Regional, District Leadership and Facility Pediatric Quality Improvement Teams (PQITs) as Champions of Implementation Sustainability 3rd NQIF 26th - 28th November 2013 Victor A Masbayi, Eliphace Mkumbo University Research Co., LLC/Tibu Homa Project

PURPOSE The purpose of this presentation is to describe the THP experience in implementing sustainability activities specifically: – To describe the THP experience in sustaining gains – To highlight the importance of having sustainability as an intervention component – To demonstrate the importance of developing a sustainability strategy in collaboration with stakeholders

PLANNING FOR SUSTAINABILITY - Strategy Make sustainability a tangible activity of the program – “Program Objectives: The ultimate goal of this program is to reduce mortality of children under five with severe febrile illness through increasing proper diagnosis and treatment of febrile illness cases in the Lake Zone. In order to achieve this, this program will achieve the objectives of increasing availability and accessibility to essential facility- based curative and preventive child health services; ensuring sustainability of critical child health activities; and increasing linkages within the community to promote healthy behaviors”. Meet stakeholders to discuss and define sustainability of gains to be made by the project

Define the expected evidence that will indicate sustainability implementation is in process THP stakeholders wanted to: – Fill gaps in IMCI at PLHF’s – Fill gaps in c-IMCI training – Make IMCI/Malaria focal persons an integral part of the training and mentorship process – Improve tools for data collection – Integrate Dx and Tx of febrile illnesses into the CCHP – Have R/CHMTs take over planning and implementation of the improvement activities – Advocate for policy changes based on program experience PLANNING FOR SUSTAINABILITY - Strategy

Identify key people among the stakeholders that you will work with – THP selected : Regional and District team leadership i.e. RAS, RMO, DED, DMOs, Social welfare officers Other partners with prior experience e.g. Wajibika Collaboratively define sustainability THP used a workshop platform to develop a strategy and framework collaboratively with the following:, – Forty-six MOH officers, professionals, Zonal and Regional authorities – the Technical Advisory Group – R/CHMTS (Mwanza, Mara and Kagera) – Administrative Secretary (RAS), District Executive Directors – Private sector companies - the Sahara Media Company and the Geita Gold Mine Company. PLANNING FOR SUSTAINABILITY - Strategy

Doing sustainability - Strategy Engage IMCI/NMCP, ZHRC and R/CHMTs Quarterly meetings on implementation progress and future plans Work with R/CHMTs to come up with a plan for a step by step hand over of planning and implementation Enhance capacity to identify skill gaps, design and plan interventions

Doing sustainability - Strategy Build capacity of R/CHMTs in planning, budgeting and resource mobilization Train R/CHMTs in Financial Management Link R/CHMTs to local funding partners e.g. Private sector for Corporate social responsibility opportunities Mentor health managers to improve skills in planning, budgeting & resource mobilization.

Doing sustainability - Strategy Data management & plans Strengthen the R/CHMTs to oversee institutional data management systems and include CM improvements into annual plans Assess improvements in the capacity of health facilities to continue to plan the implementation of CM activities

STUDYING SUSTAINABILITY Assess continued availability of mRDTs and anti-malarial drugs. Assess existence a continuous system training HF-based personnel on CM Assess the support of the private sector, including the potential mobilization of additional resources. Assess the capacity and commitment of regional and district officers to monitor and supervise CM Assess accountability mechanism (including incentives) for the quality of CM Assess status of facility level interventions Assess the credibility of mRDTs and CM based on diagnosis

STUDYING SUSTAINABILITY Review extent of results: Five (5) CHMTS out of 22 have taken action: – Proposals have resulted in: Plans to renovate a pediatric ward at a district hospital with funds from a local donor. Boat ambulances are under construction for yet another district with difficult access due to marshy islands. – Two CHMTs have financed and distributed U5s OPD cards to their health facilities. – One district has all its health facilities operating accounts managed by the facility health committees.

TAKING ACTION Take the CHMTs that have acted and: – Review progress in implementation of activities and improvements in CM. – Identify and document promising practices and challenges. – Identify and apply approaches for addressing issues arising during implementation in order to sustain gains. – Discuss and agree on how to actualize the practice of collection and use of data for planning. – Discuss and agree on how to effectively implement standard practices of patient care at facility level. – Spread the practices successfully adopted by CHMTs

Acknowledgements  The RMOs and DMOs of Kagera, Mara, Mwanza and Geita Regions  R/CHMTs of Kagera, Mara, Mwanza and Geita Regions  IMCI Unit and NMCP, MOHSW  USAID/Tanzania  Collaborating, Baylor, CRS, PACT