Creating an Enabling Environment for PE/E Interventions
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Creating an Enabling Environment for PE/E Interventions 23 February 2011 Addis Ababa, Ethiopia Lindsay Morgan. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February 2011. Outcomes Depend on Context. Interventions for Impact in Essential

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Creating an Enabling Environment for PE/E Interventions

23 February 2011

Addis Ababa, Ethiopia

Lindsay Morgan

Interventions for Impact in Essential Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Outcomes depend on context
Outcomes Depend on Context

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Health systems 101
Health Systems 101

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Other aspects of the health s ystem
Other Aspects of the Health System

  • Fill in with pics – terrain, and something showing social interactions..culture

  • Physical environment

  • Climate

  • Terrain

  • Population Density

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


And others
And others…

  • Social Environment

  • Culture

  • Household characteristics

  • Individuals

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


For Effective PE/E Care-- What Needs to Happen?

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Step 1 a woman learns she is pregnant
STEP 1: A Woman Learns She Is Pregnant

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Between point a and point b what needs to happen
Between Point A and Point B –What Needs to Happen?

A

B

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


How can we help women seek care
How Can We Help Women Seek Care?

Insurance toovercome financial barriers to accessing services

  • Social Insurance: national programs financed by combination payroll and other taxes and premiums, with exemptions for the poorest

  • Community-Based Insurance: smaller, voluntary, community-based initiatives to reach rural dwellers and informal sector

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Results and challenges
Results and Challenges

  • Care-seeking more likely

  • Reaching the poorest isn’t easy

  • Coverage of CBI tends to be small and increases slowly

  • Insurance schemes challenging to implement and fund

  • They depend on the benefit package

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Another approach for overcoming financial and social geo barriers
Another Approach for Overcoming Financial and Social/Geo Barriers:

Targeted Subsidies

Vouchers: Apurchaser contracts accredited health facilities and vouchers are distributed to patients entitling them to services at contracted facilities. Voucher is either heavily subsidized or free, and provider is reimbursed for the cost of provision, plus a reasonable profit, after delivery is verified.

Conditional Cash (or in-kind) Transfers: transfer cash to ease constraints on household investment in human capital development by reducing out-of-pocket expenditures and opportunity costs; induce health and nutrition behavior changes by conditioning the transfers on the use of preventive health services and attendance to health education talks.

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Results and challenges1
Results and Challenges Barriers:

  • High demand for vouchers for delivery-related services; increased revenue for facilities

  • Managing claims is time consuming and difficult to verify whether services have been delivered

  • CCTs are powerful motivator

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Overcoming geographic barriers
Overcoming Geographic Barriers: Barriers:

Bring Services to Communities

  • Community Health Workers

  • Mobile clinics

  • Health camps

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Results and challenges2
Results and Challenges Barriers:

  • Strengthened links between communities and health facilities/health system

  • Challenges of overburdened workers, regulation, trouble establishing clear lines of supervision and support

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Step 2 woman arrives at facility for care
STEP 2: Barriers:Woman Arrives at Facility For Care

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Between point b and point c what needs to happen
Between Point B and Point C – What Needs to Happen? Barriers:

B

C

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


How can we help providers deliver quality care
How Can We Help Providers Deliver Quality Care? Barriers:

Quality Tools

  • Provide guidelines

  • Introduce continuous quality improvement processes (such as Standards-based Management and Recognition)

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Rewarding quality care
Rewarding Quality Care Barriers:

  • Accreditation of facilities in voucher schemes

  • Accreditation of hospitals in Brazil

  • Payment linked to quality score in Burundi and Rwanda

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


In Summary… Barriers:

Success of PE/E interventions can be helped or hindered by strengths and weaknesses in the health system

Interventions for Impact in Essential

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011


Interventions for Impact in Essential Barriers:

Obstetric and Newborn Care

Africa Regional Meeting, 21-25 February 2011

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