Collaboration Workshop for Health System Strengthening

1. Collaboration Workshop for Health System Strengthening Triangle Global Health Consortium December 2, 2009

2. FHI Experience with HSS • FHI has many years of HSS experience through its management of public health programs and conducting public health research in developing countries • The programs have not always been labeled HSS • The following are illustrative examples of FHI’s work under each of the 6 health system building blocks

3. Service Delivery • Organization & Integration of Services • Integration of FP & TB services into HIV services • Creation of referral networks: KIDMAP for OVC in Nigeria, HIV program referral model in Zambia • Study on effects of HIV/AIDS services on use of other services in Rwanda* • Quality Improvement Efforts • Strengthened TB services in Senegal • Reduction of mother-to-child transmission of HIV, improved continuity of AIDS treatment, & increased cure rate of TB in Mozambique & Tanzania *Price, Jessica E., Leslie, Jennifer Asuka, Welsh, Michael and Binagwaho, Agnès'Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects', AIDS Care, 21: 5, 608 — 614

4. Work Force Development • Development of Training Curriculum for Capacity Building of Health Workers • HIV/AIDS, STI, FP, RH, OVC services • QA/QI, data management & analysis, research methods • Piloting of Innovative Solutions to Address Health Workforce Gaps • “Retired but not tired” program in Tanzania • Research on task-shifting in Rwanda • Training of local staff in operational and clinical research and research utilization in Kenya, India, and Vietnam

5. Health Information Systems • Development of Electronic HIS • Patient-tracking systems: LAMIS in Nigeria, Smart Care in Zambia • Data management systems: CAMIS in Cambodia, SISE in Senegal • Support for Surveys, Surveillance, M&E Systems • National IBBS in Nigeria & Vietnam • Conduct of data quality audit (DQA) in many countries

6. Governance • Support to Development of National Policies, Strategies, & Guidelines • Palliative care policy in Ivory Coast • National HIV/AIDS strategies in many countries • National STI management guidelines in India • Advocacy • Advocacy for direct state financing & leveraging of resources in India • Advocacy for essential drugs to be included in New Rural Health Insurance Mechanism in China

7. Medical Products, Vaccines, & Technologies • Product Quality Compliance • Comprehensive quality assurance of contraceptives & drugs • Support to procurement & distribution systems • Training of product quality lab personnel and assessing quality control of manufacturers producing public health commodities in developing countries • Lab Services Strengthening • Clinical research • Service delivery

8. Health Financing • Measuring incremental costs of interventions • Incremental cost of community-based PMTCT in Nepal • To inform budgeting process of MoH or part of CEA • Microeconomics & average costs of Studies • Costs of clinic-based HIV/AIDS services in Zambia • Costing of scaling-up services • Studies on financial sustainability of services in developing countries • Training NGOs in cost-recovery in many African and Latin America countries

9. Challenges • Few sponsors fund holistic HSS programs that effectively address all 6 building blocks • The contribution of current disease-control programs to HSS is not well documented • Not enough evidence on the best ways to design a HSS strategy • Should there be an HSS program or an HSS component of a vertical disease-control program?