The development of the EHP in the context of limited resources. The development of draft health bill. The availability of the National Health Policy, other health policies and standards and guidelines for delivery of the EHP. Existence of mechanisms for conducting formal health sector reviews and monitoring of the performance of the health sector. Increasing alignment of partners within the sector. Functioning governance structures within the health sector. Strong partnerships with HDPs and other stakeholders including the community. Alignment of HSSP targets with the MGDS and MDGs. Decentralization of the health system to District assemblies (partially). Establishment of CMS trust. Availability of standards for the different levels of health facilities. Commitment to increasing Human resources. Strong commitment to mobilization of financial resources. Limited implementation and enforcement of policies, guidelines, standards and protocols; and delayed revision of PIM. Shortage of human resource and inequitable distribution. Increasing number of donor funded projects. Non-alignment with some donors which results into inequitable distribution of resources and inappropriate management and utilization of resources i.e., human, financial and logistic Procurement systems require further strengthening Inadequate health service coverage and utilization. Financial management and accountability system requires continual strengthening. Weak referral system and overreliance on central hospitals for EHP delivery. Poor coordination of public-private activities in the health sector. Non-adherence to capital investment plan at district level Poor performance of contractors in infrastructure Lack of utilities in some facilities. Poor transport management system Lack of adequate attention to social determinants of health. Weak monitoring and evaluation system and lack of utilization of data for decision making. Slow implementation of decentralization. OPPORTUNITIES THREATS
Government’s commitment to improve the health service delivery and quality of care through priority and cost effective interventions. Government commitment to public-private partnerships in health service delivery. Decentralization of services for effective community participation in health services delivery. Commitment by donors to support the health sector. Compromised national ownership through parallel processes and uncoordinated oversight Shortage of human resources. Lack of control over determinants of health. Climate change. Illiteracy, poverty and high levels of population growth. Lack of capacity to implement the decentralized health system. Rising cost of medical equipment, drugs, supplies and construction materials. Irrational drug use. Donor dependency. Lack of capacity of training institutions to fulfill human resource needs of MOH. Costs of service level agreement to ensure universal coverage and difficulties in implementation of SLA’s • Migration of experienced professionals from the public sector. Limited capacity of the existing means of communication to reach all segments of the population impacting on IEC/BCC activities. Resistance from some HDPs to adhere to the agreed requirements and harmonization of budget cycle, fund disbursement and reporting. Approval of the draft health Bill may take time. Inadequate resource mobilization to meet resources needed to finance the HSSP.
Annex 7: Roadmap for developing the HSSP and stakeholders involved EVENT OUTPUTS 2010 2011 Meetings with partners /stakeholders and MOH on design of HSSP All stakeholders Agreeing on the process of developing the HSSP End of term review Consultations with all stakeholders Briefing on finding of end of term review by consultants Update meeting on design of POW 11 9th July MOH, Civil society , DPs' core team chosen , reports from TWG's Burden of disease presentation district expenditure survey presentation showed high costs on Non EHP conditions agreement to
interventions and targets to be achieved in the next POW, Identified gaps in information required to develop the next POW and agree on methodology for collecting such information core group meetings MOH, DEV partners , UN , civil society , training institutions , CHAM Development of ToRs and choice of consultants, agreement of and comments on HSSP drafts, monitoring progress Extended TWG's HR QA, M&E Finance and procurement, EHP,(and specific EHP areas) PPP, Essential Medicinesand medical supplies , hospital reform , nutrition HIV Various stakeholders, privatisation commission , Ministries of education and finance Local government Development of strategies for each area.
document 2nd Internal review meeting all stakeholders 2nd comments incorporated in document external review meeting stakeholders, including EPND presentation on MGDS Discussions and presentations on 5 key areas midyear review Presentation and discussions on some key areas that needed to be changed draft of HSSP circulated and comments received and adjusted zero-4 comments received and incorporated from partners and MOH Annex 8: Leading 10 selected factors & diseases or injuries Malawi Top 10 risk factor Top 10 diseases
ANNEX 9: AN EHP FOR MALAWI DEFINED BY LEVEL OF HEALTH CARE DELIVERY Primary health care Secondary health care Tertiary care National Strategy Community Health centre Community hospitals District hospitals Zomba mental, Rehabiliation Ref hospitals ( KCH, QECH, Zomba, Mzuzu) national level HQ Public health interventions Disease prevention and health promotion individuals / communities /settings Implement Integrated vector control measures in all settings : community , schools orphanages , workplaces , Health facilities Provision of IRS services in high risk areas Promote IRS Promote IRS Promote IRS Promote IRS Promote IRS Advocate for healthy environmental policies : Promote and carry out drainage and larviciding of vector (mosquito) breeding sites in all settings Advocate for healthy settings : workplaces cities , learning institutions environmental impact assessment Provision of LLITNs (HH level ) Provision of LLITNs Provision of LLITNs Provision of LLITNs Provision of LLITNs Provision of LLITNs Advocate for companies to fulfill their corporate responsibilities towards health ( environmental control , and larvaciding etc) Promote healthy village /workplace policies bylaws on drainage etc Promote healthy lifestyle /behavior change thro’ community mobilization IEC / advocacy and healthy settings programmes Early recognition of danger signs , Community/social mobilisation IEC / advocacy on Early recognition of danger signs , mental health promotion , lifestyle, nutrition, disability Community/social mobilisation IEC / advocacy on Early recognition of danger signs , mental health promotion , lifestyle, nutrition, IEC / advocacy on Early recognition of danger signs , mental health promotion , lifestyle, nutrition, IEC / advocacy on Early recognition of danger signs , mental health promotion , lifestyle, nutrition, IEC / advocacy on Early recognition of danger signs , mental health promotion , lifestyle, nutrition, IEC / advocacy on Early recognition of danger signs , mental health promotion , lifestyle, nutrition, patient support groups Develop communication strategies , and support districts to develop communication strategies based on priority areas /conditions
mental health promotion Promote safe water, sanitation and hygiene Address priority issues based on disease burden : Environmental & personal hygiene, safe water/sanitation , nutrition food service outlets inspections, border posts checks , (/subsidized water purification tablets , hygiene promotion (PHAST) through IEC (/subsidized water purification tablets , hygiene promotion (PHAST) through IEC (/subsidized water purification tablets , hygiene promotion (PHAST) through IEC Develop guidelines for healthy settings ( communities , workplaces etc) environmental health waste management etc Promote healthy settings programme (workplace village , urban, healthy cities etc) Implementation of healthy settings /model villages programmes /cities workplaces , learning institutions , Outreach and supervision HP officers environmental health , HSA's Outreach and supervision HP officers environmental health , HSA's Outreach and supervision HP officers environmental health , HSA's Healthy workplaces (health facilities ) Healthy workplaces (health facilities ) Advocate for healthy public policies , food and nutrition advertising, tobacco , alcohol road safety , workplace policies etc Promote family planning , Community based family planning provision of contraceptives (through social marketing village clinics outreach and in hot spots,youth friendly outreach services, linkages with door to door HTC, safer sex negotiation targeting high risk behavior s, normative change Integrated family planning through different entry points (FP, MCH, ART, HTC), promotion of safer sex (dual protection), benefits of spacing for health of mother and child. , Integrated family planning vasectomy , other surgery through different entry points (FP, MCH, ART, HTC),, related health promotion…. integrated family planning through different entry points (FP, MCH, ART, HTC),, related health promotion…. integrated family planning through different entry points (FP, MCH, ART, HTC),, related health promotion…. integrated family planning (through different entry points (FP, MCH, ART, HTC),, related health promotion…. Development of guidelines policies standards etc, M&E research advocacy Revitalised communications strategy to promote uptake of family planning
Provide mass treatment at community and schools for NTDs, schistosomiasis, soil helminths (deworming outreach , village clinics , basic package of ANC PNC PMTCT Follow up case management and referral Uncomplicated delivery uncomplicated delivery and complications of delivery. (BEMoNC) PAC uncomplicated delivery and complications of delivery PAC Uncomplicated delivery and surgery Development of guidelines policies standards etc, M&E research advocacy MVA post abortion care, , male circumcision , VIA FANC implant insertion/removal , BEMOnc MVA post abortion care, , male circumcision , VIA FANC implant insertion/removal , BEMOnc uncomplicated delivery and complications of delivery complicated delivery and complications of delivery Referral of complicated cases Referral of complicated cases Cemoc, chryotherapy, comprehensive Fanc, gyneacology and obs services (need more details on CH”S ) Rehabilitation and palliative care Home based care follow up for chronic/palliative Referral for HBC Referral for HBC treatment /case management of acute trauma and mental health and refer as necessary Referral for HBC Development of guidelines policies standards etc, M&E research advocacy Community based rehabilitation rehabilitation of clients with trauma , mental health conditions , referral rehabilitation of clients with trauma , mental health conditions , referral rehabilitation of clients with trauma , mental health conditions , referral rehabilitation of clients with trauma , mental health conditions , referral ( both up and down ) treatment of cases of acute trauma and mental health and initial rehabilitation making disability aids )?MAP Development of guidelines policies standards etc, M&E research advocacy
Annex 12: HSSP core health performance indicators Indicator Purpose Data source Monitoring Frequency Aggre gation Baseline (2010-11) Target (2011-12) Target (2012-13) Target (2013-14) Target (2014-15) Target (2015-16) Comments Health impact 1 - Maternal Mortality Ratio (MMR) Impact DHS (NS0) Quiennially 675/ 100000 155/ 100000 2 - Neonatal Mortality Rate (NMR) Impact DHS (NS0) Quiennially 31/1000 12/1000 3 - Infant Mortality Rate (IMR) Impact DHS (NS0) Quiennially 66/1000 45/1000 4 - Under five Mortality Rate (U5MR) Impact DHS (NS0) Quiennially 112/1000 78/1000 Coverage of health Services 5 - EHP coverage (% Facilities able to deliver EHP services) Outcome HMIS Annually National 74% 77% 80% 83% 86% 90% 6 - % of pregnant women starting antenatal care during the first trimester Outcome HMIS Annually National 9% 11% 13% 15% 17% 20% 7 - % of pregnant women completing 4 ANC visits Outcome HMIS Annually National 8 -% of eligible pregnant women receiving at least two doses of intermittent preventive therapy Outcome DHS (NS0) Quiennially National 60% 80% 90% 9 -Proportion of births attended by skilled health personnel Outcome HMIS WMS Annually National 58% 75% 60% 76% 65% 77% 70% 78% 75% 79% 80% 80% 10 -Penta III coverage Outcome EPI Annually 89% 90% 91% 92% 93% 94% 11 - Proportion of 1 year-old children immunized against measles Outcome EPI Annually 88% 89% 89% 89% 90% 90% 12 - Proportion of 1 year-old Outcome HMIS Annually 63.7%
children fully immunized 13 -% of pregnant women who slept under an insecticide treated net (ITN) the previous night Outcome DHS (NS0) Quiennially 49.4% 75% 80% 14 -% of under 5 children who slept under an insecticide treated net (ITN) the previous night Outcome DHS (NSO) Quiennially 55.4% 75% 80% 15 -Neonatal postnatal care (PNC) within 48 hours for deliveries outside the health facility Output DHS (NS0) Quiennially National Baseline to be established from DHS 2010 16 - % of women who received postpartum care after delivery by skilled health worker within seven days Output DHS (NS0) Quiennially 10% 15% 20% 25% 25% 30% 17 - Prevalence of HIV among year old pregnant women attending ANC Outcome DHS (NS0) Quiennially National 12% 9% 6% ???? 18 -% of HIV+ pregnant women who were on ART at the end of their pregnancy (to reduce mother to child transmission and for their own health) Outcome HIV /AIDS Annually National 35% 68% 75% 78% 80% 82% 19 - % of health facilities satisfying health centre waste management standards Output Health Annually 35% 55% 20 - % surveyed population satisfied with health services (by gender and rural/urban) Outcome SDSS (MHEN) Annually National 83.6% (urban) 76.4% (rural) 85% (urban) 85% (rural) 90% (urban) 90% (rural) Coverage of Health Determinants 21 -% of households with an improved toilet Output DHS (NS0) Quiennially 46% 60% 22 -% of households with access to safe water supply Output NS0) Quiennially 88% (MICS 2006)