Designing improvement for local ownership, great results, and learning

Transcription

1 Leading Transformational Change Across the System great results, and learning M. Rashad Massoud, MD, MPH, FACP Director, Project Senior Vice President, Quality & Performance Institute Mirwais Rahimzai, MD, MBA, MPH University Research Co., LLC Center for Human Services 1 Session Objectives After this session, participants will be able to proactively design improvement projects with the view to achieving: 1. Local ownership 2. Great results 3. Sustainability 4. Scale-up 5. Institutionalization 6. Learning great results and learning 1

2 USAID Applying Science to Strengthen and Improve Systems Project FY2014 Activities 3 USAID Health Care Improvement Project FY2014 Activities 4 great results and learning 2

3 Contributions to Achieving the MDGs in FY14 MDG Countries where ASSIST and HCI activities contribute in FY14 Haiti, Kenya, Malawi, Mozambique, Nigeria, Tanzania, Uganda Haiti, Kenya, Malawi, Mozambique, Nigeria, Tanzania, Uganda Afghanistan, Georgia, Kenya, Malawi, Mali, Mozambique, Nigeria, Tanzania, Uganda 5 Afghanistan, Burundi, Cote d Ivoire, Georgia, Haiti, India, Kenya, Madagascar, Malawi, Mali, Mozambique, Nicaragua, Nigeria, South Africa, Swaziland, Tanzania, Uganda Afghanistan, Botswana, Burundi, Cote d Ivoire, Ethiopia, Georgia, India, Indonesia, Kenya, Madagascar, Mali, Nicaragua, South Africa, Tanzania, Uganda, Ukraine Botswana, Burundi, Cote d Ivoire, Ethiopia, Haiti, India, Kenya, Lesotho, Malawi, Mozambique, Nicaragua, Nigeria, Pakistan, South Africa, Swaziland, Tanzania, USAID Uganda Applying Science to Strengthen and Improve Systems Country Integrated Design Plan Design Design continues iteratively throughout the project Implementation Continuing activities Year Upfront design, implementation & scale-up with sustainability in mind Sustainability Upfront design with scale-up in mind Scale-up Continuing activities Upfront design, implementation & scale-up with institutionalization in mind Institutionalization Year Learning: Knowledge Management & Research 6 great results and learning 3

4 Afghanistan: What are we trying to accomplish and at what scale? Work with the MOPH to build infrastructure for health care improvement Begin with three demonstration collaboratives with a focus on maternal and neonatal deaths: Provincial Facility-based collaborative Provincial Community collaborative Kabul Maternity Hospital collaborative Start in 3 selected provinces (out of 34) in slices of, 2 districts in each province. 533,518 out of 1,144,800 in Balkh 477,677 out of 882,900 in Kunduz Four Public and Additional Private Hospitals. Malalai Hospital 40,000 approx births per year. great results and learning 4

5 Afganistan: Phasing of High-Impact Technical Interventions in Demonstration Maternal and Newborn Collaborative Service Type Phase One Phase Two BHC CHC Hospital Community Communitymidwives; CHW s Community-to- Facility Linkages ANC: Birth preparedness/complication readiness; Tetanus; Iron/Folate Post-partum: Essential Maternal and Newborn Care; Danger sign recognition i and care seeking ANC: Birth preparedness; Tetanus; Iron/Folate Birth: AMTSL/ENC; IP Post-partum: ENC; maternal/newborn monitoring; counseling ANC: Birth preparedness; Tetanus; Iron/Folate Birth/post-partum: AMTSL/ENC; IP (basic); post-partum partum monitoring and discharge ANC: NA Birth/Post-partum: AMTSL/ENC; IP (basic); post-partum monitoring and discharge ANC: Birth preparedness/complication readiness (facility and community services.) ANC: Screening, stabilization and referral for complications (prep-eclampsia and other) Birth: Clean delivery; AMTSL (pending MOPH approval) Post-partum: t Screening, stabilization, i and treatment of maternal and newborn complications (sepsis, etc.) ANC: Screening and management of pre-eclampsia/eclampsia Birth: Partogram; early intervention for obstructed labor; IP (expanded) Post-partum: FP (LAM; progestin-based oral contraceptives) ANC: Screening and management of pre-eclampsia/eclampsia Birth: Partogram; IP (expanded); complications management (hemorrhage, eclampsia, sepsis, newborn asphyxia and LBW) Post-partum: FP (LAM; progestin-based oral contraceptives) ANC: NA Birth: Partogram; IP (expanded); complications management (hemorrhage, eclampsia, sepsis, newborn asphyxia and LBW) Post-partum: FP; maternal and newborn sepsis; LBW ANC/Birth/Post-partum: Referral/counter-referral for maternal newborn complications National Quality Provincial Improvement Health / System Assurance Department Provincial Quality Improvement Team RH QI Team DH QI Team CHC QI Team BHC QI Team RH DH CHC BHC HP HP HP HP Community QI Team HP HP HP HP Community QI Team HP HP HP HP Community QI Team HP HP HP HP Community QI Team Learning Session Facility Collaborative Sessions Joint Sessions Community Collaborative Sessions great results and learning 5

6 Afghanistan, 5 hospitals in Kabul: Partographs completed in five hospitals 11 Afghanistan, 5 hospitals in Kabul: Mothers awareness of newborn danger signs 12 great results and learning 6

7 Afghanistan, 5 hospitals in Kabul: Average compliance with Essential Newborn Care standards 13 Wave Sequence Spread great results and learning 7

8 Afghanistan: Scaling up AMSTL 100 Percentage of vaginal births for which 3 AMTSL elements were performed (oxytocin within 1st minute after delivery, cord traction, uterine massage) 80 Percentage Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Demonstration Wave 1 Wave 2 15 great results and learning 8