Scaling up RBM in the context of health systems development
R.Knippenberg, UNICEF, 2/2/2000

Next slide  Last slide  Back to the list of documents

 

 

Conditions for scaling up RBM

  1. Simple standardized technology:
    • safe and simple, available, affordable
  2. Community based operational strategies
    • focus supply & demand, target poorest households, flexible implementation
  3. (Inter) National Policies and Support
    • accountability health sector, sustainable, equitable financing complementarity of partners
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

1.    Simple standardized technology:

  • safe and simple to use at household level
    • rapid diagnostic tests
    • combination drugs or blister packs
    • standard net sizes, insecticide doses
  • available and affordable
    • international competitive bidding
    • global negotiations with industry
    • local production
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

2.   Community based operational strategies

  • Agree on Integrated minimum care package at Health Center, Community and household level responding to need and demand.
  • Ensure both supply and demand conditions esp. for poorest households
  • Flexible implementation management: learn by doing through community based monitoring involving all stakeholders
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

2.a.  Refocus Minimum Care Packages

  • At Health Center Level: IMCI including malaria, EPI, Stop TB, HIV/AIDS prevention and care, maternal health care incl. malaria profylaxis; health promotion incl. impregnated bednets.
  • At community/household level: promotion of 12 family care practices including:
    • home based care of childhood illness incl. malaria
    • Promoting use of impregnated bednets
    • care of women incl. intermittent mal.profylaxis
    • infant breast and complementary feeding
    • promotion of personal and environmental hygiene
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

2.b.   Key Supply and Demand Conditions to Ensure Effectiveness of malaria prevention and treatment

First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Operational Strategies to ensure conditions

  • Availability: see above
  • Access for the poor: go beyond public health systems; involve NGO’s, communities and private sector
  • utilization/continuity and compliance:
  • communication and community support to support family care practices
  • quality of care: standardized simple technology; training, regulation, accreditation; peer control; consumer pressure
  • NB: FULLFILLING ALL CONDITIONS REQUIRES EFFECTIVE PARTNERSHIPS.
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

2.c. Flexible implementation Management

  • Community based monitoring as local problem solving tool (management by exception)
  • Half-yearly analysis of routine information
  • Minimum set of Indicators as “alarm signals”
  • Hierarchy of indicators reflects impact conditions
  • Analysis of plausible causes of “bottlenecks” steered by hierarchy of indicators
  • Needs involvement communities + health staff in analysis and deciding corrective action
  • Follow-up on impact of action through changes in bottlenecks.
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Monitoring As a Problem Solving Tool at Community Level. Target Population: families for bednets; cases for treatement

First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Monitoring and Problem Solving at (sub) district Level: comparing health centers, villages and families

First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

3.   National Policies and Support

  • Make health sector accountable to health outcomes in poor incl. RBM in resource allocation implementation and monitoring
  • Sustainable and equitable financing:
    • earmarked (inter) national funds for supplies and central support (surveillance, communication)
    • earmarked funds for operating PHC systems
    • protect households from high prices
  • Complementarity of programs, countries and partners using comparative advantage
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Partner Support for scaling up RBM

  1. Simple standardized technology:WHO Supply affordable drugs,nets etc UNICEF
  2. Community based operational strategies: (sub)national governments; NGO’s, UNICEF
  3. National Policies & Financing:
    • National Governments and Dev. Banks
    • GOV/UNICEF/ WHO advocacy for outcome (rbm) focus and poor friendly health systems
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Summary of health systems/RBM issues

  1. Access to malaria prevention & treatment
    1. revitalize existing health centers malaria diagn./treatment + bednets integrated with imci / sm = mcp (moh/who/unicef/ngo) partnership private sector/quality ass.
    2. expand health infrastructure (moh/wb/adb)
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Summary of health systems/rbm issues cont.

  1. reaching unreached
    • mobile strat /outreach clinics: (moh)
    • community based/vhw: (ngo)
    • informal private providers/village shops-(usaid/ngo) social marketing esp bednets usaid (for all: gov to regulate)
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Summary of health systems/rbm issues cont.

  1. Information/communication to improve
    1. use, compliance (min ed. ngo/unicef, usaid)
    2. political will (all partners; intercountry bodies)
    3. Quality of care (moh/ who)
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Summary of health systems/rbm issues cont.

  1. financing issues:
    • reduce costs drugs/diagnostic tests (rbm)
    • regulate costs private sector/social marketing balance sustainability with equity (moh/ngo/usaid/unicef)
    • revitalize/expand phc system (moh/wb/adb)
    • ensure operating costs phc system
    • communication (various sectors/usaid/ngo/unicef)
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Recommendations

  1. Standardise, simplify and scale up existing technologies ìncl. regulation
  2. Funding to be earmarked for RBM in National Budgets and during debt relief-HPIC negotiations
  3. Follow up on Harrare conclusions and identify additional dimension for Geneva meeting (what’s new)
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Next steps

  1. exchange experience on approaches for partner coordination and complementarity
    • specific responsibilities each partner
    • countries/communities in driver seat
  2. Coordination of resource mobilization, facilitating disbursement mechanisms at country, regional and global level
  3. Discuss RBM funding opportunities / modalities incl. social funds-HIPIC etc
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Suggestions for scaling up RBM

  • Mobilize funding to improve access-quality of RBM esp. to reach hard to reach areas, requiring expansion health infrastructure for sustainability
  • Ensure affordable-quality drugs, nets etc. in public and NGO and for profit private sector
  • mobilize NGO and private sector for RBM governments to facilitate community ownership and integrate RBM in community cost sharing
  • take malaria control beyond experts to create social RBM movement in context of health sector reform. Requires simple/standard technology
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Funding of RBM at Nat. level

  • Base allocation of donor funding on national RBM/health sector strategies/plans and trust
  • health sector activities.
  • Make RBM outcome into objective of HSR
  • orient SWAP-Basket funds to RBM outcomes
  • transparency but lighten conditionalities and harmonise conditionalities between partners
  • simplify disbursement procedures for funds
  • highlight economic impact malaria to mobilize HIPIC funds for health outcomes for the poor
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Next Country level steps to scale up

  • Build on existing national health strategies in place, including private/community sectors
  • simplify-standardise tools
  • integrate strategies in existing RBM programs
  • improve managerial skills for scaling up
  • coordinate donor funding/complementarity
  • RBM outcomes indicator health sector reforms
  • include RBM in basket/sector-wide funds
  • ensure follow up Harare-Geneva decisions governments/partners to be held accountable
First slide  Previous slide  Next slide  Last slide  Back to the list of documents

 

 

Next global level steps to scale up RBM

  • follow up with countries and partners on implementing recommendations Harare-Geneva in proactive way (beyond reporting)
  • Mobilize/reorient bridge funding to scaling up RBM in context of Harare recommendation.
  • Include priority health interventions (incl. RBM) in guidelines for HIPIC, social funds...
  • Work with country gov/partners to include RBM interventions in HIPIC-social fund proposals
  • Global RBM actions to solve country obstacles e.g.
    • Simplifying-standardizing tools-technology
    • reducing costs of quality RBM commodities
First slide  Previous slide  Back to the list of documents