1. Integrated service
components
Health Systems
Development
Interventions
Changes in service activities &
content: (e.g.. Kangaroo
mother, maternal health care,
improving access to preventive
health technologies etc)
Enabling
sub-system inputs…
• Train frontline workers to provide evidence-based maternal and neonatal
health services that are currently not being provided.
• Implement interventions that are proven to reduce under-five mortality
by increasing the capacity of providers at community, sub-district, and
district-level service points.
• Coordinate community and clinic-based activities to standardize access to
anti-malarial preventive measures and therapeutic regimes.
Health workforce
size, composition
& training
• Strengthen referral systems
to reduce maternal and
neonatal mortality.
Information for
decision-making
Essential drug supply
& logistics
Health financing and
planning
Leadership &
governance

2. Pillar #1: Strengthening of referral services
GEHIP services to be added as…a
…CHPS doorstep
Outreach
Level A
…Community
Health
Compound care
Level A
Sub-district referral
services
Level B
Pillar #1 Referral System Inputs:
Organization for emergency management:
 Community engaged training for
emergency recognition and response?
Yes=1, zero otherwise
 Community Health Officer resident and
trained for emergency management?
Yes=1, zero
otherwise
Yes=1, zero
otherwise
 Sub-district emergency response system
developed?
Yes=1, zero
otherwise
Yes=1, zero
otherwise
Communication systems for emergency management:
 Emergency obstetric & child care
referral system functional?
Yes=1, zero otherwise Yes=1, zero
otherwise
 Community recognition of emergencies
training completed?
Yes=1, zero otherwise
Logistics systems for emergency response:
 Community-based cost sharing for
emergency services functioning?
Yes=1, zero
otherwise
 Ambulance or equivalent available and
functioning?
Yes=1, zero
otherwise
Pillar #1 Referral System OUTPUTS:
• Referral case volume by type Continuous variables Continuous variables

3. Information for
decision-making
Essential drug supply
& logistics
Leadership &
governance
Health Systems
Development
Interventions
Health financing and
planning
Enabling
sub-system inputs…
Health workforce
size, composition
& training
Integrated service
components
Changes in workforce inputs
(investment in staff, staff
composition, and in-service
training on essential services
to address gaps in service
delivery)
A strategy of Pillar 2:
Retraining the frontline workers of the
Community-based Health Planning and
Services (CHPS) Initiative in doorstep service
delivery

4. Healthcare services Community service
capabilities
Level A
Sub-district clinical
capabilities
Level B
Pillar #2 INPUTS
Pillar #2: Promotion and prevention inputs:
• Post partum outreach and care: “Four visit
package” training completed for workers in
this area?
Yes=1, zero otherwise Yes=1, zero otherwise
• Post natal care for newborns (Promotion
of skin-to-skin contact, other
interventions) introduced?
Yes=1, zero otherwise Yes=1, zero otherwise
• Community Health Officer resident &
comprehensive reproductive health
services fully functioning?
Yes=1, zero otherwise
Pillar #2 Curative health service inputs:
• IMCI services fully functioning? Yes=1, zero otherwise Yes=1, zero otherwise
• Directly Observed Therapy, Short-course
(DOTS)fully functioning?
Yes=1, zero otherwise
Pillar #2 OUTPUTS
• HMIS case volume for IMCI treatable
illness/catchment area population
Continuous Continuous
• Kangaroo Mother Case volume/catchment
area population
Continuous Continuous
• HMIS caseloads for seven leading causes of
morbidity/population of catchment area.
Continuous variables Continuous variables
• HMIS immunizations by antigen Continuous variables Continuous variables

5. Pillar #3: Easing information capture for community-based healthcare
workers and providing supportive information feedback

6. Pillar #3: Strengthening Primary
Healthcare Management Information
Systems
GEHIP services to be added as…a
Community-based
capabilities
Level A
Sub-district clinic
capabilities
Level B
Input indicator:
 Simplified record keeping introduced and
functioning?
Yes=1, zero otherwise
Output indicators:
 Data feedback received in the past three
months?
Yes=1, zero otherwise Yes=1, zero otherwise
 Data used for decision-making in the past
three months?
Yes=1, zero otherwise Yes=1, zero otherwise

7. Information for
decision-making
Leadership &
governance
Health Systems
Development
Interventions
Health financing and
planning
Enabling
sub-system inputs…
•Strengthen the operation of
the essential medicine
distribution system in GEHIP
districts.
Integrated service
components
Health workforce
size, composition
& training
Essential drug supply
& logistics
Pillar #4: Develop a
supply monitoring
system for essential
drugs and equipment.

8. Pillar 4: Strengthening Primary Healthcare
Supply and Logistics Capabilities
GEHIP services to be added as…a
Community-based
capabilities
Level A
Sub-district clinic
capabilities
Level B
Pillar #4 INPUTS: Stock flow monitoring capabilities developed:
• Stock flow monitoring system introduced and
fully functional
Yes=1, 0=otherwise Yes=1, 0=otherwise
Pillar #4 OUTPUTS: Indicators of effective stock flow management:
 Number of essential (“tracer”) drugs missing
among 21 possible drugs…
0, 1, 2, 3…. 21 0, 1, 2, 3…. 21
 Number of essential (“tracer”) drugs missing
among 21 possible drugs…
0, 1, 2, 3…. 21 0, 1, 2, 3….. 21

9. Information for
decision-making
Essential drug supply
& logistics
Leadership &
governance
Health Systems
Development
Interventions
Enabling
sub-system inputs…
• Adapt Tanzania’s PlanRep tool for allocating
healthcare resources according to burden of
disease to facilitate rational healthcare
planning and decision-making at the district
level: District Health Planning, Analysis,
and Reporting Tool (DiHPART)
• Utilize DiHPART for informing resource
allocation at Levels A, B, and C
• Add $0.75 per year to the Common Fund
Integrated service
components
Health workforce
size, composition
& training
Pillar #5
Adapting Tanzania’s district
planning and reporting toolkit
to Ghana: PLANREP.
The District Health Planning
and Reporting Tool (DiHPART)
Health financing and
planning

10. DiHPART as a Tool…
….. allows plans and budgets to be aligned to
Intervention addressable shares of the disease
burden or health needs of the population,
using district health intervention profile
developed from DSS sites.
• Monitoring the effect of DiHPART on health
systems strength involves assessing the
discrepancy between the actual pattern of
expenditure and expected pattern, based on the
district Burden of Disease profile.

12. Translating the desired profile
Into an index of DiHPART action:
An index of system strength at any service point
is the sum of the discrepancies between actual
HMIS registered services over a 90 day period
and the district profile for the 8 categories of
the Burden of Disease…

13. Pillar 5: Strengthening Primary Healthcare
Planning and Resources Inputs
GEHIP services to be added as…a
Community-based
capabilities
Level A
Sub-district clinic
capabilities
Level B
DiHPART planning inputs:
• For each service point, the sum of the HMIS
case volume (by intervention) minus the
expected case volume (based on the district
profile for 8 classes of interventions)
Continuous variable Continuous variable
GEHIP Incremental resource inputs:
• Total GEHIP revenue expended this quarter: Cumulative 90 day
contribution
in US Dollars per
capita
Cumulative 90 day
contribution
in US Dollars per
capita
• Engagement of other sectors in health: Total
District Assembly Revenue invested in
implementation (as a Health Common Fund
Supplement)
Cumulative 90 day
contribution
in US Dollars per
capita
Cumulative 90 day
contribution
in US Dollars per
capita
• Engagement of other investors in health:
Investments of international partners in
health in implementation (by pillar)
Cumulative 90 day
contribution
in US Dollars per
capita
Cumulative 90 day
contribution
in US Dollars per
capita

14. Information for
decision-making
Essential drug supply
& logistics
Health Systems
Development
Interventions
Health financing and
planning
Enabling
sub-system inputs…
Integrated service
components
Health workforce
size, composition
& training
Leadership &
governance
Changes in
leadership
capabilities at
each level in the
system. Strengthen the health system by team
training that promotes leadership for
integrated health care at each
operational level.