Project HEART
Transition Monitoring
Challenges and Successes of
Monitoring Health System Capacity
August 12, 2010
Rozalin Wise
Transition Monitoring System: Goals
• Document capacity of health system to
meet HIV/AIDS Prevention, Care and
Treatment needs pre, during and post
transition
• Increase monitoring of systems and
processes to guide program interventions
focused on health systems strengthening
beyond site level
• More uniform monitoring system across
countries
Transition Monitoring System:
Design Overview
• Capacity assessment of each Result area proposed
in Transition Plan
• Assessment scores transformed to same scale
allowing plotting on spider diagram
• Capacity assessments repeated annually at
minimum
1. Health
Outcomes
6. Enabling
Environmen
t
100
80
60
40
20
0
2. Health
Service
Provision
3. District
Health
Office
Capacity
5.
Community
Capacity
4. Main
Local NGO
Capacity
Baseline
Final
The Transition Vision:
A strong house!
Health Outcomes:
Clients have continuous high quality
Health
Outcomes
Health
Outcomes
HIV care and
treatment
delivered by
(“the (“the
roof”)roof”)
local partners (the “roof”)
Health
Health
Service
Service
Provision
Provision
(Quality&&
(Quality
Access)
Access)
RESULT11
RESULT
Management
Operational
Capacity of
Government,
Government
NGOs
or Local
&
Private
Organizations
Sector
managing
health system
Client and
Community
Client and
Engagement
Community
Engagement
(active civil
society,
RESULThigh
2
demand)
RESULT 3
RESULT 2
Enabling Environment (the
(“the“foundation”)
foundation”)
Policies, political stability, human rights,
gender equality, etc.
Transition Monitoring System:
Design Overview
Result Area
Unit of Measure
Assessment
Tool/Process
RESULT 1:
Services Provision
Health Facilities
Site Capacity Profile (SCP)
RESULT 2:
Health System
Management
- District Health Authorities
- Primary local NGO
(transition partner)
supporting systems
strengthening
- SCP/MoH Capacity
Assessment
- Organizational Capacity
Assessment (OCVAT tool)
RESULT 3:
Community
Linkage
Key informants in health
facility catchments areas
SCP/Structured Interviews
with CBOs and Support
Groups
Enabling
Environment
National
Existing development/
policy indexes
(policy, political stability,
corruption, etc.)
Transition Monitoring Timeline
Assessment
First Implementation
OCVAT
June - Sep 2010
Site Capacity Assessment
Sep - Oct 2010 pilot
Nov 2010 – Feb 2011
First Implementation
Community Capacity
Assessment
Same as Site Capacity
MOH Capacity
Assessment
Pending finalization of
CDC H-CAT 2
Organizational Capacity: The OCVAT
(Organizational Capacity and Viability Assessment Tool)
• Semi-quantitative: Each indicator scored on 1-5 scale,
representing stages of capacity
• Implementation: Two phases
– External Assessment – conducted by EGPAF Global
– Self-Assessment – facilitated workshop w/ staff
representing all departments/functions
• External evaluators give scores
• Participating staff give scores, median = official score
• Results presentation: Compare scores, highlight
strengths, weaknesses, discussion
• External facilitator decides final scores if no consensus
Service Provision:
Site Capacity Profile (SCP)
• Capacity Areas: ART, PMTCT, Peds, Treatment
Support, Pharmacy, Laboratory Services,
M&E/Reporting, Quality Improvement Program,
Finance
• Measures infrastructure, staffing and
management/provision of services for each capacity
area
• Coupled with existing Quality of Care measures
• Score generated per capacity area
• Implementation: Program Officers complete using
existing routine data, visit site to collect the rest OR
use as QI activity with site QI Committee
MOH Capacity Assessment
• Will be based on CDC MOH Capacity Assessment
tool
• Working Group with representation from all EGPAF
Project HEART countries will adapt ensuring
necessary country context specification and
comparability to extent possible
Community Capacity Assessment
• Focused on provision of support services
• For key support services, measures core
competencies:
– Availability, Quality, Linkage (referral process),
Utilization Barriers
– Rapid – each competency, a few key questions
• Informants:
Site Staff, CBO Leaders, Support Groups
• Countries decide which support services to
focus on (modules developed for all)
Conclusion
• Series of capacity assessments
capture health system’s capacity to
provide continuous quality HIV/AIDS
care and treatment
• Demonstrates relationship of key
components and their contribution to
the whole
Thank you!