Geneva Health Forum Archive

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GHF2014 – PS35 – Social Media and Global Health: The “How to” and “What for”

14:00
15:30
PS35 THURSDAY, 17 APRIL 2014 ROOM: 3
ICON_Fishbowl
Social Media and Global Health: The "How to" and "What for"
SPEAKERS:
Dr. Greg Martin
Editor-in-Chief, Journal of Globalization and Health, Ireland
Mr. Sebastian Majewski
Senior Communications Officer, Gates Foundation, United States
OUTLINE:
This session will comprise two presentations followed by questions and discussion about the use of social media in the global health space. Dr Greg Martin (Globalization and Health) will give a brief overview of lessons learned through his experience in using social media to create virtual “communities” across borders. This will be followed by a presentation by Sebastian Majewski (Gates Foundation) in which he will talk about exciting work that is being done using social media monitoring to tackle some of the more urgent public health and development problems globally.
PROFILES:

photo greg martinDr. Greg Martin

Dr. Greg Martin is a South African doctor with a masters in public health and an MBA degree. Dr Martin’s involvement in global health has spanned a wide rang of subject matter including maternal and child health, cancer prevention, access to medicine and the treatment and care of people living with HIV, amongst others. He recently stepped down from the role of Director of Elimination of Mother to Child Transmission at the Clinton Health Access Initiative in order to move to Ireland where he recently got married. He is currently with Editor-in-Chief of the journal Globalization and Health and runs a Global Health YouTube channel as well as working as a clinician in a local hospital in Dublin.

Sebastian_Majewski_20131209_0020Mr. Sebastian Majewski

Sebastian Majewski (@sebmaje) is Senior Communications Officer at the Gates Foundation. Guided by social media monitoring and data analysis, Majewski’s evidence-based marketing approach focuses on social media’s potential to influence, inform, and legitimize agenda-setting in the international community. With more than six years’ experience in digital communications for UNICEF, UNDP and UNDESA, Majewski has been at the core of shaping global advocacy strategies for the largest humanitarian organizations.

Sebastian lectures master students of France Business School on social media monitoring, and is a regular speaker at social media conferences such as Social Media Week, Benchmark, and Dreamforce.

GHF2014 – PS30 – Debate Motion: “This house believes reverse innovation in health is a distinct category of innovation that holds the key to creating effective future health solutions.”

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12:15
PS30 WEDNESDAY, 16 APRIL 2014 ROOM: 3
ICON_Debate
Debate Motion: “This house believes reverse innovation in health is a distinct category of innovation that holds the key to creating effective future health solutions.”
MODERATOR:
Dr. Greg Martin
Editor-in-Chief, Journal of Globalization and Health, Ireland
FOR THE MOTION:
Dr. Shams B. Syed
Program Manager, African Partnerships for Patient Safety (APPS), Global Partnerships Lead, WHO Service Delivery & Safety (SDS), Switzerland
Ms. Vivasvat Dadwal
Senior Fellow at the University of Ottawa, Centre on Governance, Canada
AGAINST THE MOTION:
Mrs. Bronwyn Lay
Writer, Jurist, Australia
Dr. Sunoor Verma
Executive Director, Geneva Health Forum, Switzerland
PROFILES:

photo greg martinDr. Greg Martin
Editor-in-Chief, Journal of Globalization and Health, Ireland

Dr. Greg Martin is a South African doctor with a masters in public health and an MBA degree. Dr Martin’s involvement in global health has spanned a wide rang of subject matter including maternal and child health, cancer prevention, access to medicine and the treatment and care of people living with HIV, amongst others. He recently stepped down from the role of Director of Elimination of Mother to Child Transmission at the Clinton Health Access Initiative in order to move to Ireland where he recently got married. He is currently with Editor-in-Chief of the journal Globalization and Health and runs a Global Health YouTube channel as well as working as a clinician in a local hospital in Dublin.

 

ShamsSyedIMG_2475Dr. Shams B. Syed, Program Manager, African Partnerships for Patient Safety (APPS), Global Partnerships Lead, WHO Service Delivery & Safety (SDS), Switzerland

Dr. Shams Syed is responsible for overseeing African Partnerships for Patient Safety (APPS), based at WHO Headquarters in Geneva. He has led the development and implementation of the programme since its inception in 2008. He assumed responsibility for global partnership development in the newly formed WHO Department of Service Delivery & Safety in 2013. Dr. Syed received his medical degree from St. George’s, University of London, and subsequently practiced as an independent General Practitioner in the UK. He received postgraduate public health training at the University of Cambridge. Subsequently, he trained in Preventive Medicine at Johns Hopkins University, is US Board Certified in Public Health & Preventive Medicine and a Fellow of the American College of Preventive Medicine. His previous experiences include: involvement in a future-focused multi-country health systems research consortium; working at the Pan American Health Organization with seven Caribbean countries on strengthening health systems with a focus on surveillance systems; and working as the Advisor on Family and Community Health at the WHO Country Office in Trinidad and Tobago with a focus on quality of care. Dr. Syed has a focused academic interest in reverse innovation in global health systems.

 

PS03_Vivasvat_DadwalMs. Vivasvat Dadwal

Viva is a civil servant by day, community-builder by night. Viva's multidisciplinary interests span local, national, and international spheres. She is engaged in a range of socially and politically minded activities - from Canadian history to global health. She is a Senior Research Fellow at the Centre on Governance at the University of Ottawa and Associate Editor of the London School of Economics-affiliated journal Globalization and Health. She has held prestigious internships at the World Health Organization and Permanent Mission of Canada to the United Nations and to the World Trade Organization in Geneva. She is also a guest blogger for World Bank's youth blog, Youthink! Viva holds a B.Sc. (Hons) in Biology from the University of Windsor, and an M.A. in Public and International Affairs from the University of Ottawa.

 

Sunoor -130Dr. Sunoor Verma
Executive Director, Geneva Health Forum, Switzerland

Dr. Sunoor Verma is the Executive Director Geneva Health Forum.As a senior development expert, Sunoor Verma has worked in emergency, conflict and post-conflict situations. He has led the establishment of complex partnerships and coalitions by negotiating strategic agreements and their implementation plans. He has set up programs across sectors, including, Education, Health, Protection, Injuries, Sanitation, HIV/AIDS, Harm Reduction, Conflict Resolution, Refugees, Internally Displaced Persons, Environment, Culture, Gender, Minority issues etc. He has worked in various locations, including Western Europe, South East Europe, South Asia, South East Asia, North Africa and Australia. Among others, he consulted and worked with UNHCR, UNICEF, and the European Centre for Minority Issues, Cambridge University and the Australian Society of Plastic Surgeons. Sunoor Vema has been the principal consultant of the strategy consulting practice ‘ProCube’ and is the founder of www.csrforchildren.org.

He is a seasoned speaker on the topics of strategy, partnerships and leadership. He is also sought after for his skills as an effective moderator on high-voltage panels. In a previous avatar, Sunoor Verma was a practicing cardiothoracic surgeon.

 

PS30_Lay Profile PhotoMrs. Bronwyn Lay

Bronwyn Lay currently lives with her family in rural France near the Swiss border.

Before moving overseas, Bronwyn worked as a legal aid lawyer in Melbourne, obtained post-graduate qualifications in political theory and was involved with various community organisations.

She now spends her time writing and pondering the world from the safety of her vegetable patch.

 

GHF2014 – PS27 – Health as an Indicator of Sustainable Development: How Health Can Contribute to and Benefit from Sustainable Policies

10:45
12:15
PS27 THURSDAY, 17 APRIL 2014 ROOM: 13
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Health as an Indicator of Sustainable Development: How Health Can Contribute to and Benefit from Sustainable Policies
MODERATORS:
Dr. Carlos Dora
Department of Public Health and Environment, World Health Organization, Switzerland
SPEAKERS:
Prof. Ilona Kickbush
Director, Global Health Programme, The Graduate Institute of International and Development Studies, Switzerland
Health as an Indicator of Sustainable Development: How Health Can Contribute to and Benefit from Sustainable Policies
Ms. Natalie Mrak
Student, Masters of Development Studies, The Graduate Institute for International and Development Studies, Switzerland
Mr. Callum Brindley
Student, Masters of Development Studies, The Graduate Institute for International and Development Studies, Switzerland
Dr. Ralph Chapman, Environmental Studies Director, Victoria University, Wellington, New Zealand
Dr. Philippa Howden-Chapman, Professor of Public Health, University of Otago, and Director of the New Zealand Centre for Sustainable Cities, New Zealand
OUTLINE:
This session will begin with a comprehensive overview of the expansive literature, encompassing more than 20 years, on how health indicators can serve as measures of sustainable development and the presentation of a tool that has been developed which essentially combines all of this literature on indicators into one space. This will then set the stage for discussion on how this literature can essentially be placed into action. The session will entail perspectives from local, national and global levels as well as academic circles in order to provide a more comprehensive overview of the progress that has been made in incorporating health into sustainable development objectives as well as the challenges and the bottlenecks which still remain. The aim is to stimulate creative thinking and discussion around innovative ways through which health can become more embedded in the sustainable development agenda.This discussion is crucial particularly as the post-2015 development agenda talks continue. While the first set of Millennium Development Goals (MDGs) were a momentous endeavor to tackle crucial issues affecting the most vulnerable, they did not provide a comprehensive and integrated approach to tackling these challenges. Health was a dominant theme in the first set of MDGs, composing 3 of 8 goals but as 2015 approaches it is apparent that these goals do not comprehensively address the major health challenges of the 21st century for both developed and developing countries alike. While barriers to overcoming communicable diseases, maternal and child health still exist, issues such as tropical diseases (NTDs) and non-communicable diseases (NCDs) are posing challenges to existing approaches to health. A horizontal integrative approach is crucial to overcoming these new health challenges. For instance, good water and sanitation could prevent the infection from the majority of  NTDs while changes in daily routines, such as the substitution of motor transport for public or active transport, could reduce the incidence of NCDs.While recent literature has called for the inclusion of health in the post-2015 sustainable development agenda, there has not been a substantial discussion on how it could fit into this agenda and what exactly this health goal would look like as well as its feasibility at all levels of government from global to national to local.
PROFILES:

Carlos Dora_squareDr. Carlos Dora

Carlos Dora, is a coordinator at the WHO HQ Public Health and Environment Department, leading work on health impacts of sector policies (energy, transport, housing and extractive industry), health impact assessment and co-benefits from green economy/climate change policies. He previously worked at the London School of Hygiene and Tropical Medicine (LSHTM), at the WHO Regional Office for Europe, at the World Bank, and with primary care systems in Brazil after practicing medicine. He serves in many science and policy committees, has an MSc and PhD from the LSHTM.  His publications cover health impact of sector and sustainable development policies, HIA and health risk communication.

Ilona KickbushProf. Ilona Kickbush

Ilona Kickbusch is the Director of the Global Health Programme at the Graduate Institute of International and Development Studies, Geneva. She advises organisations, government agencies and the private sector on policies and strategies to promote health at the national, European and international level. She has published widely and is a member of a number of advisory boards in both the academic and the health policy arena. She has received many awards and served as the Adelaide Thinker in Residence at the invitation of the Premier of South Australia. She has recently launched a think-tank initiative “Global Health Europe: A Platform for European Engagement in Global Health” and the “Consortium for Global Health Diplomacy”.

Her key areas of interest are global health governance, global health diplomacy, health in all policies, the health society and health literacy. She has had a distinguished career with the World Health Organization, at both the regional and global level, where she initiated the Ottawa Charter for Health Promotion and a range of “settings projects” including Healthy Cities. From 1998 – 2003 she joined Yale University as the head of the global health division, where she contributed to shaping the field of global health and headed a major Fulbright programme. She is a political scientist with a PhD from the University of Konstanz, Germany.

PS27_Natalie_MrakMs. Natalie Mrak

Natalie   Mrak is a Global  Health  Project Coordinator with the Access to Health (A2H) team. In  parallel, she is also pursuing a Master´s in Development Studies, with a concentration on Human, Financial and Economic Development, at the Graduate Institute for International and  Development Studies (IHEID).  At  the  Institute,  she  is  focusing  on  global health issues. including  health  and  sustainable  development  as  well  as  the role of emerging  economies  in  global  health  governance and diplomacy. While in Geneva,   Natalie   has   interned  for  Otsuka  Pharmaceuticals  in  their communications  division  and in the community mobilization unit at UNAIDS. Prior  to  her  arrival in Geneva, Natalie worked at UNICEF headquarters in New York for 4 years as the Executive Assistant to the Chief of the HIV and AIDS  programme. In addition, she has a Master´s in International Relations from  the  City College of the City University of New York (CCNY) where she focused  on  gender  and  development  issues  in  Eastern  Europe. Natalie received  her  Bachelor´s  degree  from Kenyon College where she received a dual degree in History, with honors distinction, and Spanish Studies as well as Magna Cum Laude and Phi Beta Kappa honors.

PS27_Callum_BrindleyMr. Callum Brindley

Callum Brindley is studying a Masters of Development Studies at the Graduate Institute for International and Development Studies in Geneva. He is also a part-time researcher with the Global Health Programme and has co-authored two WHO publications on Health in All Policies and health in the post-2015 development agenda. Prior to his post-graduate studies, Callum worked for three years with the Australian Agency for International Development.

Ralph Chapman (aug06) VUW photoDr. Ralph Chapman

Ralph directs the Graduate Programme in Environmental Studies at Victoria University. An environmental economist, he’s worked on energy, transport, urban design and climate change. He’s also worked with the New Zealand Ministry for the Environment, the NZ Treasury; the British Treasury in Whitehall; the OECD, in the Beehive, and as a negotiator for New Zealand of the Kyoto Protocol. Ralph has a first in engineering, a Masters in public policy, and a PhD in economics.

GHF2014 – PS07 – Improving Maternal and Child Health Services

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15:30
PS07 TUESDAY, 15 APRIL 2014 ROOM: LEMAN ICON_Fishbowl
Improving Maternal and Child Health Services
MODERATOR:
Dr. Anayda Portela, Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Switzerland
SPEAKERS:
Maternal Health Workforce Management in Vietnamese Health Communes
Mrs. Thi Hoai Thu Nguyen, PhD student, Faculty of Health Management, Hanoi School of Public Health, Vietnam
Integrating Community Participation in Maternal and Newborn Health Services: Burkina Faso
Integrating Health Promotion to Improve Maternal and Newborn Health in El Salvador
Ms. Janet Perkins, Health Programme Officer, Health Department, Enfants du Monde, Switzerland
Linking Health And Educations Measures To Improve Early Childhood Development Programmes: Kyrgyzstan
Dr. Anara Doolotova, Health Programme Officer, Health Department, Aga Khan Foundation, Kyrgyzstan
New Model of Formative Supervision to Improve Health Outcomes in Ukraine
Mr. Martin Raab, Senior Public Health Specialist and Project Manager, Head of the Unit, Health Technology & Telemedicine Unit, Swiss Center for International Health, Swiss Tropical and Public Health Institute, Switzerland
OUTLINE:
PROFILES:

Nguyen Profile PhotoMrs. Thi Hoai Thu Nguyen

Nguyen, Thi Hoai Thu (MSc) is a lecturer in the Hanoi School of Public Health and is a PhD student of the Queensland University of Technology. Her research encompasses issues related to health system governance. Her recent research includes multi-partner research in the three Asian countries including Vietnam, HESVIC (Health systems stewardship and regulation in Vietnam, India and China) funded by the European Commission.

PS07_PerkinsMs. Janet Perkins

Janet Perkins is a Programme Officer in the Health Department of Enfants du Monde, a nongovernmental organization based in Geneva, Switzerland, where she provides technical support to maternal and newborn health projects in Bangladesh, Burkina Faso, El Salvador and Haiti. She also works as a consultant to the World Health Organization. She obtained her MPH at the University of Texas Houston Health Science Center in 2008.  She has previously worked with governmental and non-governmental organizations on health promotion in Houston, Texas, U.S.A.

Doolotova PhotoDr. Anara Doolotova

Dr. Doolotova has been working in the public health sector in Central Asia for almost 30 years after graduating from the Kyrgyz Medical State University in Kyrgyzstan.  In 1995, she graduated from the Kyrgyz Research Obstetrics and Pediatrics Institute and obtained my PhD in Medical Science (PhD). Additionally, she successfully completed her non-degree Hubert Humphrey fellowship in public health policy and management for mid-level professionals at the Johns Hopkins University (2007 to 2008) in Baltimore, USA.

She has six years of project management experience, four of which she spent in Kyrgyzstan implementing the Project HOPE, a USAID program on child survival. She spent two years in Tajikistan implementing the Water Sanitation of Mission East project, which was funded by Denmark, EU. Also, she worked for almost two years as the Regional Monitoring & Evaluation Coordinator in Kyrgyzstan, Tajikistan and Turkmenistan with Creative Associates, implementing the Quality Learning Project. Currently, Dr. Doolotova is working as the Health Program Officer of Aga Khan Foundation coordinating the health programs, strategy development and fundraising. From 2011 she has been working as a focal point of Central Asia Health Systems strengthening project (CAHSS) in two regions of Kyrgyzstan. CAHSS aims to strengthen health systems to improve the health of men and women, particularly women of reproductive age, newborns and children under five in target areas of Pakistan, Afghanistan, Tajikistan and Kyrgyz Republic. The project is funded by DFAID.

GHF2014 – PS03 – Primary Health Care Reforms and Family Medicine

10:45
12:15
PS03 TUESDAY, 15 APRIL 2014 ROOM: 15 ICON_Fishbowl
Primary Health Care Reforms and Family Medicine
MODERATOR:
Prof. Jan De Maeseneer
Head of the Department of Family Medicine and Primary Health Care of Ghent University, Belgium
SPEAKERS:
Identifying and Addressing Structural Quality Gaps in Primary Health Care in Tanzania
Dr. Dominick Mboya
Research Scientist, Research Department, Ifakara Health Institute, Tanzania
Medical Student and Clinical Teaching Staff Attitudes and Perception of Family Medicine: Tajikistan
Prof. Dilrabo Kadirova
Professor of Family Medicine, Chair of Family Medicine Nb. 1, Tajik State Medical University, Tajikistan
The Impact of the Family Health Team (FHT) model on UNRWA PHC clinic: a success story in a resource-limited and refugee setting
Dr. Ali Khader
Family Health Team Coordinator, Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jordan
Making the Profession of Family Doctors Attractive for Future Doctors: Kyrgyzstan
Dr. Salima Sydykova
Teacher, Kyrgyz State Medical Academy I.K. Akhunbaev, Kyrgyzstan
Dr. Flora Lucas Kessy
Senior Lecturer in Development Studies, Mzumbe University, Dar es Salaam Campus College, Tanzania
OUTLINE:
PROFILES:

JanDeMaeseneerProf. Jan De Maeseneer

Professor Jan De Maeseneer is a family physician and Head of the Department of Family Medicine and Primary Health Care of Ghent University. His research at the university focuses on Education, Health Promotion, Health inequity, Health Services Research and Global Health. He published more than 100 articles in scientific journals.

In 2013 Jan De Maeseneer was appointed to the Expert Panel on effective ways of investing in health of the European Commission. In 2012 Jan De Maeseneer became a member of the Global Forum on Innovation in Health Professional Education at the Institute of Medicine in Washington. (Read more…)

 

PS03_Mboya_squareDr. Dominick Mboya

Dominick Mboya has over 25 years experience as medical practice and teaching, currently employed as a research scientist at Ifakara Health Institute in Tanzania, responsible for coordinating Health System Quality Improvement initiatives implemented by Ifakara Health Institute through Initiative to Strengthen Affordability and Quality of Health Care (ISAQH). The initiative is funded by Novartis Foundation for Sustainable Development. Apart from that he is the Intervention coordinator for the Connect project designed to test the model of trained and paid Community Health Workers to accelerate achievement of MDG 4 & 5, the project is funded by Doris Duke Foundation and Comic Relief. (Read more)

Kadirova PhotoProf. Dilrabo Kadirova

Prof. Dilrabo Kadirova is the Head of the Family Medicine Department No.1 of the Tajik State Medical University (TSMU) named after Abu Ali ibn Sino, MD, Professor. She has over 25 years of teaching experience.

Prof. Kadirova received her candidate of science and doctorate degrees studying at the Medical University in Moscow. Her research focuses on cardiology, in particular hypertension and its prevalence, diagnosis and treatment of different age groups: women, youth, elderly and senile, as well as the development of family medicine in the Republic of Tajikistan (RT). (Read more)

Dr. Khadrer_squareDr. Ali Khader

Worked as medical doctor in different clinics and hospitals in Jordan and Saudi Arabia, worked at different managerial and technical levels with the United Nations Relief and Works Agency (UNRWA). Developed guidelines, training materials, assessment tools, project and research proposals, developed PHC interventions, conducted scientific and operational research, published papers in the fields of maternal and child health, NCDs, Tobacco, school health, micronutrient deficiencies, family medicine…..  provided guidance and mentoring to staff and junior researcher. Represented UNRWA health department in regional and international meetings.

Kessey Profile PhotoDr. Flora Lucas Kessy

Flora Lucas Kessy, a Senior Lecturer in Development Studies at Mzumbe University, Morogoro Tanzania holds a PhD in Agricultural and Consumer Economics with a major in Family and Consumer Economics and a minor in Women and Gender in Global Perspective from University of Illinois at Urbana Champaign, USA. Dr. Kessy has researched and published on issues related to income and non-income poverty, social sectors development and good governance. In particular, she has researched on poverty reduction strategies in Eastern and Southern Africa, poverty escape routes, covariate and idiosyncratic shocks affecting households in Tanzania and social protection. In the area of governance, she is involved in public expenditure studies for the health sector and water sector and the use of evidence for actions to improve maternal and newborn health. (Read more)

 

Dr. Greg Martin

Dr. Greg Martin is a South African doctor with a masters in public health and an MBA degree. Dr Martin’s involvement in global health has spanned a wide rang of subject matter including maternal and child health, cancer prevention, access to medicine and the treatment and care of people living with HIV, amongst others. He recently stepped down from the role of Director of Elimination of Mother to Child Transmission at the Clinton Health Access Initiative in order to move to Ireland where he recently got married. He is currently with Editor-in-Chief of the journal Globalization and Health and runs a Global Health YouTube channel as well as working as a clinician in a local hospital in Dublin.

Administrative Integration of HIV Monitoring And Evaluation: A Case Study From South Africa.

Author(s) Mary Kawonga1, Sharon Fonn2, Duane Blaauw3.
Affiliation(s) 1Department of Community Health, Wits School of Public Health, Johannesburg, South Africa, 2School of Public Health, Wits School of Public Health, Johannesburg, South Africa, 3Centre for Health Policy, Wits School of Public Health, Johannesburg, South Africa.
Country - ies of focus South Africa
Relevant to the conference tracks Health Systems
Summary With increasing global focus on the integration of vertical programmes within health systems, methods are needed to analyse whether general health service (horizontal) managers at district level exercise administrative authority over disease programmes (administrative integration). This study adapts "decision space" analysis to measure administrative integration of HIV programme monitoring and evaluation (M&E). The study shows that horizontal managers exercise high degrees of authority in producing HIV information but not in using it for decisions, while vertical managers use HIV information but in silos. The lack of M&E integration may undermine district health system strengthening aims.
Background In South Africa, integration is a health sector reform priority, while several vertical programmes exist, notably for HIV, tuberculosis (TB), and maternal and child health (MCH). Historically a national HIV/AIDS directorate and specialist HIV managers have vertically managed the HIV programme and HIV programme managers account for ear-marked HIV programme funding through dedicated parallel reporting mechanisms. This is at odds with current health sector decentralisation reforms that envisage integrated management of health services under the control of generalist (horizontal) managers at a decentralised district level. National health policy envisions health districts as the foundation of the national health system.
Objectives If health districts are to be the foundation of the health system as envisaged, then horizontal district managers would need to be allocated and to exercise authority over district health services, including disease-specific interventions (i.e. administrative integration). This study examines whether this is happening in the South African health system. We use the HIV programme as a case study given its traditionally vertical approach, and focus on the M&E (information) function as a tracer for analysing administrative integration. The research aims are to:
1. Describe the extent to which horizontal managers exercise authority over HIV M&E coordination.
2. Explore factors associated with exercised authority.
Methodology The research explores two hypotheses: a) vertical managers exercise higher degrees of authority than horizontal managers in administering HIV M&E; and higher management capacity and HIV M&E knowledge are associated with higher degrees of exercised authority. This cross-sectional study was conducted in two of South Africa’s nine provinces. Fifty one participants were interviewed including: a) managers primarily responsible for general health services or general health information (horizontal manager) and b) those responsible for vertical services or information (vertical manager). HIV M&E was defined as the production of HIV information (HIV data collection, collation, analysis) and use of HIV information for decisions.In the absence of existing methods for measuring 'exercised authority' over vertical programmes, Bossert's decision-space’ approach provided a useful frame. Since decision-space analysis has not been applied to either the M&E function or in the context of programme integration, it was adapted to measure ‘exercised (administrative) authority’ in this study. We defined exercised authority as a manager undertakes tasks to oversee HIV data collection, collation and analysis, and uses HIV data to review the programme and take action. To measure this, we first identified the M&E tasks that managers were expected to perform within each M&E domain (collection, collation, analysis, use) and then administered a semi-structured questionnaire to collect data on participants’ performance of these tasks. We developed four sub-scales to measure the degree of exercised authority for each M&E domain. Sub-scales comprised several items (M&E tasks), which we coded ‘no’ if a respondent did not perform the task (score zero) or ‘yes’ if s/he did. We computed an ordinal dependent variable for each HIV M&E domain and coded observed scores as ‘low’, ‘medium’, and ‘high’. We performed ordinal logistic regression to explore whether explanatory variables (actor type [horizontal or vertical], health system level, highest, qualification, duration of management experience, management capacity score, and M&E knowledge score) were predictive of higher degrees of exercised authority.
Results More than 75% of participants were female, with an undergraduate degree or higher, and had some management
training. Participant characteristics were similar between vertical and horizontal managers. Horizontal managers attained higher mean scores for HIV data collection.
Conclusion In light of the increasing focus on health system strengthening and integration, our research makes a contribution
by providing a method and scales for measuring and monitoring administrative integration. We anticipate that
these scales will be strengthened further by empirical testing on larger samples and varied settings. In applying this
method to South Africa’s public sector HIV programme, we find that HIV M&E coordination is generally not administratively integrated, characterised by horizontal managers exercising little authority in using HIV data, and vertical managers using HIV data in sub-programme silos. We argue that this programme model potentially undermines South Africa's policy aims of integrated management of district health services under the authority of horizontal general health service managers. The research also indicates that plans for integrating the HIV programme within the health system at decentralised district level should include investments in strategies to equip horizontal managers with the knowledge and skills to use programme data for decision-making.

The Impact of the Family Health Team (FHT) model on UNRWA PHC clinics: a success story in a resource-limited refugee setting.

Author(s) Ali khader1, Majed Hababeh2, Irshad Shaikh3, Yousef Shahin 4, Wafaa Zeidan 5, Akihiro Seita6.
Affiliation(s) 1Health Department- UNRWA, UNRWA, Amman, Jordan, 2health, UNRWA, Amman, Jordan, 3Health, UNRWA, Amman, Jordan, 4Health, UNRWA, Amman, Jordan, 5Health, UNRWA, Amman, Jordan, 6Health, UNRWA, Amman, Jordan.
Country - ies of focus Palestine
Relevant to the conference tracks Health Systems
Summary The Family Health Team (FHT) approach brought substantive changes to the PHC services provided by UNRWA to Palestine refugees. It improved staff satisfaction and positive working environments for staff as well as a fair distribution of workload. The relationship with the community and clients become stronger. The quality of care and the utilization of resources also improved.
Background UNRWA provides comprehensive primary health care to 5 million Palestine refugees through 137 clinics in Gaza, Jordan, Lebanon, Syria and the West Bank. UNRWA has, for over six decades, used a vertical, program-oriented model to achieve substantial gains in maternal and child health in particular.
In response to the changing health care needs of Palestine refugees, particularly in the context of an aging population facing a growing burden of non-communicable diseases, increasing client loads, rising costs and stagnating resources, UNRWA is reforming its primary health care services.
The framework for this new service delivery model is the Family Health Team (FHT) approach. This is a patient-centered model that provides comprehensive PHC services to the entire family through a multi-disciplinary team of service providers at every stage of life. Families are registered with a team consisting of a doctor and one or more nurses and the team is responsible for all the primary care needs of all the family members.
Currently the FHT model is implemented in 51 health centres serving 1.5 million. Plans are ongoing to expand this model to all health centres by the end of 2015.
Objectives To assess quality and efficiency gains brought by the Family Health Team model on UNRWA primary health care services.
Methodology Methodology.
We have used different instruments to assess the impact of the FHT approach after 6 months of implementation in Rashidieh health centre providing PHC services for Palestine refugees in Rashidieh camp in Lebanon including:
Client Flow Analysis (CFA): Conducted on 23rd June 2012 . CFA tracks a client’s movements from point of arrival to the clinic, measuring time spent between service delivery points and with each service provider.
Rational drug use survey: The methodology is based on a method described in the WHO manual “How to investigate drug use in health facilities” (WHO, 1993). The survey was conducted during two consecutive days, 23rd and 24th June 2012.
Client satisfaction Survey & staff satisfaction surveys: the Survey was conducted during June 2013 and the questionnaire was developed and tested in-house.
Work-load Assessment: The assessment was conducted during two consecutive days on 23rd and 24th June 2012 to measure the workload between teams and for each staff within the team. It was developed and tested in-house.
Results The CFA indicated that the implementation of the FHT Model appears to have resulted in significantly shorter waiting times to see the physician, which was reduced from 16.0 to 8.2 minutes, (P< 5%). The mean contact time with the physician increased by 1.51 minutes (from 3.19 minutes to 4.7 minutes). The team structure had resulted in a balanced distribution of workload between staff. For example, the number of consultations with physicians were similar for both teams: (team I: 52% vs team II: 48%). The number of medical consultations decreased by 33%, a more integrated and comprehensive care (NCD, General, MCH) is provided by both teams, a more equitable workload distribution among teams with relatively equal age and gender distribution of clients. The antibiotic prescription rate decreased from 26.2% to 20.8%.
83% of staff considered the FHT either very helpful or helpful, 76% of clients are more satisfied, 66% of clients perceived higher quality and longer consultation time after the FHT implementation.
Conclusion Conclusion.
The FHT model implemented by UNRWA is an innovative approach in a refugee context with limited resources. It improves the quality of care provided at primary health care facilities with more efficient use of limited resources in term of staff, time and premises by decreasing waiting time and increasing contact time with the physician and improving client’s inflow-outflow.

Maternal Health Workforce Management in Vietnamese Health Communes

Author(s) Thi Hoai Thu Nguyen1, Andrew Wilson2, Fiona McDonald3
Affiliation(s) 1Faculty of Health, The Queensland University of Technology, Hanoi, Vietnam, 2Menzies Centre for Health Policy, The University of Sydney, Brisbane, Australia, 3Faculty of Law, The Queensland University of Technology, Brisbane, Australia.
Country - ies of focus Vietnam
Relevant to the conference tracks Health Workforce
Summary As part of a study into the governance of health workforce in Vietnam, this study examined the impact of staff qualifications, training opportunities and other factors on reported ability to perform Essential Obstetric Care services (EOCs) in two provinces. While qualifications and training were the most important factors, national and district policies, such as which health professionals can prescribe essential medications, were also important factors in limiting provision of EOCs.
Background Vietnam’s national policies recognise the importance for an effective health system to ensure sufficient human resources (Politburo Resolution No. 46/NQ-TW dated 23 February). However, current analysis indicates a number of issues, including an imbalance and maldistribution of the essential health workforce, shortages of appropriately skilled health workers and constraints in management and utilization of health workers. Parallel studies on the impact of health policies on the health workforce, the implementation of health policies and provision of health care services in Vietnam have identified a number of governance-related issues, including a lack of staff accountability, quality control measures in relation to workforce training and skills maintenance, inadequate participation of community and civil society organizations, and an unreliable health information system. Underdevelopment of governance mechanisms may be a significant barrier to the effective implementation of policies. However, so far there has been no systematic analysis to identify the points of weakness and gaps in the governance and internal management of human resources in the health care system at the provincial and district levels in Vietnam.
Objectives Ensuring access to good maternal health services is critical for Vietnam to achieve the relevant Millennium Development Goals and this requires a well-qualified maternal health workforce able to provide the EOCs. This study aims to examine the impact of national and district policies relevant to human resource management and organisational factors on the maternal health services. Specific objectives were:a) To identify the availability and qualifications of maternal healthcare providers at commune level in two provinces.
b) To identify the ability of maternal healthcare providers to provide the EOCs and the barriers to providing these services.
c) To understand how the existing organizational and policy factors influence maternal healthcare provider’s ability to provide EOCs.
Methodology The research has been conducted in five districts in two provinces in the Northern mountainous area of Vietnam. A mixed methods approach was used consisting of a self-administered questionnaire given to commune level staff and in-depth interviews with commune maternal healthcare providers and managers engaged in maternal health at district and provincial levels. The questionnaire consisted of four sections namely: demographic information relevant to maternal healthcare providers, the training opportunities they attended, self-rated ability to perform EOCs and a scale to measure elements of work motivation.The sample for the quantitative survey is 192 maternal healthcare staff who volunteered to complete the questionnaire. In-depth interviews were conducted with 60 participants of whom 18 chosen to represent the different workforce groupings and have been fully analysed.Initial analysis to explore the differences in maternal health workforce between the two provinces consisted of two way tabulations with statistical significance testing using the Chi-square test. All variables found to be significant in this analysis and the potentially confounding variables were incorporated into multivariate regression analysis to identify the independent associations with the ability to perform EOCs.

For the qualitative analysis the subset of 18 interviews was transcribed. Inductive analysis was used to identify, code and organize themes arising from the raw data, with quotations servings as units of analysis. Data was analysed for consistently occurring themes or categories using a qualitative research package, N-Vivo software.

Results Analysis of the survey indicates there are distinct differences between the provinces as to the mix of maternal health professionals, their qualifications, their access to further training, and their self-reported ability to perform EOCs at the commune levels.The multiple logistic regression analysis showed that staff were more likely to report having training on all EOCs if they worked at district level, had higher qualifications (university and equivalent or higher) and obstetric expertise.In both provinces, only 21.6% of staff reported being able to perform all EOCs. The most common reasons reported by staff for not being able to perform EOC services is “Because I am not allowed to do this”, followed by “Lack of training” and “Lack of drugs and equipment”.

The most important determinants of ability to perform the EOCs were qualification and training. Although having attended training course in the last 12 months was not significantly associated with ability to perform EOCs in univariate analysis, in the multivariate analysis it was significant.

Data from the in-depth interviews confirms a common theme that respondents felt constrained in their potential roles by policies. It is also identified other organizational, policy and resource constraints faced by staff and managers at the commune and district levels.

Conclusion 1. The study provides a better understanding of the factors influencing the health workforce’s capacity and capability in the maternal health context in Vietnam.
2. The restrictions on who can perform EOCs should be reviewed to improve access to full EOCs.
3. To use health workforce most efficiently and effectively, all appropriately trained staff need to be given the authority to carry out all EOCs including prescription of essential medicine regardless of qualifications.Given that access to maternal health services provided by appropriately trained health care workers has been shown to be important to better maternal and child health, this reform would assist Vietnam to achieve the MDGs.

Provider Initiative Approach to Enhance Family Planning Uptake in Women of Reproductive Age in Rural Communities in Osun State, Nigeria.

Author(s) Ademola Adelekan1, Elizabeth Edoni2.
Affiliation(s) Health Promotion and Education, University of Ibadan, Ibadan, Nigeria, Community Health Nursing, Niger Delta University, Bayelsa, Nigeria.
Country - ies of focus Nigeria
Relevant to the conference tracks Women and Children
Summary Despite decades of progress in improving the delivery and availability of family planning services, high levels of unmet need for family planning still exist in many countries. This suggests that novel approaches are needed to extend access to family planning services to women and couples who desire to limit or space their childbearing but are not currently using contraceptives. The integration of family planning with other health services may be one such approach. Although integration may seem logical, the results of efforts to integrate child or primary health care services with other services suggest that integration presents many logistic challenges and that caution is advisable.
What challenges does your project address and why is it of importance? Despite decades of progress in improving the delivery and availability of family planning services, high levels of unmet need for family planning still exist in many countries. This suggests that novel approaches are needed to extend access to family planning services to women and couples who desire to limit or space their childbearing but are not currently using contraceptives. The integration of family planning with other health services may be one such approach. Although integration may seem logical, the results of efforts to integrate child or primary health care services with other services suggest that integration presents many logistic challenges and that caution is advisable. Integrating family planning services with other health services may be an effective way to reduce unmet need. However, greater understanding of the evidence regarding integration is needed. The study determined the effectiveness of provider initiated approaches to enhance family planning uptake among women of reproductive age in rural communities in Osun State, Nigeria.
How have you addressed these challenges? Do you see a solution? A total of 10 out of 30 Medical Officer of Health (MOH) in Local Government Areas in Osun State were randomly selected and trained on Provider Initiated Approach to scale up the uptake of FP among women of reproductive age in rural communities in Osun State, Nigeria. The selected MOH were equipped with FP knowledge and skills on how to integrate FP with other health services. The trainees in turn trained lower health workers who are the primary service providers in rural areas in their various local government health facilities. Women within the reproductive age are assessed for FP needs in antenatal care, maternal and child health, Post Natal Clinic, HIV counseling and testing and other reproductive health services. Family Planning messages were discussed with women through micro-teaching, IEC Materials and as well as client provider interaction. This was done from March to August, 2012.
How do you know whether you have made a difference? Utilization of FP services increased from 5.8% to 30.2% within 3 months and 42.9% after 6 months. The prevalent use of Intrauterine device, injectable, implant and emergency contraceptives increased from 12.8%, 10.1%, 0.2% and 4.7% respectively to 30.8%, 29.7%, 3.9% and 12.9% respectively. Identified barriers to use of FP among women included inadequate knowledge of FP, negative perceptions of FP, financial constraints and inadequate spousal approval. Excess workload for health workers was recorded as a major challenge in this approach.
Have you or the project mobilized others and if so, who, why and how? There was an increased in uptake of family planning services due to use of provider initiative family planning. More health care providers should be trained towards using this approach since current evidence suggests that integration of family planning with other health services using provider initiative approach may be beneficial.
When your donor funding runs out how will your idea continue to live? The government, through the Ministry of Health, will take over the project