1 Scaling Up is Hard to Do… How an IC makes a difference! The Basic Health Services Project, Yemen

2 Purpose - Reasons Purpose Introduce selected Best Practices to reduce maternal and neonatal mortality Reasons Commitment to MDGs Absence of Post Partum Care Low quality of EmONC

3 Best Practices selected 1.Immediate and Exclusive Breast Feeding 2.Neonatal Infection Prevention 3.Vitamin A for Women After Delivery 4.PP/PA Family Planning/HTSP 5.KMC for LBW infants 6.AMTSL 7.Neonatal Resuscitation 8.Immunization of newborn Total budget: 50,000 – 75,000 – 250,000

4 Scaling-Up steps IC : leadership, plan of action, team building, protocols, indicators, training, monitoring, regular meetings, learning sessions, spread strategy Quality team formed in each facility Coaches identified Referral hospitals as starting points Spread to PHC centers

5 Activities Protocols developed and adopted 1 IC set up, replicated 318 Providers trained in 6 hospitals 6 hospitals introduced new practices Scale up started in 2010 in 130 facilities Trainers trained for phase 3 of scale up

6 Linkages Scaling-up is now part of MOPHP Plan MOPHP / HSS program (WB) integrated BP training curriculum in its training Development partners within RHTG established subgroup for scale up Other donors now supporting scale up in new governorates

7 Modifications Added 3 BPs Added infrastructure support Linked with quality efforts Facilitated logistics improvements Facilitated MIS

8 Sample Results PP counseling rooms: 0 to 5 PAb FP/HTSP counseling: 0 to 44% Immediate Breastfeeding: at 83% Counseling on EBF: from 0 to 82% Vitamin A: from 0 to 86%. OPV to newborns: 0 to 77% KMC demonstrations: 0 to 26% of LBWs

9 Other results Training capacity increased /national core team of trainers and coaches Infrastructure improved Indicators and service statistics Integration into annual plans Leveraging other donors’ support

10 Challenges Extremely short hospital stays after normal deliveries; maximum two hours Midwives and nurses shortage during afternoon and night shifts Lack of quality culture / systems Lack of documentation and monitoring

11 Challenges(2) Supervision and management lacking Motivation Stock outs (Vit A, vaccines, IC supplies) Providers not trained in PP-IUD insertion Scale up

12 How challenges were met BPs fit with country priorities (MDG) Support from development partners Existence of real champions for BPs Strength in numbers Integration with annual plans – BPs not an extra curricular activity – MOPHP guidelines Planning to use TA to train doctors in PP-IUD

13 Ingredients for success A recognized need for rapid change Support from key sources (MOPHP, USAID) Clear indicators set by the IC members. Technical and other support from local USAID project

14 The IC appeal Promotes ownership and participation Values staff contributions and opinions Mechanism for exchanges & learning Provides peer support and pressure Venue for identifying challenges and solutions Harmonized measurement across facilities