1. Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Maternal and Newborn Health Training Package Session 12: Systems Strengthening, Integration, and Maternal and Newborn Health

2. Definition of a Health System  A health system consists of all organizations, people, and actions whose primary interest is to promote, restore, or maintain health (WHO 2007)

3. Six Building Blocks of a Health System

4. Health System Stakeholders  More than just the government – also: – Pharmaceutical suppliers – Health insurers – Private sector providers – Families who care for sick members – Etc.

5. Health Systems Strengthening  Improving the six health system building blocks and managing their interactions in ways that achieve more equitable and sustained health improvements across health services and health outcomes (WHO 2007)

6. Definition of Integration and Integrated Health Services  Integration: bringing together, combining parts into a whole  Integrated health services: management and delivery of health services so clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system

7. What Integration may Involve:  A package of interventions for a specific group  Providing a range of services in one location (or by one CHW) for a catchment population  Providing continuity of care over time  Integrating services at different levels through linkages and a referral system

8. TimeFP counseling and messagesNutrition counseling and messages AdolescenceAdvise parents and young girls to delay early marriage and childbearing; counseling on FP methods Educate youth, especially girls, on good nutrition Before pregnancy Counsel on benefits of healthy timing and spacing of pregnancies Counsel on need for iron folate, iodized salt, importance of maternal nutrition Counsel on value of breastfeeding During pregnancy Counsel on FP methods that can be initiated after birth Encourage giving birth with skilled birth attendant Encourage early use of iron- folate supplements, iodized salt, maternal nutrition, adequate weight gain, breastfeeding Birth and postnatal period Counsel on Lactational Amenorrhea Method (LAM) and benefits of healthy spacing of pregnancy Encourage giving colostrum, support for breastfeeding, exclusive breastfeeding, iron- folate supplements, consumption of food rich in vitamin A

9. Why is Integration Important to MNH?  Helps avoid missed opportunities  Improves health equity and impact  Reduces costs by allowing greater efficiency  Increases uptake and provides opportunities for promoting related health care elements  Clients want “everything under one roof” – Helps avoid costly, time-consuming multiple visits – Reduces waiting time – Clients less subject to stigma and discrimination (HIV is not stand-alone)

10. Impact of Integrated Services  Kenya: focused ANC to deliver prevention and treatment services for malaria in pregnancy. Uptake of IPTp increased from 19 percent to 61 percent.  Guinea: integrated family planning into community-based health activities, community-based distributors. Modern contraceptive use by women with child under age 2 tripled from 16 percent to 49 percent.

11. Health Systems and Integration are Linked  Integration requires a well-functioning health system. – Staff must be trained – Continuous access to commodities – Etc.

12. Supply Chain Management  MNH care and services require many life-saving commodities (ITNs, contraceptives, misoprostol, magnesium sulfate, chlorhexidine, etc.)  Supply Chain Management helps ensure medicines and supplies are consistently available

13. The Six Rights of Supply Chain Management

14. Ensuring Commodities Reach the Last Mile  The last mile represents a critical challenge in ensuring access to health commodities at the community level.  In different developing countries, the last mile of product delivery may involve different processes, different strategies, and different modes of transportation.

15. Community Health Supply Chains  In some countries, CHWs provide medicine and other commodities at the community level.  However, often supply chains cannot consistently deliver low cost commodities/medicines to the community level.  Investing in proven strategies to improve community health supply chains is critical for achieving better health outcomes for mothers, newborns, and children.

16. When Does Community-Based Supply Chain Work Best?  CHW resupply is based on demand using consumption data  Data is available and consistently used for decision making  Formalized structures exist to facilitate teamwork and motivate staff across all levels of the supply chain  Tools and training are created and utilized to drive group problem solving  Leadership exists that is committed to product availability at CHW level  Overall, supply chain system is functional and provides products at adequate levels You achieve the greatest benefit from your supply chain when all these factors are in place and working together.

17. 3 Essential Elements for a Functional Supply Chain Consumption and stock data are available and usable for supply chain decision making and problem solving A skilled and motivated work force utilizes teamwork to problem solve and achieve its supply chain goals Products flow effectively and efficiently through the system based on CHW need