership and
management projects
• Outside MSH: collaboration with CAs and other
international agencies
• First LMG OR Study: Ethiopia Human Resources for
Health
• Addressing competency gaps and improving performance
of Ethiopia health workforce at national and regional levels
• Other areas for developing evidence of effect of L+M+G:
• Gender equality
• Country ownership and transition processes
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 14

15. A Field Experience from ProACT
Nigeria
Strengthening
Facility Health Management Information System (HMIS)
for ownership and sustainability
Uche Ikenyei
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 15

16. ProACT: Strengthening HMIS
Uche Ikenyei
The Project
ProACT has site presence in 6 of Nigeria's 36 states supporting 28 CCT and 46 feeder
sites.
ProACT’s strategy focuses on strengthening health systems for improved service
delivery, ownership and sustainability
HMIS system strengthening: our Intervention
1. Strengthening the use of the national facility based data documentation tools in all
ProACT supported sites rather than having partner specific parallel reporting tools
2. Strengthening data documentation in all facilities and reporting from all CCTs and
feeder sites to the State Action Committee on AIDS (SACA) offices.
3. Conducting joint participatory Data Quality Audits (DQAs) where the participants
include M&E Officers from the SACAs, the HODs for the medical records units and
MSH M&E Teams
4. Integrating the HIV medical records units into the main medical records unit to
promote ownership and improve service delivery
5. Strengthening data use for health-related informed decision making
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 16

17. ProACT: Results
Uche Ikenyei
• 100% of all MSH supported facilities align with the national data
documentation and reporting tools while 5% of all Patient
management and Monitoring (PMM) tools were designed to meet
the data gaps that the national tools could not capture
• 100% of our comprehensive care and treatment sites now
consistently report data with the national reporting forms to their
respective State Action Committee on AIDS. This is notable where
no facilities were reporting prior to ProACT intervention
Overview of GH Jega (Kebbi State)
Medical records Library after
• Data quality in randomly selected sites improved from 58% to 68% integration
in six months with Niger state improving from 55% to 80% within
the same period
• None of the 26 CCT sites had an integrated medical records unit
pre ProACT intervention. Currently, 68% (17 sites) have fully
integrated HMIS with the overall hospital medical records
departments. This has contributed in increasing 12 months cohort
HIV client retention from 47% (2009) to 62% (2010)
• Data use to drive decision making is still nascent with currently Facility Data Presentation during the
Quarterly Management Team
only 5 of 26 (19%) CCT sites having started using data to make meeting (QMT) – GH Jega & GH
management decisions KoKo Kebbi State
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 17

18. A Field Experience from PLAN-Health
Nigeria
Leadership Development Program
and
Increase in PMTCT Uptake
Dr. Lami Samaila
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 18

19. PLAN-Health: Leadership Development
Dr. Lami Samaila
• An adapted Leadership Development Program (LDP)
was organized for several organizations working in the
same state
• One shared vision was developed for the state with each
organization creating a measurable result based on their
organizations mandate
• Seven Local AIDS Control Agencies chose to ―Increase
by 25% uptake of PMTCT services by pregnant women
by May 2011‖ as their measurable result
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 19

20. PLAN-Health: Results
Dr. Lami Samaila
PMTCT Uptake
PMTCT Uptake (2010) % Increase
(2011)
PHCs with other
4,670 6,128 31%
Implementing Partners
PHCs without
2,132 3,175 49%
Implementing Partners
All PHCs 6,802 9,303 37%
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 20

21. Increase in PMTCT Uptake
Results from a Leadership Development Program
MSH PLAN-Health Nigeria Dr. Lami Samaila
2,500
2,000
1,500
1,000
500
0
Abba Hashidu PHC Todi Tal PHC Mallam Kumo MPHC Kupto Ribadu Willi Ture
Maternity PHC Maternity Pantami Inna Town Barambu Maternity Maternity Maternity Balam
Clinic Clinic Maternity Maternity Clinic Clinic Clinic Maternity
Clinic Clinic
Pre-LDP (2010) PMTCT Uptake Post-LDP (2011) PMTCT Uptake
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 21

22. LGA Primary Health Care Facility PMTCT Uptake (2010) PMTCT Uptake (2011) % Increase Presence of other
PEPFAR
Implementing
Partners
Dukku Abba Maternity Clinic 213 346 62% None
Dukku Hashidu PHC 417 774 86% FHI 360
Billiri PHC Todi 404 535 32% FHI 360
Billiri Tal Maternity Clinic 801 845 5% ICAP
Gombe PHC Pantami 1,335 2,051 54% ICAP
Gombe Mallam Inna Maternity Clinic 79 247 213% None
Akko Kumo Town Maternity 1,713 1,923 12% FHI 360
Akko MPHC Barambu 528 715 35% None
Funa-Kaye Kupto Maternity Clinic 317 630 99% None
Funa-Kaye Ribadu Maternity Clinic 776 904 16% None
Kaltungo Willi Maternity Clinic 81 99 22% None
Kaltungo Ture Balam Maternity Clinic 138 234 70% None
All 6 LGA’s All 12 Facilities 6,802 9,303 37%
Dr. Lami Samaila
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 22

23. A Field Experience from K4H
Malawi
A Demonstration Project to Address Gaps
in FP/RH and HIV/AIDS Information Pathway
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 23

24. K4H: Addressing gaps in FP/RH and
HIV/AIDS information pathway
Four interventions were selected to improve KM at the National, District &
Community levels:
1. Leadership Development Program (LDP). An adapted LDP for knowledge
management mobilized stakeholders around creating a common vision and
action plan with desired measurable results for improving knowledge
management.
2. FP/RH and HIV/AIDS Toolkits. Toolkits are designed to be a central online
data bank housing current country specific information on FP/RH and
HIV/AIDS.
3. District Learning Centers (DLCs). DLCs were imbedded in district
hospitals and serve as central hubs of information for district and community
level health providers.
4. SMS Network. SMS intervention uses Frontline SMS (FLSMS) to provide
nurses, doctors and Community Health Workers (i.e. Community Based
Distribution Agents and Health Surveillance Agents) with immediate access
to up to date, relevant health information.
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 24

25. K4H: Results
1. Increased efficiency of referrals because CHWs could send
messages to district hospital or clinics to ensure services were
available before making referrals.
2. Widened service coverage due to more time available because
CHWs are no longer biking to meet with supervisors or reporting
stock-outs, and so spend more time in community.
3. Prompt responses to cholera, meningitis and measles outbreaks.
4. Detection and prevention of stock-outs (i.e. averted stock-outs of
DEPO, male and female condoms). When CHWs run out of
supplies, they now send an SMS and are often resupplied on the
same day, whereas in the past it could take up to one week.
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 25

26. Discussion / Questions
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 26

27. Upcoming LMG Webinars
Date Topic Presenter
June 6 Partnerships Albena Godlove
June 20 Monitoring, Evaluation, and La Rue Seims
Research
in LMG
June 27 Governing for Better Health Mahesh Shukla
All LMG webinars are scheduled from 9:00 am to 10:0 am (U.S. Eastern Time)
and are delivered via Elluminate over the Internet
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater Health Impact 27

28. Stronger health systems. Greater health impact.
Saving lives and improving the health
of the world’s poorest and most vulnerable people
by closing the gap between knowledge and action in public
health.
Management Sciences for Health — 40 years of Strengthening Health Systems for Greater 28