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

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

3. 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

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

5. Childhood mortality levels-2003
GDS 2003

7. 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

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

9. 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

10. 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?

11. 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

12. 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

13. 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

14. 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