Tracks 1 & 2 1 Country Team Action Plan Yemen Second Draft

Tracks 1 & Where are we now? 1. A ccomplishment/Progress since Bangkok BP started in 7 governorate (out of 23) Protocols developed and adopted Improvement Collaborative set up and replicated Service Providers’ training is on going Three new Best Practices were added

Tracks 1 & Where are we now? 1. A ccomplishment/Progress since Bangkok 2007 Best Practices integrated in the pre-service Community Midwives curriculum Best practices integrated in the in-service training Linked with quality improvement efforts Facilitated logistics improvements Facilitated MIS

Tracks 1 & Where are we now? 1. A ccomplishment/Progress since Bangkok 2007 About 500 service providers trained (25 trainers and 12 for Newborn resuscitation).. Scaling-up is now part of MOPHP Plan MOPHP and development partners within RHTG established subgroup for quality and best practices Other donors now supporting scale up in new governorates

Tracks 1 & Where are we now? 2. Challenges since 2007 Shortage of personnel (especially female) for 24 hour shifts Extremely short hospital stay after normal deliveries; maximum two hours Providers not convinced that delivery is a good time to talk about Family Planning Stock outs (Vit A, vaccines, IC supplies)

Tracks 1 & Where are we now? 2. Challenges since 2007 Poor motivation weakness in the documentation and monitoring Weak coordination between management and service providers Men’s involvement in RH/FP is not cultural norm and not considered in service set up

Tracks 1 & Where do we want to be? 1. Desired levels of accomplishment Scale up of the 8 Best Practices (BPs) to 5 Health Centers per year in the governorates where the best practices have already started Scale up the BPs to at least 3 health facilities including the main governorate hospital in each of the remaining 16 governorates

Tracks 1 & Where do we want to be? 2. Country Team Goal To strengthen services in the implementation of the 8 BPs in the current program sites. To scale up the 8 best practices nation wide to reduce maternal and newborn mortality and morbidity

Tracks 1 & Where do we want to be? 3. Best Practice Chosen for Scale-Up and Its Components The 8 best practices to be strengthened and scaled up in targeted health facilities in 23 governorates

Tracks 1 & What are the gaps? 1. List gap between current status and desired levels of accomplishment In the 7 governorates, where the BPs started, implementation is still localized in the main governorate hospitals and the desire is to spread to at least 5 health facilities each year. In 16 governorates BP activities have not been yet started and the desire is to have at least 3 health facilities including the main governorate hospital

Tracks 1 & What are the gaps? 2. List reasons for the gap Limited Resources (financial & human) Limited leadership capacity. Absence of the BPs in the service delivery system of the health facilities Shortage of staff, particularly the female staff. Weakness in supervision and monitoring system Poor staff motivation

Tracks 1 & What interventions can we use to close the gap? 1. List best practices and key interventions that can close the gap 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.PPH managment/AMTSL 7.Neonatal Resuscitation 8.Immunization of newborn

Tracks 1 & What interventions can we use to close the gap? 2. Describe how the interventions will address the gap Scaling up the BPs to at least 5 five health facilities in each of the 7 current governorates where the BPs have been established to ensure more coverage. Scaling up the BP to at least 3 health facilities including the main governorate hospital in each of the remaining 16 governorates, will help scaling up in the future to the rest of the facilities in these governorates

Tracks 1 & What interventions can we use to close the gap? 3. List activities to carry out the interventions Resource mobilization Increase the number of Improvement Collaboratives teams Training of public and private health staff Involvement of the health offices and hospital directors in the process of BPs planning, implementation & evaluation. Mainstream implementation of BP in the service delivery system.

Tracks 1 & What are the possible challenges to the intervention? Limited financial and human resources Shortage of personnel (especially female) for 24 hour shifts Extremely short hospital stay after normal deliveries; maximum two hours Providers not convinced that delivery is a good time to talk about Family Planning

Tracks 1 & What are the possible challenges to the intervention? Stock outs (Vit A, vaccines, IC supplies) Weak supervision & monitoring system Poor motivation weakness in the documentation and monitoring

Tracks 1 & Who are the possible partners, allies, and stakeholders? MoPHP: - Governorates health offices -Hospitals, Health centers Universities and health institutes Other government institutions: -Ministry of information - Ministry of endowment

Tracks 1 & Who are the possible partners, allies, and stakeholders? - Ministry of local Authority - Ministry of civil services Developmental partners (Donors, Social Fund for Developments,…) Private sectors NGOs ( e.g. NESMA,YMA,…..) 18

Tracks 1 & What are the modifications needed to improve the intervention’s scalability? Mesopristol( facilities-community) Partograph Magnisum sulphate Post abortion management Infant Nutrition Establish recognition mechanism for the best performance health facility

Tracks 1 & Who will be involved in scaling-up? 1. List of organization (s) responsible for scaling-up Mainly MoPHP -Governorate Health Offices and health facilities with the support of interested donor organizations Private health facilities under the guidance of the MoPHP and it’s health offices

Tracks 1 & Capacity of the organization to scale up & implications this has for scaling up It has the standards and regulations It can assist in coordination among donors and targeted health offices. Increase capacity of staff It has control over logistics It provides qualified staff through training Coordinates between services and education Supervise the quality of the training and services

Tracks 1 & Capacity of the organization to scale up & implications this has for scaling up Leadership Mainstreaming of BP in the health system Over all supervision and monitoring of the whole process TOT of 20 on BP team,3 IC teams. BHS team Ready manuals and guidelines for the training and implementation. 22

Tracks 1 & Who will be part of the team to support the process of scaling- up Director of health offices and RH directors Director of the health facility involved in the scale- up IC Team Logistics Health information system, statistics Supervisor, coach Donor representative Representative of the expert health facility

Tracks 1 & What needs to be done to ensure that the team is large enough and has the resources to support scale-up? More training for the team involved in scale up. More support to the interventions of the best practices. More establishment of IC teams Translate the commitment to action Follow up and support the process of scale up

Tracks 1 & What are the opportunities & constraints for Scaling-up? 1.opportunities: Strong commitment of the MoPHP and health offices. Willingness of interested health facilities for scaling-up Willingness of developmental partners agencies to support introduction and scaling-up Development efforts of RH services

Tracks 1 & What are the opportunities & constraints for Scaling-up? 1. opportunities: Availability of successful experiences in implementation of best practices Well trained trainers 3 Improvement collaberatives teams Support and readiness of institutions like endowment and information to advocate

Tracks 1 & What are the opportunities & constraints for Scaling-up? 2- Constraints Difficulties in changing behaviors of service providers towards better performance in PP counseling. weak supervision to improve performance

Tracks 1 & What are the opportunities & constraints for Scaling-up? 2-Constraints Low Leadership capacity at level of health facility management staff Sustainability of logistics Shortage of female staff Rotation of staff trained in BP Poor monitoring and evaluation system 28

Tracks 1 & What policy, regulatory, budgetary, or other institutional steps are needed? Best practices are part of the development efforts for the improvement of RH/FP and MNH service delivery. Therefore, policies, regulatory and budgetary steps are already set. 29

Tracks 1 & What policy, regulatory, budgetary, or other institutional steps are needed? MDGs National Health Strategy National RH/FP strategy Ministerial Decree of free family planning services Republican and ministerial Decree of free of charge delivery at public health facilities National standers of MNH services Update of job description of midwives 30

Tracks 1 & Where, when and how will the best practice be expanded? The expansion is to new geographic sites and to more health facilities targeting more population. The scale up will be in about 2-3 years Dissemination of the PP to new areas of population by learning the strengths and weakness if the previous governorates Experiences of the Improvement Collaboratives

Tracks 1 & What will be the costs of expansion and how will needed resources be mobilized? The cost is mainly for the training of staff in different skills for implementation of BP. For IEC materials, meetings and supporting visits Some of developmental partners are committed to support by different levels

Tracks 1 & How will the process, outcomes and impacts be monitored? Through regular reporting Quarterly IC meetings Field visits Monitoring of the indicators

Tracks 1 & How will results be fed into decision-making? Reporting of all reports to the governmental institutions, donors and local authorities.

Tracks 1 & What are our action steps? Action StepResponsible PersonTimeline 1.Meeting of the team of Bangkok 2010with the RHTG members to share information and more resource mobilization Population sector RHTG coordinator April Proposals for expansion in the targeted governorates for 2010 Pop sector /Health offices/ BHS team April 2010

Tracks 1 & What are our action steps? Action StepResponsible PersonTimeline 3. Practical steps to solve the challenges of the implementation Bangkok team 2010/Pop sector /Health offices/ BHS team April Opertinalized POA of the scale up of BP for Pop sector /Health offices/ BHS team May