Health Systems Strengthening and Integration of FP/MNCH in Uganda The experience of MSH STRIDES project
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1 Health Systems Strengthening and Integration of FP/MNCH in Uganda The experience of MSH STRIDES project Stronger health systems. Greater health impact. Celia Kakande, Project Director STRIDES Uganda Fabio Castaño Global Technical Lead FP/RH - MSH Women Deliver Conference, May 27, 2013, Kuala Lumpur 1
2 Presentation Objectives Share STRIDES story about building stronger integrated services in Uganda Provide examples of FP/MNCH integration Discuss how performance base incentives and corporate social responsibility programs strengthen public private partnerships 2
3 3
4 Stock outs Long distances Knowledge & skills 4
5 5
6 Health Systems Strengthening Approach Building Block National Facility Community Leadership/ Governance Health Workforce Service Delivery Financing Medical Products Vaccines &Technologies Information 6
7 Health Systems Strengthening Approach and interventions supporting integration Building Block National Facility Community Leadership/ Governance Health Workforce Service Delivery Financing Medical Products Vaccines &Technologies Information Fully Functional Service Delivery System (FFSDS) Leadership Development Program (LDP) Quality Improvement Collaboratives (QIC) Public Private Partnerships (PPP) Performance Base Contracting (PBC) 7
8 Approach to integration of FP/RH and other services and programs FP/RH and MCH But also integration of FP/RH and Nutrition MC FP/RH and PMTCT FP/RH and Malaria/MNCH FP/RH and WASH 8
9 Strengthened integrated services FFSDS Health facilities Community PP FP counseling VSC Postpartum IUD Maternal Child health passport ART clinics: PMTCT + FP Integrated home visits - Village Health Teams & drug sellers Child Days Plus Integrated Outreach Young Child Clinics: immunization, nutrition BCC: Radio talk shows, community dialogues & health facility activations 9
10 Results: FP uptake 10
11 Public facilities 15 districts: 312,268 (38.2%) of 817,916 ANC clients tested and provided with PMTCT and FP counseling (3 years) 10 facilities in QIC, increased PPIUD from 0 to 81 the 1 st month implementation Midas Touch: In 9 months women reached: 4,057; 78% ANC; 73% delivered at facilities; 40% of PNC enrolled for FP, nutrition counseling; Children <5years: 14,209 2 nd dose of Vitamin A Health facilities 11
12 Performance-based Contracts (PBCs) and Integration of FP/RH with other programs Open to all private-sector players Up to 38 subcontractors, 76% conduct integrated outreaches Services: Antenatal care, maternal health, FP/RH Ultrasound, screening for pregnancy complications, referral Child survival, immunization, nutrition, prevention/treatment of malaria, IMCI, ICCM Adolescent sexual and RH youth friendly services Cervical cancer screening 12
13 Effect of FFSDS* & PBCs on implants and IUDs 9,000 8,000 7,000 Public facilities with FFSDS + PBCs NGOs, FBOs 6,000 5,000 4,000 3,000 PBCs introduced 2,000 1,000 0 PY2Q1 PY2Q2 PY2Q3 PY2Q4 PY3Q1 PY3Q2 PY3Q3 PY3Q4 PY4Q1 PY4Q2 PY4Q3 PY4Q4 Project Year 2 Project Year3 Project Year4 IUDs (Copper) Implants Total (Implant &IUDs) *FFSDS: fully functional service delivery system; PBCs: performance-based contracts 13
14 Project s impact Saved 25,998 lives of children under the age of five Averted 1,097 maternal deaths and 125,920 disability-adjusted life years (DALYS) Generated cost saving to the Ugandan health system for more than 47 million USD 14
15 Challenges and lessons learned on integration Sustainable integrated services = stronger local systems + district-focused management and leadership Effective PBCs = integration + PPP + value for $ Postpartum ideal for FP integration but. Institutional delivery still low Quality gap and data management affects integration Stock outs still a major challenge Child Days Plus effective, no sustainable FP/immunization integration Community-based integration: VHTs + supervision + referral systems 15
16 16
17 Stronger health systems. Greater health impact. Saving lives and improving the health of the world s poorest and most vulnerable people by closing the gap between knowledge and action in public health. ckakande@strides.org fcastano@msh.org 17
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