Making the Most of International Partnerships
Clinton Health Access Initiative
5 October, 2010
Agenda
Clinton Health Access Initiative Approach
Approach in Action: Case Study
Lessons Learned
Founded in 2002, CHAI has helped governments expand
access to healthcare, with an initial focus on AIDS treatment
What we strive for…
A world in which all individuals have equitable access high-quality health care,
enabling them to live healthy and productive lives with dignity and equal
opportunity.
What we do…
We support the rapid expansion of access to high quality, essential healthcare for
all who need it by improving the organization of commodity markets and by
enabling the effective delivery of health services and efficient management of
health systems.
How we work…
We help governments to optimize the use of available resources to maximize
health outcomes.
As the AIDS and global health landscape has evolved, so has
CHAI and its approach to pressing global health issues
Problem …
CHAI’s Response …
• 50% of HIV+ children die before the
age of two, yet systems continue to
focus on treating older children
• Transitioning scale-up responsibility,
focus on infants and quality, and prove
models to prevent infection
Malaria
• Malaria kills 1 million children annually
because diagnosis and treatment are
not reaching patients
• Expand ACT access in the private
sector, improve diagnosis, and lay
groundwork for elimination
Health
Systems
• 50% of external aid is “off budget” from
national plans; resources are not
optimized to strengthen health systems
• Be a hand-in-hand partner in 2-3
countries to plan and implement
comprehensive system strengthening
Human
Resources
for Health
• Africa has 11% of the world’s
population, 24% of its disease burden,
but just 3% of its healthcare workers
• Improve capacity, deployment and
productivity of health workers to help
bridge the human resource gap
• There is a $20B gap in next 5 years
from what’s available and needed to
keep HIV treatment programs going
• Lower commodity prices, improve
efficiency of spending, and better align
donor funds with national costs
Pediatric
HIV/AIDS
Value for
Money
CHAI Zambia HRH follows the government’s leadership
to design and implement national HRH programs
Support government in
analyzing and
diagnosing HRH
bottlenecks / barriers
Holistic approach to addressing the HRH crisis
-Work with MoH to develop pragmatic, integrated, and
comprehensive solutions
-Support data-driven planning and decision making
Provide light touch
operational support to
implement MoH-driven
interventions
Coordinated and sustainable implementation of HRH
interventions
-Follow MoH leadership to un-stick bottlenecks and kick start
new initiatives to drive change
-Integrate core functional systems for ongoing oversight
Help to mobilize
resources needed
Finance the cost of implementation
-Assist governments raise large-scale, ongoing funding
internally and externally
-Rationalize the use existing funds – by redeploying or lowering
costs
CHAI Zambia HRH takes a holistic approach to HRH with a
view across the lifespan of the health workforce
CHAI HRH Program
Objectives
Partner closely with MoH to:
System-Level Outcome
Health Outputs
Increase the number
of qualified
healthcare workers
Accelerate production of
healthcare workers
Increase number of patients
seen and treated
Strengthen skills of health
workforce
Provide higher quality of care
Optimize the
distribution of
healthcare workers
Improve absorption of
healthcare workers into the
workforce
Increase number of patients
seen and treated
Improve distribution of
health workforce
Improve patient access to
primary healthcare
Optimize use of existing
health workforce
Increase number of patients
seen and treated
Formalize skills of informal
workforce
Provide higher quality of care
Improve patient access to
primary healthcare
Maximize the
productivity and
utility of formal and
informal healthcare
workers
To implement a comprehensive HRH strategy, MoH has helped
CHAI understand the partner landscape across the HRH spectrum
Increase the number of
qualified healthcare
workers
• MoH: DHRA, DPP, DCCDS, DTSS
• MoFNP
• MoE
• MoSTVT
• MoWS
• Cabinet Office
• Senate (for UNZA programs)
• General Nursing Council
• Health Professionals Council of
Zambia
• Other regulatory bodies
(Pharmaceutical Regulatory
Authority, etc.)
• TEVETA
• Health worker unions (ZUNO, etc.)
• Public and Private Health Training
Institutions
• Health facilities (clinical practice)
• Faith-based Organizations (CHAZ)
• Civil Society Organizations
• Implementing Partners
• Cooperating Partners
Optimize the
distribution of
healthcare workers
• MoH: DHRA, DPP
• MoFNP
• Public Service Management
Division
• General Nursing Council
• Health Professionals Council of
Zambia
• Health facilities
• Faith-based Organizations
(CHAZ)
• Civil Society Organization
• Implementing Partners
• Cooperating Partners
Maximize the
productivity and
utility of healthcare
workers
• MoH: DHRA, DPP, DCCDS,
DTSS, DPHR
• MoFNP
• Public Service Management
Division
• Cabinet Office
• General Nursing Council
• Health Professionals Council of
Zambia
• Health worker unions
• Public and Private Health Training
Institutions
• Health facilities
• Faith-based Organizations
(CHAZ)
• Civil Society Organization
• Implementing Partners
• Cooperating Partners
Agenda
Clinton Health Access Initiative Approach
Approach in Action: Case Study
Lessons Learned
Case Study: National Training Operation Plan (NTOP)
Achieving HRH expansion through training scale-up
As training capacity is a significant bottleneck to expanding the health workforce, how will Zambia
achieve it’s target to scale-up training output by 70%+ across 39 training institutions (TIs)?
Approach
Support government
in analyzing and
diagnosing HRH
bottlenecks / barriers
 Partner with MoH and regulatory bodies to conduct assessment
of the 39 TIs to determine resource requirements
- Lacked infrastructure and tutors and clinical instructors
 Expert interviews for feedback on quality standards
Provide light touch
operational support
to implement MoHdriven interventions
 Support MoH to produce and disseminate a 5-year costed scaleup plan
- Put scale-up infrastructure systems requirements in-place
- Help implement strategies to address the gaps: D/E tutor
and Clinical Instructor Program design
Help to mobilize
resources needed
 Funding commitment of $26 million from GRZ, partners and
Global fund
Case Study: National Training Operation Plan (NTOP)
Partner collaboration in training scale-up
Underlying the NTOP is coordination and collaboration with various partners
Health Students
• 3 Ministries: MoH, MoE, MoSTVT
• 2 Primary Regulatory Bodies: GNC, HPCZ
Infrastructure:
Health TIs
• 3 Ministries: MoH, MoE, MoSTVT
• 2 Primary Regulatory Bodies: GNC, HPCZ
• Ministry of Works & Supply
Training Quality
Standards
Financial
Commitment
• 3 Ministries: MoH, MoE, MoSTVT
• 2 Primary Regulatory Bodies: GNC, HPCZ
• Biomedical Association, CHAZ, School of Medicine,
Student Union, TEVETA
• MoFNP
• Cooperating Partners
Agenda
Clinton Health Access Initiative Approach
Approach in Action: Case Study
Lessons Learned
CHAI Zambia HRH:
Lessons Learned


National leadership is paramount
-
HRH approach must strengthen national HR systems, address key
government priorities, be aligned with national health strategic plans
-
Although a partnership dynamic is established at the outset, the
government assumes ownership of process, methodology, data, results
and next steps
-
End product is the government’s to use at its discretion
Quantitative analysis informs resource allocation and priority-setting decisions
-
Methodology and data collection process involves MoH and all relevant
stakeholders
•
-
Consensus and buy-in established at the outset
Avoid large expenditures on HRH interventions that lack clear
understanding of which interventions will have the greatest impact on
addressing shortage of workers
CHAI Zambia HRH:
Lessons Learned Continued

Coordinated support by multiple stakeholders can inform better decisions, allow
for improved resource mobilization, and avoid potential bottlenecks

National planning / strategies should be complemented with continued on-theground support to ensure implementation follow-through and sustained results
-
-
Supporting MoH to identify and rapidly remove barriers to implementation
and breakdown bottlenecks can often unlock resources and build
momentum for further progress
•
Optimize use of resources across partners
•
Avoid doing what others are already doing well
Clear means to transition responsibility and funding for the proposed
approach to the government and/or other organizations