Health Facilities Strengthening. The main thrust of the project in strengthening health facilities is to improving technical capacity and organizational expertise. All health xxxx xxxxx have been trained in IMCI and planning and evaluation. The training received on planning has been put into action in all health post with quarterly and annual plans. One of the problems identified by the MINSA staff was the inadequate link between community and health facility. The project has made a concerted effort in this area. MINSA has modified the structure for training CHWs. Training was previously centralized in Matagalpa, and has now been decentralized to each health post, thus increasing contact between the local MINSA staff and community volunteers. Regular meetings are being held in most posts with volunteers. 83% of the health posts reported meeting monthly with CHWs in the MTE. A system of referral from the community to the health post has been strengthened and was reported to be functioning in 13 of the 18 communities visited during the MTE. The referral system involves training the CHW to recognize danger signs which justify a referral to the health post. The CHWs in charge of a Base House have been trained and have received copies of the referral slip. The CHW fills out the slip to send with the person to the health post, retains a part of the slip for his/her own records, and a third section is to be filled out by the attending medical personnel and returned with the patient to the CHW for follow-up care. There are still some problems with the system, particularly in collecting information about referrals being made. There are problems with MINSA staff returning the counter-referral slip to the CHWs. The supervision of MINSA staff was identified as another issue to improve during this project. A new supervisory system has been introduced and even though it is not functioning 100%, most people expressed concurrence that it has improved. Supervisors are now using a supervision form, which focuses on improving performance through an agreed upon plan of action. When health personnel were asked during the MTE how the supervision system could be improved, 50% said by having more frequent supervisory visits.
Health Facilities Strengthening. The CS XIII Project has made progress in strengthening health facilities in the following areas:
Health Facilities Strengthening. The project inputs were not directed toward the equipment of health facilities but rather toward the strengthening of health worker knowledge and skills to ensure effective delivery of essential health services. Most of the project efforts have also been directly related to improving the capacity Memba and Nacala-a-Velha Districts to implement child survival approaches and support community structures. To accomplish this, some joint planning, monitoring and supervision with the DDS staffs has been carried out. The focus of the district level support has been on training/capacity building of health workers so that they can use their technical and management skills to perform monitoring and supervision activities as well as collect and analyze data for the country’s HIS. This will then contribute to a more informed decision-making process.
Health Facilities Strengthening. Approach for improved management and services at health facilities A key project indicator used to measure success in this area was the following: Number of CSComs that bought drugs with funds from the system of cost recovery from the past year. The result showed that all (100%) of the CSComs (health facilities) were able to accomplish this, achieving the project target of 75%. Health facility strengthening by the project in collaboration with its district MOH partner, focused on training of health providers in IMCI and C-IMCI. In addition to improved case management, health facility staff participated in the KPC surveys and the LQAS surveys as well. The latter in particular was a useful tool for them to assess the health status in their own catchment areas, as feedback to the health facility and ASACO after the analysis was always a part of the process. Many health providers became more dynamic as a result, visiting communities regularly and supporting the strategie avance activities. Plan Mali was also able to equip health facilities through the use of matching funds. And the ASACO training (the Mayor and health provider also participated) in administration, finance, drug management and the decentralized health system, also contributed to strengthen health facilities capacity to meet the needs of the population. Improved and more consistent supervision of health facilities by the district health team in Kita and the project staff was also part of the plan for strengthening the management and services of the health facilities. Lessons Learned • Per the project experience, training and capacity building contributed to better understanding of roles and responsibilities and motivation and ability to do the job. Supervision and follow up support thereafter was also important to help clarify problems coming up. • All activities related to strengthening of the government partner tended to depend on the availability of per diem. When there was no per diem involved, getting government participation seemed a little slower. Plans for sustaining health facility strengthening The key factor for sustaining health facility strengthening is the ownership of the MOH in this aspect of the program, and follow-though in terms of regular supportive supervision, continued training and training of new staff when there is turnover. Certainly during the life of the program, the Kita district team members were very active partners, and very interested in participating in all the ...
