The project will develop tailored and comprehensive capacity-building plans to support GHOs and DHMTs. Fostering improved coordination between the GHO and DHMT levels, and with health activities at the community level, is a critical role for the project and will be woven throughout all activities under this objective.
The GoY struggles to assess the coverage and quality of routinely provided health services due to a weak health management information system (HMIS) at the national level; the situation is particularly acute at the governorate and district levels. There are no national strategies related to HMIS and limited financial governmental resources hamper development of a strong HMIS. According to the National Reproductive Health Strategy 2012–2015, the HMIS department lacks
27 NSPMS 2012
an operational budget. The existing HMIS is made up of numerous parallel and vertical data systems for different health programs and governorates. Available data are incomplete and of poor quality and reporting from facility up to the national level is inconsistent and week. A 2008 report notes that only 20% of health facilities report into the HMIS. Weaknesses in data quality and flow lead to the limited use of data program monitoring, improvement, planning and resource allocation for key health programs.28
The project will develop tailored and comprehensive capacity-building plans to support GHOs and DHMTs. Fostering improved coordination between the GHO and DHMT levels, and with health activities at the community level, is a critical role for the project and will be woven throughout all activities under this objective. For instance, the project will promote Governorate and District involvement in quality-of-care (QOC) surveys and household level surveys (i.e., KPCs). The project will also support joint analysis at the GHO and DHMT levels of survey results, and use of those results for planning (including using RED for finding pockets of underserved population as well as for immunization).
Governorate level: At the GHO level, the project will build capacity in supportive supervision, using M&E techniques and tools, and improving human resources management. The project will also support the Governorate teams to create awards and public recognition of high-performing districts based on improved RMNCH/Nut services, active community participation and equity. The project will station “counterparts” within the GHO offices to work side by side with GHO teams to execute the capacity-building plan activities.
To facilitate smooth transition between emergency and development assistance, the project will also support governorates to develop and implement a strategy to help communities and families make the transition from relief and humanitarian efforts to longer-term development programs.
District level: District selection will be guided by agreed-upon selection criteria, which the project proposes should include commitment of the DHMT to 24/7 coverage of care at key facilities within the district. In such an arrangement, the selected district will commit to making emergency care for childbirth available 24/7 at any district hospital in exchange for investments in capacity building and investments at their level. If criteria for DHMT engagement and results are met, the project will further invest in peer-to-peer learning across districts, benchmarking what works.
The project will build capacity in management and supervision systems at the district level using the RED approach, providing TA and training district teams on planning, monitoring, using data for decision making and supportive supervision skills. RED is a methodology for strengthening district planning and management, supportive supervision, microplanning, community engagement and use of data for action. While it was pioneered for immunization, it can be used to help plan any schedulable service or intervention. With TA from the oproject, district teams will develop annual workplans for RMNCH/Nut based on actual needs assessments, focusing on underserved populations and marginalized communities. The project will support DHMTs to take a leadership role in coordinating the work done by all implementing and development partners in their catchment areas to encourage adequate coverage and avoid duplication of services. A
28 Management Systems International. 2008. Enhancing Government Effectiveness: An Assessment of Yemen’s Ministry of Public Health and Population (MOPHP). MSI: Washington, DC
mapping of donor assistance at the district level during the planning process will ensure that the workplan is comprehensive and integrated with other development efforts.
The project will involve health facility staff during the quarterly district-level review meeting and will also support districts to conduct data quality self-assessment (DQS), which identifies errors in data generation, compiling, recording, reporting and use of data for action. The project will support all priority districts to conduct a DQS. Health facilities will be also provided with immunization monitoring charts for monthly monitoring of children vaccinated, coverage and dropout rates, which will help health facilities to take timely action.
The project will also sensitize and build capacity of district officials on gender sensitive and gender transformative RNMCH services and programming so that they effectively champion and supervise services and programs to that end.
Community level: To incorporate feedback on the perception of quality at facilities by community members, the project will foster dialogue between DHMTs and the private sector, CSOs, and where possible, Health Development Councils (HDCs). The project will support the establishment of HDCs, strengthen HDCs where they already exist, and promote women’s engagement and leadership in these groups. Linking to the Partnership Defined Quality process outlined under Objective 5, the project will exploring the use of scorecards as useful tools to create transparency, facilitate mutual accountability, promote use of local data, measure progress across implementing areas, identify low-performing areas and in benchmarking—and therefore in guiding performance improvement.