Office of Global Healthand HIV (OGHH)
Office of Overseas Programming &Training Support (OPATS)
Maternal and NewbornHealth Training Package
Session 12: Systems Strengthening,Integration, and Maternal andNewborn Health
Definition of a Health System
A health system consists of allorganizations, people, and actionswhose primary interest is topromote, restore, or maintain health(WHO 2007)
Six Building Blocks of a HealthSystem
Health System Stakeholders
More than just the government – also:
–Pharmaceutical suppliers
–Health insurers
–Private sector providers
–Families who care for sick members
–Etc.
Health Systems Strengthening
Improving the six health system buildingblocks and managing their interactions in waysthat achieve more equitable and sustainedhealth improvements across health servicesand health outcomes (WHO 2007)
Definition of Integration andIntegrated Health Services
Integration: bringing together, combiningparts into a whole
Integrated health services: management anddelivery of health services so clients receive acontinuum of preventive and curativeservices, according to their needs over timeand across different levels of the healthsystem
What Integration may Involve:
A package of interventions for a specific group
Providing a range of services in one location(or by one CHW) for a catchment population
Providing continuity of care over time
Integrating services at different levels throughlinkages and a referral system
Time
FP counseling and messages
Nutrition counseling andmessages
Adolescence
Advise parents and young girls todelay early marriage andchildbearing; counseling on FPmethods
Educate youth, especially girls,on good nutrition
Beforepregnancy
Counsel on benefits of healthy timingand spacing of pregnancies
Counsel on need for iron folate,iodized salt, importance ofmaternal nutrition
Counsel on value ofbreastfeeding
Duringpregnancy
Counsel on FP methods that can beinitiated after birth
Encourage giving birth with skilledbirth attendant
Encourage early use of iron-folate supplements, iodized salt,maternal nutrition, adequateweight gain, breastfeeding
Birth andpostnatalperiod
Counsel on Lactational AmenorrheaMethod (LAM) and benefits ofhealthy spacing of pregnancy
Encourage giving colostrum,support for breastfeeding,exclusive breastfeeding, iron-folate supplements,consumption of food rich invitamin A
Why is Integration Important to MNH?
Helps avoid missed opportunities
Improves health equity and impact
Reduces costs by allowing greater efficiency
Increases uptake and provides opportunities forpromoting related health care elements
Clients want “everything under one roof”
–Helps avoid costly, time-consuming multiple visits
–Reduces waiting time
–Clients less subject to stigma and discrimination (HIV is notstand-alone)
Impact of Integrated Services
Kenya: focused ANC to deliver prevention andtreatment services for malaria in pregnancy.Uptake of IPTp increased from 19 percent to61 percent.
Guinea: integrated family planning intocommunity-based health activities,community-based distributors. Moderncontraceptive use by women with child underage 2 tripled from 16 percent to 49 percent.
Health Systems and Integrationare Linked
Integration requires a well-functioning healthsystem.
–Staff must be trained
–Continuous access to commodities
–Etc.
Supply Chain Management
MNH care andservices requiremany life-savingcommodities (ITNs,contraceptives,misoprostol,magnesium sulfate,chlorhexidine, etc.)
Supply Chain Management helps ensure medicinesand supplies are consistently available
The Six Rights of Supply ChainManagement
Ensuring Commodities Reach theLast Mile
The last mile represents acritical challenge in ensuringaccess to healthcommodities at thecommunity level.
In different developingcountries, the last mile ofproduct delivery mayinvolve different processes,different strategies, anddifferent modes oftransportation.
Community Health Supply Chains
In some countries, CHWs provide medicine and othercommodities at the community level.
However, often supply chains cannot consistentlydeliver low cost commodities/medicines to thecommunity level.
Investing in proven strategies to improvecommunity health supply chains is critical forachieving better health outcomes for mothers,newborns, and children.
When Does Community-Based SupplyChain Work Best?
CHW resupply is based on demand usingconsumption data
Data is available and consistently used fordecision making
Formalized structures exist to facilitateteamwork and motivate staff across alllevels of the supply chain
Tools and training are created and utilizedto drive group problem solving
Leadership exists that is committed toproduct availability at CHW level
Overall, supply chain system is functionaland provides products at adequate levels
You achieve thegreatest benefitfrom your supplychain when allthese factors are inplace and workingtogether.
You achieve thegreatest benefitfrom your supplychain when allthese factors are inplace and workingtogether.
3 Essential Elements for a FunctionalSupply Chain
Consumptionand stock dataare available andusable for supplychain decisionmaking andproblem solving
A skilled andmotivated workforce utilizesteamwork toproblem solveand achieve itssupply chain goals
Products floweffectively andefficientlythrough thesystem based onCHW need