The goal of health sector reform is:

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Gaston Sorgho

Harvard School of Public Health

Designing a ServiceDelivery Matrix

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Session Objectives

 To understand the role of standards ofservice in terms of planning,budgeting, and monitoring healthservices, and

To be able to develop a matrixdescribing the services offered at eachlevel in their own countries.

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ICPD

Focus on client

Redefinition of services to be deliveredat health facilities

Focus on rights, health, sexuality

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Findings of ICPD +5

Policy shifts made

 Implementation slow

–how to operationalize

–concern about costs

–prioritization not clear

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How to operationalize RH

Design and Delivery of RH

service delivery matrix

resource allocation:priority setting

resource utilization: costing

resource utilization: people

political analysis

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Service Delivery Matrix

1. Describe Service Delivery System

2. Elements of service prioritized

3. Services defined by level

4. Standards of service

treatment protocols

staff

equipment, supplies

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1. Describe Service DeliverySystem

Describe Levels of System

Community

Health

Center

District

Hospital

Referral

Hospital

Community

Health

Post

Referral

Hospital

Health

Center

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Describe the Service DeliverySystem

What is referral process?

 communications

 transportation

 follow up

Community

Health

Center

District

Hospital

Referral

Hospital

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2. Elements of serviceprioritized

Family Planning

Safe Motherhood

Youth

Child Health

HIV/AIDS

Gender Based Violence

Cancer Prevention and Treatment

Other…..

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Community

Health

Center

District

Hospital

Referral

Hospital

Family

Planning

Safe

Motherhood

Youth

Child

Health

How are priorities set?

2. Elements of serviceprioritized

By Whom?

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3. Services defined by level

Community

Health

Center

District

Hospital

Referral

Hospital

Family

Planning

Safe

Motherhood

Youth

Child

Health

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3. Services defined by level

Example: Safe Motherhood

 What will be done in community?

 How will referrals be achieved?

 At what level will C-sections, blood,antibiotics be available?

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3. Services defined by level

Community

Health

Center

District

Hospital

Referral

Hospital

Family

Planning

Safe

Motherhood

Youth

Child

Health

 communications

 transportation

 follow up

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3. Services defined by level

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4. Standards of service

Community

Health

Center

District

Hospital

Referral

Hospital

Safe

Motherhood

Standard Treatments

• hemorrhage

• fever

• antenatal care

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4. Standards of servicePlanning

Community

Health

Center

District

Hospital

Referral

Hospital

Safe

Motherhood

Standard Treatments

• hemorrhage

• fever

• antenatal care

 staffing

 supplies

 equipment

 building

 transportation

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4. Standards of servicecosting

Community

Health

Center

District

Hospital

Referral

Hospital

Safe

Motherhood

Standard Treatments

• hemorrhage

• fever

• antenatal care

 staffing

 supplies

 equipment

 building

 transportation

costing

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Community

Health

Center

District

Hospital

Referral

Hospital

Safe

Motherhood

Standard Treatments

• hemorrhage

• fever

• antenatal care

 staffing

 supplies

 equipment

 building

 transportation

monitoring

• quality

• access

4. Standards of service monitoring

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Matrix of Service Delivery

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Matrix of Family PlanningBurkina Faso

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Service Delivery Matrix

specific

system wide approach

prioritization explicit

basis for

–quality

– costing, budgeting

– monitoring

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Service Delivery Matrix

Family

Planning

Safe

Motherhood

Youth

Child

Health

Community

Health

Center

District

Hospital

Referral

Hospital

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Matrix of Service Delivery