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1
Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000–2010: a systematic review
Maurice Bucagu, Jean M. Kagubare, Paulin Basinga, Fidèle Ngabo, Barbara K Timmons & Angela C Lee
Reproductive Health Matters
(2012)
CC
From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public health system, with the aim of reducing maternal and newborn deaths in line with Millennium Development Goal 5, among many other improvements in national health. Based on a systematic review of the lit
...
erature, national policy documents and three Demographic & Health Surveys (2000, 2005 and 2010), this paper describes the reforms and the policies they were based on, and provides data on the extent of Rwanda’s progress in expanding the coverage of four key women’s health services. Progress took place in 2000–2005 and became more rapid after 2006, mostly in rural areas, when the national facility-based childbirth policy, performance-based financing, and community-based health insurance were scaled up. Between 2006 and 2010, the following increases in coverage took place as compared to 2000–2005, particularly in rural areas, where most poor women live: births with skilled attendance (77% increase vs. 26%), institutional delivery (146% increase vs. 8%), and contraceptive prevalence (351% increase vs. 150%). The primary factors in these improvements were increases in the health workforce and their skills, performance-based financing, community-based health insurance, and better leadership and governance. Further research is needed to determine the impact of these changes on health outcomes in women and children.
more
Draft May 2011
The first ever nursing and midwifery services policy document in the history of MoPH was developed with the following aims:
1. Create a positive environment for Nursing and Midwifery Policy and Practice
2. Promote education, training and career development for nurses an ... d midwives.
3. Contribute to the strengthening of health systems and services
4. Monitor the development of nursing and midwifery professions and ensure their quality
5. Streamline Nursing and Midwifery Workforce Management
6. Develop Partnerships for Nursing and Midwifery Services more
The first ever nursing and midwifery services policy document in the history of MoPH was developed with the following aims:
1. Create a positive environment for Nursing and Midwifery Policy and Practice
2. Promote education, training and career development for nurses an ... d midwives.
3. Contribute to the strengthening of health systems and services
4. Monitor the development of nursing and midwifery professions and ensure their quality
5. Streamline Nursing and Midwifery Workforce Management
6. Develop Partnerships for Nursing and Midwifery Services more
Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery
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of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities’ input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes.
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Lesotho’s predominantly rural population faces significant health challenges within a setting of inadequate human resources for health. It is essential that nurses and nurse-midwives, who together make up the largest health workforce in the country, be adequately prepared to address Lesotho’s He
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alth Priorities according to the Poverty Reduction Strategy Paper (PRSP) in the settings where they work. Under the HRAA project, Jhpiego conducted a task analysis study to obtain data on job duties or tasks performed by these cadres, as well as information about how often the tasks are performed, if and where tasks were learned, and the self-perceived level of competence in performing the tasks.
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The purpose of the PAS III is to guide Pakistan’s overall national response for HIV and AIDS through 2020, through focused interventions with set targets, costs, roles and responsibilities. The successful implementation of PAS III involves multiple stakeholders to achieve priority outcomes outline
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d in the Strategy. The Strategy focuses on allocating limited resources to scale up high-impact, high-value interventions such as HTC and treatment to reduce AIDS related deaths and new HIV infections. Priorities in the PAS III have been identified to ensure maximum impact in reducing new infections, especially among key populations, improving treatment uptake and retention, and improving the quality of life of people living with HIV and AIDS in the context of limited financial and human resources.
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The report explores strategies for sustaining the country’s responses to the three diseases and eventually transitioning away from external funding and programmatic support. It takes stock of Kenya’s health financing landscape and identifies opportunities and challenges for sustaining effective
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coverage of HIV, TB, and malaria services in the long run, mindful of macro-fiscal and institutional constraints. The report informs ongoing dialogue within government, including among the Ministry of Health, National Treasury, Council of Governors, and National AIDS Control Council, as well as between government and development partners.
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The provision of safe and efficacious blood and blood components for transfusion or manufacturing use involves a number of processes, from the selection of blood donors and the collection, processing and testing of blood donations to the testing of patient samples, the issue of compatible blood and
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its administration to the patient. There is a risk of error in each process in this “transfusion chain” and a failure at any of these stages can have serious implications for the recipients of blood and blood products. Thus, while blood transfusion can be life-saving, there are associated risks, particularly the transmission of bloodborne infections.
Screening for transfusion-transmissible infections (TTIs) to exclude blood donations at risk of transmitting infection from donors to recipients is a critical part of the process of ensuring that transfusion is as safe as possible. Effective screening for evidence of the presence of the most common and dangerous TTIs can reduce the risk of transmission to very low levels. more
Screening for transfusion-transmissible infections (TTIs) to exclude blood donations at risk of transmitting infection from donors to recipients is a critical part of the process of ensuring that transfusion is as safe as possible. Effective screening for evidence of the presence of the most common and dangerous TTIs can reduce the risk of transmission to very low levels. more
The toolkit is a collection of assessment tools and checklists that describe the key considerations to be taken into account when transitioning to Option B/B+. The toolkit provides a roadmap to support the planning and implementation of Option B/B+, and to help countries scale up more effective inte
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rventions and programs to achieve the goals of the Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive.
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USAID/KENYA Evaluation Services and Program Support (ESPS)
The United States Agency for International Development (USAID) has a solid track record of supporting health and development initiatives in Kenya. AIDS, Population, and Health Integrated Assistance (APHIA) is the agency’s flagship hea ... lth initiative in the country. APHIA is currently in its third iteration, APHIAPlus, which began in January 2011 and is slated to end in December 2015. APHIAPlus was designed to contribute to Result 3 (“Increased use of quality health services, products, and information”) and Result 4 (“Social determinants of health”) of USAID/Kenya’s implementation framework. The main technical areas of focus are HIV/AIDS; malaria; family planning (FP); tuberculosis (TB); maternal, newborn, and child health (MNCH); and water, sanitation, and hygiene (WASH). more
The United States Agency for International Development (USAID) has a solid track record of supporting health and development initiatives in Kenya. AIDS, Population, and Health Integrated Assistance (APHIA) is the agency’s flagship hea ... lth initiative in the country. APHIA is currently in its third iteration, APHIAPlus, which began in January 2011 and is slated to end in December 2015. APHIAPlus was designed to contribute to Result 3 (“Increased use of quality health services, products, and information”) and Result 4 (“Social determinants of health”) of USAID/Kenya’s implementation framework. The main technical areas of focus are HIV/AIDS; malaria; family planning (FP); tuberculosis (TB); maternal, newborn, and child health (MNCH); and water, sanitation, and hygiene (WASH). more
This external performance evaluation of the Malawi Girls’ Empowerment through Education and Health Activity (ASPIRE), conducted 2.5 years after ASPIRE began, establishes the activity’s progress against its objectives, proposes adaptations for the final year, and captures lessons for application
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in future girls’ empowerment, health, and education programming in Malawi.
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Health System Review: Achievements and Challenges
Tangcharoensathien, Viroy; Patcharanarumol, Walaiporn; Panichkriangkrai, Warisa
World Health Organization (WHO)
(2016)
C_WHO
Policy Note: Thailand Health Systems in Transition
By 2002, Universal Health Coverage was achieved through three public insurance schemes: the Civil Servant Medical Benefit Scheme (CSMBS) for civil servants and their dependents, Social Health Insurance (SHI) for formal sector employees, and the U ... niversal Coverage Scheme (UCS) for the remainder of the population.
The establishment of these three schemes has changed the way health care is financed. A supply-led system, under which all Ministry of Public Health (MOPH) health facilities received an annual budget allocation from the MOPH, has now been completely replaced by a system in which the three public purchasers - separated through a purchaser-provider split - manage a demand-led system of financing. more
By 2002, Universal Health Coverage was achieved through three public insurance schemes: the Civil Servant Medical Benefit Scheme (CSMBS) for civil servants and their dependents, Social Health Insurance (SHI) for formal sector employees, and the U ... niversal Coverage Scheme (UCS) for the remainder of the population.
The establishment of these three schemes has changed the way health care is financed. A supply-led system, under which all Ministry of Public Health (MOPH) health facilities received an annual budget allocation from the MOPH, has now been completely replaced by a system in which the three public purchasers - separated through a purchaser-provider split - manage a demand-led system of financing. more
The major areas of focus for the plan will be:
- Social mobilization and community empowerment (health promotion & education for disease prevention);
- Promotion of access to safe water, good sanitation and hygiene;
- Surveillance and laboratory confirmation of outbreaks;
- Prom ... pt case management and infection control;
- Complementary use of oral cholera vaccine (OCV) for cholera endemic communities; and
- Coordination and stewardship between and for all actors.
- Monitoring, supervision, evaluation and operation research to ensure continued improvement in service delivery. more
- Social mobilization and community empowerment (health promotion & education for disease prevention);
- Promotion of access to safe water, good sanitation and hygiene;
- Surveillance and laboratory confirmation of outbreaks;
- Prom ... pt case management and infection control;
- Complementary use of oral cholera vaccine (OCV) for cholera endemic communities; and
- Coordination and stewardship between and for all actors.
- Monitoring, supervision, evaluation and operation research to ensure continued improvement in service delivery. more
Research results of sexual and gender-based violence (SGBV) prevention and response before, during and after disasters in Indonesia, Lao PDR and the Philippines
This report contributes new evidence on why and how sexual and gender-based violence (SGBV) risks increase during humanitarian disasters ... . It details how humanitarian actors can better prevent and respond to such escalation of SGBV, and better meet the needs of affected women, girls, men and boys. This research is based on community views of disaster-affected women, adolescent girls, men and adolescent boys in three South-East Asian countries: Indonesia, Lao PDR and the Philippines. more
This report contributes new evidence on why and how sexual and gender-based violence (SGBV) risks increase during humanitarian disasters ... . It details how humanitarian actors can better prevent and respond to such escalation of SGBV, and better meet the needs of affected women, girls, men and boys. This research is based on community views of disaster-affected women, adolescent girls, men and adolescent boys in three South-East Asian countries: Indonesia, Lao PDR and the Philippines. more
Women and Health Initiative Working Paper No. 1. Women and Health Initiative
Improving maternal health in the context of the sub-Saharan African HIV epidemic requires greater understanding of the relationships between HIV disease and maternal morbidity and mortality, integrated and effective resp ... onses by the health system, and a social context which promotes quality care and encourages use of MCH and HIV services. Advancing the proposed research agenda will make an invaluable contribution by generating needed evidence for policy and practice that improves the maternal health of women who are living with HIV, as well as those who are not. Bringing together maternal health and HIV researchers, policy-makers and program implementers to reduce HIV-related maternal morbidity and mortality and improve the HIV response for women represents an opportunity and a challenge. more
Improving maternal health in the context of the sub-Saharan African HIV epidemic requires greater understanding of the relationships between HIV disease and maternal morbidity and mortality, integrated and effective resp ... onses by the health system, and a social context which promotes quality care and encourages use of MCH and HIV services. Advancing the proposed research agenda will make an invaluable contribution by generating needed evidence for policy and practice that improves the maternal health of women who are living with HIV, as well as those who are not. Bringing together maternal health and HIV researchers, policy-makers and program implementers to reduce HIV-related maternal morbidity and mortality and improve the HIV response for women represents an opportunity and a challenge. more
Level of stunting among Bangladeshi children <5years declined from 51% in 2004 to 36% and underweight from 41% in 2007 to 33% (BDHS 2014). But the decrease in wasting rate is not as expected, which is only from 17% to 14.3 % over last decade. Approximately 3.1 % (BDHS 2014) of under-5 children suffering from SAM only b
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y weight-for-length or height z-score (WHZ) <-3 criterion and estimated to be a total of ~ 450,000. Because, there are no national information on prevalence of SAM using mid upper arm circumference (MUAC) and presence of bipedal oedema in under-5 children, thus the actual number of children suffering from SAM could be much higher than the current estimate.
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