HOLISTIC SYSTEMS THINKING APPROACH: GETTING MORE OUT OF OUR INVESTMENTS

Transcription

1 HOLISTIC SYSTEMS THINKING APPROACH: GETTING MORE OUT OF OUR INVESTMENTS 14 December 2016

2 EARLY ON IN TEACHING ABOUT SYSTEMS, I OFTEN BRING OUT A SLINKY. IN CASE YOU GREW UP WITHOUT ONE, A SLINKY IS A TOY A LONG, LOOSE SPRING THAT CAN BE MADE TO BOUNCE UP AND DOWN, OR POUR BACK AND FORTH FROM HAND TO HAND, OR WALK ITSELF DOWNSTAIRS. I PERCH THE SLINKY ON ONE UPTURNED PALM. WITH THE FINGERS OF THE OTHER HAND, I GRASP IT FROM THE TOP, PARTWAY DOWN ITS COILS. THEN I PULL THE BOTTOM HAND AWAY. THE LOWER END OF THE SLINKY DROPS, BOUNCES BACK UP AGAIN, YO-YOS UP AND DOWN, SUSPENDED FROM MY FINGERS ABOVE. WHAT MADE THE SLINKY BOUNCE UP AND DOWN LIKE THAT? I ASK STUDENTS. -- DONNELLA MEADOWS THINKING IN SYSTEMS; 14 December 2016

3 BID Initiative The Challenge There are strong challenges related to data quality around immunizations in Africa, yet few can identify which problems matter most and where. Lack of reliable, accessible, actionable data on the barriers impeding immunizations coupled with trained and empowered data users at all levels. The Vision Empower countries to enhance immunization and overall health service delivery through improved data collection, quality, and use. The Approach Partner with demonstration countries Tanzania and Zambia to: Identify the most pressing routine immunization service delivery problems. Develop, perfect, and scale solutions with the users on the ground throughout the health system. Facilitate peer learning with other sub-saharan African countries in design, testing, and applying interventions. 3

4 The Challenge

5 How big are these problems? Which ones matter most? Is it a 25% Problem? Is it 25, 1% Problems? 5

6 14 December

7 Solutions for Many? 14 December

8 Multiple Interventions Working Together 8

9 Products, Policies & Practices, People Delays in Data Denominator Issues Supply Chain Issues of Access Local Data Use 9

10 Tanzania challenges In partnership with Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) through the Immunization and Vaccines Development (IVD) Program, the BID Initiative identified a number of critical data-related challenges: Incomplete or untimely data. Inaccurate or uncertain target population for calculating immunization rates. Difficulty identifying infants who do not start immunization or who drop out (defaulter tracing). Lack of unique identifiers for infants. Poor data visibility into supplies at the facility level to district-level data and stock. Complex data collection forms and tools. Insufficient supply chains and logistics management. Inadequate data management and use capacity at all levels of the health system.

11 Tanzania interventions To solve the challenges, the BID Initiative, in consultation with MOHCDGEC and healthcare workers at all levels of the health system, identified the following interventions: Electronic immunization registry with supply chain information. Automated, simplified report generation. Barcodes on child health cards and vaccine supplies. Targeted supportive supervision for health workers. Peer support networks. Data use campaigns.

12 Electronic Immunization Information System 12

13 System before and after 13

14 Data Use Interventions Stakeholder analysis User Advisory Group (UAG) Data visualization/dashboards Micro-training videos Data use campaign Peer networks (WhatsApp) Newsletters Targeted supportive supervision Cross-site visits Edutainment Roles & responsibilities 14 December

15 A system for producing health impact through data Investments Improved data outputs Improved health system functionality Improved health system performance Improved impact and efficiency Data systems governance Data systems architecture Human resource capacity Data use Improved data quality Improved information use Strategic planning Performance Management Service delivery Improved resource allocation Expanded coverage Improved case finding, linkage, retention Greater impact Incidence Burden Improved value health outcomes/ $

16 Locating levers for intervention

17 Cycle of HIV transmission Schematic of sexual networks from clusters with heterosexual transmission Most young women <25 years acquire HIV from older men (Mean age difference = 8.7 years) Men years (N=79) Knew HIV status: 21.5% VL > 50,000 : 37.1% Community HIV prevalence: 40.3% 39% of the men linked to a woman < 25 are simultaneously also linked to a woman years Most men & women years acquire HIV from similarly aged partners (Mean age difference = 1.1 years) Young women <25 years (N=43) Knew HIV status: 23.3% 62% of male partners are years Women years (N=56) Knew HIV status: 42.6% 63% of male partners are years Community HIV prevalence: 22.3% Community HIV prevalence: 59.8% When young women reach >25 years they continue the cycle

18 Differentiated care is the simplification of HIV services to address the preferences of various groups of people living with HIV (PLHIV) while reducing unnecessary burdens on the health system. Global critical enablers PEPFAR Global Fund UNAIDS WHO Academia Advocacy Investment 1 Operational guidelines Community of practice of early adopter countries Investment 2 Adaptation to local context using QI methods Leadership Data Advocacy Nat l guidelines Nat l strategic plans Local critical enablers? Nat l budgets PEPFAR COP GF concept notes Scale Up? 18

19 SMALL GROUP DISCUSSIONS - SPLIT INTO GROUPS 4-5 GROUPS RIGHT WHERE PEOPLE ARE SITTING

20 SMALL GROUP DISCUSSIONS SUMMARY FROM EACH PANELIST

21 Thank you. Q&A Session 21

22 Connect with us! Dr. Henry Mwanyika Skype hmwanyika Apollo TEMU Skype abstemu LinkedIn Laurie Werner Skype lawerner2 Marty Gross Skype martyjgross 22