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Delivery of Improved Services for Health II “Care for Others, Care for Yourself” Delivery of Improved Services for Health II (DISH II) Project Collaboration between USAID, MOH, selected districts, FLEP and four U.S. partner institutions: JHU/CCP INTRAH MSH JHPIEGO Background

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Delivery

of

Improved Services

for

Health II

“Care for Others, Care for Yourself”


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Delivery of Improved Services for Health II (DISH II) Project

  • Collaboration between USAID, MOH, selected districts, FLEP and four U.S. partner institutions:

    JHU/CCP

    INTRAH

    MSH

    JHPIEGO


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Background Project

  • Three-year extension of DISH-I (October 99-September 2002)

  • Total funding $16 million

  • Coverage:

    • 12 out of 45 districts

    • 30% of the population


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Coverage Project


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DISH II Objectives Project

  • Increase provision of key components of the National Minimum Health Care Package

  • Strengthen integration of health services and quality of care

  • Change critical reproductive and MCH behavior

  • Achieve greater sustainability of health systems and human resources at district levels


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DISH II Quality Team Project

  • A total of 71 staff members:

    • 6 expatriate experts

    • 34 national experts

    • 31 administrative and support staff


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DISH II Key Implementation Features Project

  • Implemented in a decentralization structure:

    • Districts receive a grant to implement activities agreed upon with the project

    • Some activities cut across districts and are directly implemented by the project


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DISH II Project Management Project

  • Weekly project management meetings

  • Districts quarterly review meetings

  • Semi-annual project review meeting

  • Collaboration meetings with MOH and other partners in the RH area

  • Quarterly reports

  • Annual SO4 report


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DISH I Evaluation Survey Project

Findings


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DISH I Results Project

Percent of men and women currently using a modern family planning method, by year


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DISH I Results Project

Percent of place of delivery for last births in the three years preceding the survey, by year


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DISH I Results Project

Percent of women by ever using a condom, ever testing for HIV, by year


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DISH I Results Project

Percent of children born in the three years preceding the survey exclusively breastfeeding, by age of child


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Highlights of DISH I Results Project

  • Use of modern FP increased from 13% to 20%

  • Deliveries at facilities increased from 48% to 54%

  • Condom ever use for STD/HIV prevention increased

    • 12% to 20% among women

    • 27% to 40% among men

  • Among 4-6 months old infants, exclusive breastfeeding increased from 17% to 43%



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Quality of Care Studies Project

  • DISH-trained providers provided integrated services, especially HIV/STD prevention

  • Quality was higher for FP than for ANC

  • Overall, improvements are needed in areas such as client participation in counseling

  • Exit-interviews show high client satisfaction with service. However, FGD showed mixed feelings.


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DISH I Challenges Project

  • Maintaining FP use momentum - increase use of LTFP

  • Improving antenatal care seeking behavior

  • Increasing facility deliveries


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DISH I Challenges Project

  • Child nutrition

  • Improving health service management

  • Increasing availability and use of HIV testing and counseling services



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DISH II Project Management Project

  • Produced the first 18 months work plan

  • 12 district work plan workshops held

  • One-year district grant contracts finalized, funds disbursed

  • Two quarterly reports produced

  • Several collaboration meetings with MOH and other partners in the RH area



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DISH II Training and Clinical Services Component Project

Training and supervision continues:

  • Indirectly by training trainers who in turn train service providers in their respective districts

  • As the project directly conducts training in additional areas introduced in DISH II: EOC, PAC, LTPM


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Training component cntd. Project

  • Established district training & supervision teams in all districts; trained these trainers in IMCI & PAC

  • Update training for 8 doctors in LTPM

  • Supervised district trainers conducting IMCI training in all project districts

  • Updated/modularized comprehensive RH curriculum for nurses & midwives as well as for nursing assistants

  • Working on IPC/C training curriculum



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DISH II Behavior Change Communication Component Project

  • Male involvement in family planning campaign launched

    • Fourth video in Time to Care series: “A Question of Children”

    • TV and radio spots

    • “Health Matters” newsletter

  • Preparation activities started for:

    • Child nutrition campaign

    • HIV/AIDS core transmitters campaign


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DISH II Health Management and Quality Assurance Component Project

HMIS, Logistics System, Supervision,

Quality of Care, HSD/Facility Management


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DISH II Health Management and Quality Assurance Component Project

  • Conducted health facility inventory

  • Updated HMIS officers in new HMIS software

  • Updated district computer equipment

  • Compiled HMIS monthly data

  • Conducted workshop to design DISH II quality of care improvement strategy

  • Assessed logistical system in all districts



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DISH II Monitoring and Evaluation Component Project

  • Disseminating DISH survey findings at district level. A national dissemination is scheduled for September 6, 2000

  • Designed and established a monitoring and evaluation system

  • Conducted a special study to explain HMIS recently observed trends in utilization of RH services


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DISH II Challenges Project

  • Noted declining trends in key RH utilization indicators that suggested clients are shifting to private services


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DISH II Upcoming Activities Project

  • Training and Clinical Services

    • Training and supervision of trainers

    • District training of service providers

    • Training of nursing assistants through distance learning

  • Behavior Change Communication

    • New campaigns in Child Health, Immunization, Adolescent Reproductive Health, and LTPM


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DISH II Upcoming Activities Project

  • Health Management and Quality Assurance

    • Implement the Quality of Care Strategy

    • Continue compiling of HMIS data

    • Develop consumption-based drug system and train facility staff in drug needs assessment


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DISH II Upcoming Activities Project

  • Monitoring and Evaluation

    • Impact analysis

    • Study on the role of private sector in providing RH

    • Establishing of MCH audit system

  • Management

    • Conduct mid-year review meeting


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Lessons Learned to Date Project

A need for developing new approaches to involving districts in national strategy formulation

A need for some flexibility & resources in the national strategy to respond to district priorities and implementation strategies


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Lessons Learned to Date Project

Joint operational planning of activities between BCC and training components is critical

Improved capacity is needed to implement national IEC strategies