Early lessons learned and promising
practices:
Supporting Provincial Health
Departments and Districts in
Mozambique
Dr. Antonio Mussa
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
OVERVIEW
• TRANSITION APPROACHES IN MOZAMBIQUE
• ACTIVITY UP-DATE
• LESSONS LEARNED
• NEXT STEPS
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
TRANSITION APPROACHES IN
MOZAMBIQUE
• To augment sub agreements with the
Government of Mozambique (GOM) at
provincial & district level to include some of
the activities previously directly supported by
ICAP
• To ensure sustainability and to directly
strengthen health system capacity
• To strengthen role of civil society by
facilitating transfer of key activities to
existing or new local NGOs
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
HISTORY OF SUB AGREEMENTS
ICAP - GOM
• HUMAN RESOURCES FOR HEALTH (HRH) / STAFFING
WITH 5 PROVINCIAL HEALTH DEPARTMENTS (DPS), 1
CENTRAL HOSPITAL, MINISTRY OF INTERIOR &
MINISTRY OF DEFENSE SINCE 10/2008
• PROVINCIAL HEALTH SCIENCES INSTITUTE
(NAMPULA): 3 PRE-SERVICE TRAINING COURSES
SINCE 9/2008
• NEW PRE-SERVICE TRAINING SUB AGREEMENTS WITH
INHAMBANE PROVINCE & MINISTRY OF DEFENSE FOR
5 COURSES IN 2010
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
HRH/STAFFING
Professional Category
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Basic Level Nurse
Biologist
Cleaners/ Support staff
Counselor
Data Clerk (Admin. Technician)
Driver
Lab Technician
Maternal Child Health Nurse
Medical Doctor
Mid-Level Clinical Officer
Mid-Level Nurse
Pharmacy Technician
Psychologist
Recepcionist (Admin. Assistant.)
Stock Clerk
August 11th, 2010
Staff by Province - 2010
Maputo City
93
Gaza Province
49
Inhambane Province
28
Zambezia Province
48
Nampula Province
96
TOTAL
314
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
EXPENSES ON HRH STAFFING
EXPENSES in USD ON HRH STAFFING
PROVINCE
TOTAL
2005
2006
2007
2008
DSCM
18,631
106,526
192,104
150,920
468,182
MCH
1,421
13,175
15,343
11,451
41,390
MoD
19,335
81,820
106,016
51,680
258,851
28,040
48,123
39,472
115,636
Gaza Province
15,939
20,721
31,081
67,741
Inhambane Province
26,565
44,275
47,971
118,811
Maputo City
Maputo Province
MoI
Zambezia Province
13,432
55,653
98,238
84,578
251,901
Nampula Province
14,371
95,560
202,327
158,719
470,976
TOTAL
67,191
423,278
727,147
575,871
1,793,486
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
SUB AGREEMENTS
SUBAGREEMENTS
BUDGET in USD
2009*
DSCM
159,208
HCM HR
90,959
MAPUTO
MoD
92,615
MoD PreService
GAZA
139,091
115,390
INHAMBANE
PreService
ZAMBEZIA
146,082
358,556
NAMPULA
PreService 156,122
TOTAL
2010 **
505,395
136,768
324,411
167,837
504,741
618,303
252,129
702,539
784,344
165,316
1,258,023 4,161,783
* 2009 refers to expenses on HRH Staffing
August 11th, 2010
** 2010 budget consider
expanded
scope
of work
beyond HRH staffing
8th Annual
Track 1.0 ART
Program
Meeting
Maputo - ICAP Mozambique
Step I
Expand SOW of Provincial and District subcontracts to further
transition responsibilities for greater sustainability and
strengthening of health systems
• CONSENSUS BUILDING MEETINGS WITH EACH DPS
• DISTRICT PLANNING SESSIONS: ICAP provincial teams
discussed facility reports (checklists and programmatic
data), Standards of Care (SOC) Continuous Quality
Improvement (CQI) instruments with the Districts as a
basis for District planning:
 Indicators with low performance were prioritized &
analyzed
 Solutions identified have been transformed into
activities for the District plans
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
Step II
Transition responsibility to Provincial & District level to ensure
sustainability and strengthening of health systems
PROVINCIAL PLANNING MEETINGS
•
Participants: District Director, Chief Medical Officer &
admin/finance staff from each District where ICAP is
operating, representatives from DPS & ICAP team
 Presentation of transition objectives, planning process
and tools to be used
 Districts & DPS present their plans which include
activities, time line and the resources needed
 Compilation and final revision of an overall plan by
Districts & DPS
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
LESSONS LEARNED- I
•
Transition is a new approach for all stakeholders
(CDC, ICAP, MOH) “learning by doing”
• Time constrains of DPS that impede participation
in scheduled meetings & review and release of
documents lead to slowing of process; a focal point
person could facilitate progress
• Limited planning and administrative/finance
management capacity at DPS level indicates need
for increased capacity building activities
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
LESSONS LEARNED II
•
More guidance from central level MOH to DPS
would facilitate planning and implementation
process
• More consensus building needed among central
level MOH & CDC to better define indicators and
targets; strengthen M&E system to monitor
transition
• Need for better harmonization of tools used by
Track 1.0 transition implementers (planning, finance
training, funding proposal writing) to standardize
the USG approach for DPS support
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
NEXT STEPS- I
Finalize and obtain CDC approval for DPS
subcontracts
Build operational capacity of the DPS through:
additional staffing & program management
training of existing staff
building financial management capacity
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
NEXT STEPS- II
Build programmatic capacity of DPS in:
data collection and reporting
supportive supervision
partner coordination activities
program management in technical areas
adherence support & patient empowerment
Monitoring & Evaluation of the successful
implementation of sub agreements and plans
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
CONCLUSION
Plan to support and monitor the process
from the administrative/financial
perspective as well as from its potential
impact on achievement of targets and on
quality of care
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique
THANK YOU !
August 11th, 2010
8th Annual Track 1.0 ART Program Meeting
Maputo - ICAP Mozambique