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

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

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

 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)

 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

 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

Time FP counseling and messages
Adolescence Advise parents and young girls to delay early marriage and childbearing; counseling on FP methods
Before pregnancy
Counsel on benefits of healthy timing and spacing of pregnancies
Nutrition counseling and messages
Educate youth, especially girls, on good nutrition
During pregnancy
Counsel on FP methods that can be initiated after birth
Encourage giving birth with skilled birth attendant
Counsel on need for iron folate, iodized salt, importance of maternal nutrition
Counsel on value of breastfeeding
Encourage early use of ironfolate 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, ironfolate supplements, consumption of food rich in vitamin A

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)

 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.

 Integration requires a well-functioning health system.
– Staff must be trained
– Continuous access to commodities
– Etc.

 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

 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.

 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.

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.

3 Essential Elements for a Functional
Supply Chain
Products flow effectively and efficiently through the system based on
CHW need
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