Session 12: Systems Strengthening, Integration, and Maternal and Newborn Health
Session Rationale
This session provides basic information on health systems (including supply chain management, as an example), why this is important for MNH, and what Volunteers are doing to strengthen health systems in the context of MNH. Participants also review different types of integration within MNH care and services. Participants develop and share innovative ways to integrate care and services and strengthen health systems relevant to their work.
Time 105 minutes
Audience Peace Corps trainees/Volunteers assigned to Health sector programs during PST/IST
Terminal Learning Objective
After learning about the continuum of care model for Maternal and Newborn Health and the three delays that increase the risk of maternal and/or newborn death, participants will describe the ideal journey of a woman of reproductive age throughout her lifecycle, from pre-pregnancy all the way through delivery and motherhood, including at least three potential barriers to achieving a successful journey
After conducting a community assessment and learning about antenatal care, PMTCT, labor and delivery, and post-partum and newborn care, participants will demonstrate the steps they will follow to implement at least one evidence-based practice to improve maternal and newborn health outcomes, including steps to engage their communities.
Session Learning Objectives
1. Through a case study and small group work, participants identify at least three components of a health system and three elements of a strong supply chain system that contributed to improved contraceptive prevalence rates in Rwanda.
2. Through an individual task and ranking game, participants identify at least five innovative ideas to strengthen health systems and integrate messages and services that a Volunteer can feasibly support or implement.
Session Knowledge, Skills, and Attitudes (KSAs)
1. Appreciate how components (or building blocks) of a well-functioning health system work together for maternal and newborn health. (A)
2. Review definitions, elements, and examples of a health system and of integrated MNH services and care. (K)
3. Identify at least three components of a health system and three elements of a strong supply chain system for a family planning project in Rwanda. (K,S)
4. Identify at least five innovative ideas to strengthen health systems and integrate messages and services that a Volunteer can feasibly support or implement. (S)
Prerequisites
Global Health Training Package:
· What Is Health? What Is Public Health?
· Global Health Challenges, International Responses, and Determinants of Health
· The Peace Corps’ Role in Global Health and Guiding Principles for Health Volunteers
Maternal and Newborn Health Training Package
· Introduction to Maternal and Newborn Health
· Conducting a Maternal and Newborn Health Community Assessment
· Healthy Timing and Spacing of Pregnancies
· Pregnancy and Antenatal Care
· Preparing for Labor and Delivery
· Community Mobilization for Emergencies
· Postnatal Care for the Mother and Essential Newborn Care
· Breastfeeding
· Engaging Influential Actors
· HIV and Maternal and Newborn Care
Sector: Health
Competency: Foster Improved Maternal, Neonatal, and Child Health
Training Package: Maternal and Newborn Health
Version: Oct-2014
Trainer Expertise: Trainer has a health background. Trainers could include a Health sector program manager/APCD or Health technical trainer.
/ MNH: Systems Strengthening, Integration and MNH |Version: Oct-2014| Page 3 of 20Session Outline
Motivation 15 min 6
Introduction to Health Systems 6
Information 25 min 6
An Overview of Health Systems and Integration and How They Relate 6
Practice 35 min 12
Responding to Increased Demand for Contraceptives in Rwanda 12
Application 30 min 14
What Can We Do? Ideas to Integrate Messages and Services and to Strengthen Health Systems 14
Assessment 15
Trainer Notes for Future Improvement 15
Resources 15
Handout 1: How Volunteers Can Strengthen Health Systems 16
Trainer Material 2: This is Maya Crying: Introduction to Health Systems 18
Trainer Material 4: Diagrams and Small Group Task 19
Trainer Material 5: Innovative Idea Individual Task 21
Contributing External Experts: Claudia Conlon (USG lead, Saving Mothers, Giving Life), Joan Haffey (independent consultant, Advancing Partners and Communities Project)
Session: Systems Strengthening, Integration, and Maternal and Newborn Health
Date: [posts add date]
Time: [posts add xx minutes]
Trainer(s): [posts add names]
Trainer Preparation
1. Review the entire session plan, handouts, and PowerPoint presentation and plan the session according to the time you have available.
2. Organize participant seating in small groups, if possible at café-style tables with 5-6 participants per group/tables.
3. Write session learning objectives on a sheet of flip chart paper and tape to the wall.
4. Tape the continuum of care framework wall chart (developed in Session 1 of this training package) to the wall.
5. Photocopy Handouts 1, 2 (separate file), and 3 (separate file) -- one copy per participant.
6. If using the video option for the Motivation section, play the video from Trainer Material 1 (see separate file) or download that same video “Healthy Systems Create Healthy Futures: Meet Maya” from https://www.youtube.com/watch?v=PFVCNUOM5Us (2.5 mins). Test for sound and quality.
7. If using the story option (see Trainer Material 2) instead of the video for the Motivation section, before the session, identify a participant who can practice reading the story and who will then read it aloud to the rest of the participants during the session. If possible, he or she should listen to the narrator in the video and imitate this style of reading.
8. Prepare all equipment necessary to show Trainer Material 3: PowerPoint (separate file).
9. Prepare Trainer Material 4 and Trainer Material 5 for use in the Practice and Application sections of this session (prepare charts and task on flip charts).
Materials
Equipment
§ Flip chart and flip chart stands
§ LCD projector and laptop
§ Speakers for video (if feasible)
§ Screen or wall space
§ Markers and masking tape
§ Index cards/notecards (three per participant)
Handouts
§ Handout 1: How Volunteers Can Strengthen Health Systems
§ Handout 2: Using Last Mile Distribution to Increase Access to Health Commodities (separate file)
§ Handout 3: Case Study from Rwanda (separate file)
Trainer Materials
§ Trainer Material 1: Video: Health Systems Create Healthy Futures: Meet Maya (separate file)
§ Trainer Material 2: This is Maya Crying: Introduction to Health Systems
§ Trainer Material 3: PowerPoint (separate file)
§ Trainer Material 4: Diagrams and Small Group Task
§ Trainer Material 5: Innovative Idea Individual Task
Motivation 15 min
Introduction to Health Systems
A video (or story), using simple language, tells how a well-functioning health system contributes to healthy newborns. Participants identify the components (building blocks) and qualities of a well-functioning health system and relate this to their own experience and observations.
1. Introduce the session.
· Tell participants that the session will begin with a quick introduction to health systems
2. Show the 2 minute, 31 second-long video from Trainer Material 1 (see separate file), “Healthy Systems Create Healthy Futures: Meet Maya” (or read the story aloud as per Trainer Material 2: This is Maya Crying: Introduction to Health Systems).
3. Large group discussion.
· Ask participants: “What are the components of a health system that contributes to maternal and newborn health? What did you observe in the video (or hear from the story)?”
Note: Let participants respond. They may mention supplies (soap, vaccines, vitamin supplements), delivery of those supplies, human resources (skilled providers who were educated), infrastructure (hospitals and clinics), health financing, governance and accountability, health information systems, and service delivery.
· Ask participants: “According to this video (or story), what makes a strong health system?”
Note: Let participants respond. They will likely mention that a strong health system involves all its components working together. For example, if there is no truck or transport, vaccines cannot be delivered to reach pregnant women and newborns.
· Ask participants: “What are some of your own observations from your community about health system components and their functioning that affect maternal and newborn health?”
Note: Let participants respond. Their answers will be very context specific. Participants may mention stock-outs of family planning products, medicines, and ITNs; lack of fuel/transport for health personnel to reach certain communities or to effectively supervise community health workers; lack of health workers with current skills in emergency obstetric and neonatal care, lack of health infrastructure in remote communities, etc.
Information 25 min
An Overview of Health Systems and Integration and How They Relate
This section provides basic information on health systems (including supply chain management as one example) and integration, how these concepts are related, and why this is important for MNH. The session includes a Volunteer’s story on how she strengthened health systems (data and information management) in the context of MNH.
1. Transition by introducing the two learning objectives of the session, to let participants know what they will do for the rest of the session, and explain how this session might help their work at site:
· Through a case study and small group work, participants identify at least three pieces of a health system and three elements of a strong supply chain system that contributed to improved contraceptive prevalence rates in Rwanda.
· Through an individual task and ranking game, participants identify at least five innovative ideas to strengthen health systems and integrate messages and services that a Volunteer can feasibly support or implement.
2. Introduce this section by opening Trainer Material 3: PowerPoint (separate file) while explaining to participants that this session focuses on health systems and the importance of integrated services and that you will look at each separately in more detail and discuss how these concepts are related.
3. [SLIDE 2]: Definition of a Health System
Possible Script: WHO states that a health system consists of all organizations, people, and actions whose primary interest is to promote, restore, or maintain health[i].
4. Ask participants: “What are the most important building blocks of a health system?” Take a few responses, then show Slide No. 3.
5. [SLIDE 3]: Six Building Blocks of a Health System
Possible Script:
The six building blocks of a health system are:
· Leadership/governance: ensuring policy frameworks exist, provision of appropriate regulations, accountability, effective oversight, and coalition-building
· Health care financing: a good health financing system raises adequate funds for health to ensure people can use needed services and that they are protected from impoverishment associated with having to pay for these services
· Health care workforce: sufficient numbers and mix of competent, responsive, and productive staff
· Medical products and technologies: equitable access to essential medical products, vaccines, and technologies that are safe and cost-effective and have assured quality and efficacy
· Information and research: a well-functioning health information system ensures the production, analysis, dissemination, and use of reliable and timely information on health determinants, health systems performance, and health status
· Service delivery: delivery of effective, safe, and high-quality health interventions to those who need them, when and where needed, with minimum waste of resources[ii]
6. [SLIDE 4]: Health System Stakeholders
Possible Script: A health system is more than just the government – it includes all stakeholders, such as associations of medical professionals, private sector actors such as health insurers, and families who care for sick members.[iii]
7. [SLIDE 5]: Health Systems Strengthening
Possible Script: Health systems strengthening is improving the six health system building blocks and managing their interactions in ways that achieve more equitable and sustained health improvements across health services and health outcomes.[iv]
8. How Volunteers are Involved in Health Systems Strengthening
· Distribute Handout 1
· Ask participants to read it silently
· Ask participants how this Volunteer helped to strengthen the health system in the district where she worked, and what else they might have considered doing in that situation
Note: Let participants respond. Possible responses include:
· Strengthening the information and research element which, in turn, strengthens leadership—the district health office can make better decisions based on data
· Strengthening health care work force by training health staff to use GPS to gather, analyze, and use health information
9. Introduce the concept of integration to participants.
10. [SLIDE 6]: Definition of Integration and Integrated Health Services
Possible Script: The dictionary definition of integration means bringing together or combining parts into a whole. WHO defines integrated health services as: the management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system.[v]
11. [SLIDE 7]: What Integration may Involve
Possible Script: Integration may involve:
· a package of interventions for a specific group
· providing a range of services in one location (or by one CHW) for a catchment population
· providing continuity of care over time
· integrating services at different levels through linkages and referral systems[vi]
12. Solicit Thoughts from Participants.
Possible Script: Considering the definition and what integration involves, and reflecting on what you’ve learned, name some ways that maternal and newborn care and services are integrated.
Note: Let participants respond. They will likely provide the following examples:
· The MNH continuum of care illustrates how maternal and newborn care is integrated over time (from adolescence to postpartum) and at different levels (household, community, and facility).
· Focused ANC care and services include a package of interventions for pregnant women, including screening for HIV and STIs, healthy timing and spacing of pregnancies, nutrition counseling, malaria prevention and treatment, etc. Likewise, postnatal visits integrate a range of care and services for both the mother and newborn.