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Creating an Enabling Environment for PE/E Interventions 23 February 2011 Addis Ababa, Ethiopia Lindsay Morgan

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

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  1. 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

  2. Outcomes Depend on Context Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February 2011

  3. Health Systems 101 Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February 2011

  4. 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

  5. And others… • Social Environment • Culture • Household characteristics • Individuals Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February 2011

  6. 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

  7. STEP 1: A Woman Learns She Is Pregnant Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February 2011

  8. 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

  9. 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

  10. 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

  11. 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

  12. Results and Challenges • 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

  13. Overcoming Geographic 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

  14. Results and Challenges • 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

  15. STEP 2: Woman Arrives at Facility For Care Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February 2011

  16. Between Point B and Point C – What Needs to Happen? B C Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February 2011

  17. How Can We Help Providers Deliver Quality Care? 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

  18. Rewarding Quality Care • 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

  19. In Summary… 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

  20. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February 2011 Thank you! wwww.mchip.net Follow us on:

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