Strengthening Management to Support Health System Integration
In 2005 we worked with our Ministry of Health partners to initiate a shift toward decentralized management of integrated primary health care in three target provinces (Manica, Sofala and Tete). HIV care services, integrated ANC, HIV testing and education, and home-base care were strengthened through enhanced integration of services into the broader primary health care system that links and integrates a continuum of accessible services within facilities and between facility and community-based services.
The goal of this shift is to create stronger and more sustainable Mozambican health systems and improve the delivery of integrated primary care. In Mozambique the provision of services in facilities is directly managed by district health offices, so we have begun support for integrated health care management at the district level by strengthening management capacity building, improving supply chain management and developing operational research tools.
Management Capacity Building
To improve management capacity, we developed a district-based multidisciplinary teams (DMT) who will provide day-to-day support to district and facility counterparts where HIV-related services are provided.
Our DMTs consist of five technical advisors, focusing on:
- Clinical HIV care (adult, pediatric and TB/HIV)
- Care and treatment and health education
- Maternal child health (including prevention of mother-to-child transmission, or PMTCT)
- Monitoring and evaluation (M&E)
- Management and leadership
The DMTs work to improve service delivery through support for clinical mentoring, district-level data analysis, resource management, program evaluation, leadership training, program supervision, and pilot testing of new strategies. Stronger district management and better data systems and evaluation tools will support integration of HIV services into primary health care at health facilities.
Supply Chain Management
A continuous and predictable availability of key diagnostic equipment and supplies (such as hematology, biochemistry, malaria, syphilis, HIV, CD4, and X-ray tests) is critical to ensure that patients receive quality health care.
The availability of these diagnostic tests in Mozambique is limited by available infrastructure, equipment, staff, and reagents. In areas where additional resources are required to achieve a desirable coverage of these services, HAI will support the purchase of equipment, improve infrastructure, and provide training. Operations research projects conducted by our staff with Ministry partners will determine the most efficient placement of fixed or mobile units and establishing the regions they serve, in a fashion that responds to infrastructural capacity, staffing levels, supply transportation systems, patients, and population densities.
Inventory management is employed to determine efficient supply ordering policies. In addition, resource pooling reduces the total amount of inventory on-hand while satisfying uncertain demands levels.
Managers review clinic data
Operations Research and Implementation Science
Operations research is critical to improving evidence-based decision-making across traditional disease-based categories. Managers and implementers are using strategic information and evaluation techniques for decision-making. We focus on strengthening strategic information capacity at the provincial, district, and local levels, including community-based organizations, through training and development of new tools to:
- improve data collection
- standardize data systems
- improve data analysis and utilization for planning and decision-making
- conduct special studies to assess health system operations, examine patient flow, identify bottlenecks in service provision, and test new interventions
At the provincial level, we work with our Ministry of Health counterparts to strengthen data collection and analysis processes using the health information system (HIS) and Basic Module, harmonize data collection streams and data sets, train provincial-level counterparts, promote links with planners to ensure that data are used in provincial planning cycles, and help plan and develop special studies.
At the district level, DMTs will also focus on improving data collection processes and data flow from facility to district to province, and help develop skills for use of data in management decision-making at the district level. DMTs will help train district managers to conduct special studies and evaluations to test new interventions and tools.
These efforts are funded by the Doris Duke Charitable Foundation and PEPFAR.