Terms of Reference for HSSO

Dr Wai Mar Mar HtunDeputy Director (Planning)

Terms of Reference for HSSO

In collaboration with the Division of Planning, States/ Region Directors and Township Medical Officers, to:

1. Facilitate the development of health system planning guidelines.

2. Conduct baseline health system assessments of selected Township clusters.

3. Facilitate the development of Coordinated Township Health Plans.

4. Support States and Divisions to conduct programs of supportive supervision according to guidelines developed.

5. Participate in research and development of Health Financing schemes in Township clusters.

Terms of Reference

6. Assist in the development and oversight of new costing guidelines of coordinated Township Health Plans.

7. Assist in the development and oversight of strategies to revitalize health committees and CHW participation in preventive health programs

8. Facilitate communications between NGOs and the DOH for Agreements of Work in hard to reach or never reached areas.

9. Assist in the development and oversight of human resource development activities, including integrated training programs, and the design and evaluation of retention schemes for rural midwives and PHS 2.

10. Support the enhancement of M & E activities (including programs of annual review) within the current system of HMIS).

Terms of Reference

11. Periodically report to the HSS working group on the research, development and implementation of health systems innovations (health planning, health financing, social mobilization).

12. Assist the DOH and HSS Working Group to facilitate uptake of findings into policy and practice by disseminating findings of research in public health forums, HSS Working Group Meetings, Annual Program Reviews and through publications.

Planning & Management

PROBLEMS found during HSS AssessmentLack of coordinated planlack of management trainingInfrequent supervision and monitoring

RESPONSE• CTHP (costed) • Financing of supervision of regular supervision at

all levels• Quarterly and annual review meetings

PLANNING & MANAGEMENT

To strengthen the Township Health Systems we have invested in…1. HSS Assessments (with guidelines) √2. Mapping HTR (detail mapping identifying P, E, S

barriers) √3. Coordinated Township Health Plan (including

RHC/SH plans) (with guidelines) √4. Costed Planning with Financial Analysis and Gap

identification √5. Monitoring and supervision according to CTHP

Role of HSSO:PLANNING & MANAGEMENT • Full Partipation in HSS assessment √

• For those who will get to townships ahead of assessment, start with preliminary collection of data and filling in tables for planning and management, helping midwives to fill in mapping data for 2012, HR tables, Infrastructure tables etc, after negotiating with TMO √

• For those townships where assessment was conducted in 2013 (2012 data), also try with collection of 2011 data as above √

• Mapping HTR (detail mapping identifying P, E, S barriers) –try to make sure midwives understand P,E,S barriers in identifying HTR √

Service DeliveryPROBLEMS found during HSS AssessmentLow skilled birth attendanceLack of access in HTR area by pregnant mothers (P,E,S barriers)

PLAN RESPONSE• FINANCING strengthening referral systems between village and hospital

(patient referral fund HEF) - includes improved transport from village level and costs of treatment

• MOBILITY increased TA/DA for midwives to move to additional villages more frequently (villages under her sub centres) plus Package service according to micro plan (MCH + Nutrition + ES +EPI)

• COMMUNICATION regular meetings with local authority/ VHWS and advocacy to local authority (for identification of poor/ referral/selection of AMW/VHW etc)

Service DeliveryTo strengthen the Township Health Systems we have invested in…(to be implemented from 2013)1. Delivering package of service (MCH +EPI +

Nutrition + EH) by Group of BHS 2. Develop micro plan for this service in group at

each RHC emphasizing to reach mothers and children from HTR

3. Delivering quality of service4. Supporting DA/TA for those activities (calculation

in CTHP)

Roles of HSSO: Service Delivery • Monitor and supervise the package of services for

Quality service provision • Check whether they follow their tour program• Check whether they've filled up the data in fields• Sometimes ask the community with your own

interest whether there is improvement in quality of service (random)

• U1 forms preparation for them to get per-diems and U2 for support for travel

Health FinancingPROBLEMS found during HSS Assessment

Lack of operational finance for providers and economic barriers in the community

RESPONSE

• Costed CTHP with financial support for operations• Referral funds (HEF) to solve economic barriers in the

community

FINANCING

To strengthen the Township Health Systems that we have invested in…1. Hospital Equity Funds for the poor to access2. MVS and later CBHI3. Health Financing Management Skill4. Development of Sub Committee for Funds

Management5. Following Financial Management Guidelines6. Identification of poor (work together with TMO)

Role of HSSO: FINANCING

• Discussing with TMO/staff to get ideas on how to initiate Hospital Equity Funds (write down the discussion points)

• Try to ask about THC's activities• Ask permission to attend future THC meeting as

observer and to include HSS in agenda and assist TMO in developing meeting minutes;

• Ask when will the sub committee for fund management under THC/THSC will be formed and note down the process

• Assist TMO with ideas for identification of poor according to guidelines

Human Resources

PROBLEM

Low midwife population ratio and incorrect skill mixPoor retention of staff in HTR

PLAN RESPONSE

• Training of the auxiliary midwife and CHW• Refresher training of the AMW and CHW• Regular CME from BHS to VHW at RHC and sub RHC• Renovation of RHC/construction of sub centers• Per-diems for operations

HUMAN RESOURCE FOR HEALTH

To strengthen the Township Health Systems that we have invested in…1. Recruitment/Training of AMWs & refresher

training2. Recruitment/Training of CHWs & refresher

training3. HR Research (for retention of HWF) and follow up

thereafter

Role of HSSO: Human Resource for Health

• Discussing with TMO/staff in identifying AMW/CHW from HTR areas/villages where midwives cannot reach and where there is a need (20 each for recruitment and training)

• If TMO permits, involve in training of CHW/AMW for some parts

Training

PROBLEM Lack of training on management & research

RESPONSE• Modified MEP training• HSR training• HSR grant

Capacity Building for Management & Leadership

To strengthen the Township Health Systems that we have invested in…

1. TOT given to HSSOs on M&L & then to BHS2. Improve facilitating skills of BHS3. Improve team building amongst BHS4. Improve knowledge management5. Improve Continuous Personal Professional

Development

Capacity Building for Health Systems Research

To strengthen the Township Health Systems that we have invested in…• 1. TOT given to HSSOs on HSR & then to BHS2. S/D personnel conducting operational research

on HSS implementation at respective townships3. Ignite and assist TMO/senior HAs to write

proposal for operational research and conduct research (evaluative)

Capacity Building for Evaluation Tools

To strengthen the Township Health Systems that we have invested in…

1. TOT given to HSSOs on Evaluation tools & then to BHS

2. TOT on coordinated action of 4 programs to HSSOs & then to BHS

3. TOT on financial management

Infrastructure

PROBLEM10 sub RHC have no building Only 1 facility with a delivery roomLimited housing for retention of staffLimited water and electrical supply (no power in sub

centres)

RESPONSE• Increased institutional delivery through improved facility

(constructions and renovations including delivery room at sub RHC and RHC)

• Include water/sanitation/electrical supply in construction work

Infrastructure

To strengthen the Township Health Systems we have invested in… 1. Constructing new Sub Centers2. Renovating RHCs3. Installing solar4. Identification and prioritization of most needy

with TMO/BHS

Essential medicines

PROBLEM Limitations in supplies of ED and equipment (no

replenishment for 10 years)

RESPONSE• Essential Drugs to TH/SH/RHC/ sub center level • Equipment (RHC kit/HA kit/MW kit/CDK) • Incremental for 4 years

Supplies & Equipment

• To strengthen the Township Health Systems we have invested in…1. Stock out of ED2. Equipment maintenance3. Need for the coming year

Role: checking for incoming S&E from GAVI HSS Monitoring use and stock out at all levels

Supervision

PROBLEM Lack of supervision check list

RESPONSE• Supportive supervision • TA for supervision• Check-list is the RHC plan• Data Quality and service quality

DATA QUALITY and SERVICE QUALITY

• To strengthen the Township Health Systems we have invested in…1. HSS assessment- DQA and SQA includes for 2 HTR

and 1 easy to reach –think to expand it to othersRole of HSSO:

Data quality check whenever you visit RHC/sub RHC and note down Teach midwives on data quality during CME

HSSOs equipped

Lap Top for M&E and many other inputs/process • If possible, open g-mail account in areas where internet is accessible to get contact• Always note down whatever you observe/any progress in your lap top•Monthly report to Division of Planning of progress of work in writing upon the Inputs and process whether following CTHP as planned or not• Be innovative and be accountable and transparent upon your job

Your work will be measured by the improvement of Township you’re concerned –

• In planning and management• In service delivery (performance indicators)• In utilization of health centers by poor people• in Financial management• In HSR• In management and leadership roles• In Human Resource management• In M&E• In provision of S&E