SCOPE OF WORK

In line with the Global Fund Strategy 2017-2022 to invest in building sustainable and resilient systems for health (or “RSSH”), the proposed project will implement, document and disseminate innovative approaches to improving the screening, testing and treatment of HIV, TB and malaria and improve integrated service delivery at facility and community levels in a selected number of countries from the Global Fund differentiated portfolio.

A. TASKS

1. Identify the ‘bottlenecks’ to providing Quality of Care (or “QoC”)

a)       Conduct a specialized study of QoC in ANC and PNC clinics, in addition to the use of existing HFA’s and routinely collected data, in a sample of facilities in the identified target districts (if detailed quality of care data is needed);

b)      If necessary undertake a secondary analysis of data for a small sample of districts and/or sites where the HFA was implemented in a subset of countries. This would include utilizing the latest epidemiologic information, routine service data and the Health Facility Assessment (or “HFA”) data to help support decision-making at the facility around management and service models (i.e. differentiated care, patient-centred care, task shifting or other Human Resources practices, etc.);

c)       Partner with the Ministry of Health at national and/or local levels and work directly with the sites identified to share data and design an action plan based on the findings;

d)      Document information collected to refine the specific package of interventions and focus needed for each site or cluster of health facilities to improve the availability and quality of antenatal and postnatal care provided for mothers and new-borns, reflective of a differentiated facility specific approach.

2. Design and introduce a Quality Improvement process at health facility level

a)       Strengthen the capacity of healthcare providers and managers working at participating health care facilities in the provision and assessment of ANC and PNC and on the use of a standards-based audit as a mechanism for improving care;

b)      Develop national and locally agreed evidence-based standards for care that are defined and measurable;

c)       Identify immediate gaps in terms of essential equipment and supplies at facility level that are essential for the provision of antenatal and postnatal care;

d)      Document and disseminate the lessons learnt.

3. Evaluate effectiveness and efficiency

a)       Generate the evidence to reproduce and scale-up intervention packages and solutions to increasing availability and improving quality of care for integrated HIV, TB and malaria services during antenatal and postnatal care;

b)      Document differentiated approaches to improving the quality of care at ANC and PNC facilities using a health systems strengthening approach;

LSTM’s Approach

Our programme aligns to existing health systems, increasing capacity-building across all levels and providing support via interventions and technical assistance, as well as generating evidence. Built on the foundations from the completed phases in Nigeria and Tanzania, we incorporate developments and lessons learnt to improve and further develop this programme.

The initial phase focuses on the defining of needs and approach to be adopted with the Ministry of Health and our in-country partners in Kenya, Nigeria, and Tanzania. To provide a platform for sustainability, all aspects of the programme are integrated into existing national initiatives to maximise the long-term incorporation of the interventions. They are gradually ‘handed-over’ to the Ministry of Health.

We promote capacity building and co-learning across different levels with the aim to optimise existing structures. The use of already available supportive supervisors, quality improvement systems and Master Trainers (MT) to cascade the competency-based training are key and ensure that experts in each country have ownership of and are co-creators of the programme.

In addition, and in partnership with the Centre for Research on Health and Social Care Management department in the university of Bocconi, LSTM will conduct a cost effectiveness assessment of the interventions in Kenya. The overarching aim is to provide insights on the value for money associated with the planned interventions and identify the most efficient alternative given the available budget.