creating an enabling environment for pe/e interventions 23 february 2011 addis ababa, ethiopia...
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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 - PowerPoint PPT PresentationTRANSCRIPT
Creating an Enabling Environment for PE/E Interventions
23 February 2011Addis Ababa, Ethiopia
Lindsay Morgan
1Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
Outcomes Depend on Context
Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
Health Systems 101
3Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
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 CareAfrica Regional Meeting, 21-25 February 2011
And others…
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Social Environment•Culture•Household characteristics•Individuals
Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
For Effective PE/E Care-- What Needs to
Happen?
6Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
STEP 1: A Woman Learns She Is Pregnant
7Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
Between Point A and Point B –What Needs to Happen?
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A B
Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
How Can We Help Women Seek Care?
Insurance to overcome 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
9Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
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
10Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
Another Approach for Overcoming Financial and Social/Geo Barriers:
Targeted SubsidiesVouchers: A purchaser 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.
11Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
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
12Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
Overcoming Geographic Barriers:
Bring Services to Communities
•Community Health Workers•Mobile clinics•Health camps
13Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
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
14Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
STEP 2: Woman Arrives at Facility For Care
15Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
Between Point B and Point C – What Needs to Happen?
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B C
Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
How Can We Help Providers Deliver Quality Care?
Quality Tools•Provide guidelines•Introduce continuous quality improvement processes (such as Standards-based Management and Recognition)
17Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
Rewarding Quality Care
Accreditation of facilities in voucher schemes
Accreditation of hospitals in Brazil Payment linked to quality score in
Burundi and Rwanda
18Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
Success of PE/E interventions can be
helped or hindered by strengths and weaknesses
in the health system
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In Summary…
Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011
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Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February 2011