High Impact Rapid Delivery approach for MDG4,5 Dr George Amofah Director Public Health Ghana Health Service

OUTLINE Policy Context Current Situation Response (HIRD: principles, process) Progress Challenges Way Forward

POLICY CONTEXT Millenium SUMMIT IN 2000 147 world leaders agreed to a global compact to reverse poverty, hunger, illiteracy, environmental degradation, discrimination and disease UN SPECIAL SESSION ON CHILDREN IN 2000 DREW ATTENTION TO URGENCY TO REDUCE CHILD HEALTH AU ASSEMBLY THRO TRIPOLI DECLARATION TO ACCELERATE ACTION FOR CHILD SURVIVAL IN 2005 PRIOROTIZATION OF CHILD SURVIVAL IN NEPAD AFRICAN PEER REVIEW MECHANISM CALLS COUNTRIES TO MONITOR MDGS, ESP 4

Current situation Under-five mortality rate as of 2003 (DHS) was 111 per 1000 live births. Worsening indicators in Upper West, Northern, Central regions. Still high in Upper East though making progress. No apparent change in maternal mortality At current pace Ghana may not achieve MDGs Calculated that we need to reduce mortality by 8.2% annually instead of current 0.6% in Africa if MDGs are to be achieved

Childhood mortality levels-2003 GDS 2003

Current Situation-2 Majority of deaths in children due to small number of common, preventable and treatable conditions The paradox is that a set of cost-effective and affordable interventions (esp for MDG4,6) known and can prevent 63% of current childhood mortality Sadly most of these interventions have been applied in only a few places with low coverage For public health impact you need not less than 60% district wide coverage for most interventions

Phases of PH interventions in relation to coverage Maintenance 60 coverage Scaling up 20 Initiation Time period

Response (HIRD principles) Urgent need to do things differently and do different things. Complex factors involved therefore no single MDA can achieve goals hence need for multi-agency action working in partnership A partnership for Achieving MDG4&5 using the High-Impact Rapid Delivery approach (HIRD) therefore proposed and initiated by MOH/GHS and all our partners in 2005 Involves moving proven known cost-interventions to scale through fast track approach by multiple actors Package of key interventions delivered in integrated manner as part of MTEF/Health development plans of regions/districts (cf Part of strategic RCH plan) Aim at high district wide coverage over short timeframe Use lessons drawn from other projects e.g ACSD and Wassa experience Focus at community and household levels USE OF LOCAL COMMUNITY STRUCTURES (CBAs, WOMEN’S SUPPORT GROUPS, NGOs, other MDAs etc) Includes system wide strengthening and addressing larger socio-cultural and economic factors Sources of funding: GOG, health fund, Global fund, GAVI, other earmarked funds, district assemblies etc Regular systems for monitoring, review, support and evaluation

Process Strategy was to Implement HIRD first in UWR, NR, UER and CR up to Dec 2006, then to remaining six regions in 2007 Based on finding answers to the following district by district: Where do we want to get to? Vision Where are we now? Current situation Why are we at current situation? Situation analysis using ‘but why’ approach What do we want to do? Goal, objectives and targets How do we get there? Strategies and key actions and activities Where and when? What resources do we need and from where?

PROGRESS SO FAR Regional Planning workshops completed in all 4 regions from Dec 2005 to Feb 2006 District specific plans developed and shared with partners (see excel planning templates) Using plans as basis for implementation and support and funding by all stakeholders, including developmment partners MOH/GHS accepted HIRD as basis for achieving MDG4&5 and reflecting same in priorities and budget, especially concerning commodity security DANIDA funds to districts JICA support to expand CHPS and provide basic equipment for all health facilities in UWR UNFPA funding of aspects of RCH UNICEF extending ACSD-like support to 3 northern regions Church of Christ Latter Day Saints support to train hospital staff in neonatal resuscitation in the 4 regions Child health promotion week in May 2006 Nationwide mass Measles/polio/VAC/ITN campaign in November 2006 Review in December 2006 in Tamale

Key Challenges Late release of additional funds Poor involvement of other MDAs at district DHMTs not involving District hospitals Tendency to projectise HIRD by managers Funding for huge capital investment required esp for EOC/BOC for MDG5 Weak M&E component so far

Way Forward Extension of HIRD to six remaining regions (ASR, WR, ER by end of June 2007; BAR, VR and GAR by Dec 2007) based on lessons learnt so far Consolidating gains made in 4 original regions Strengthening M&E component Ensuring that HIRD is integrated as part of District Health Development Plans Improving inter-sectoral linkages and community based systems Contract out certain interventions (esp community based) to others (MDAs, NGOs) with comparative strength Begin investing in health systems esp EOC now esp for MDG5

Conclusion HIRD is an attempt to scale up known priority cost-effective interventions for MDG4,5 in line with policy of ministry and international community while at same time ensuring strengthening of health systems to support interventions Based on districts’ own defined strategies with enough flexibility for district managers to make a difference