Child Health Programme Manager’s Guidelines Experiences from Bangladesh Kathmandu, 17 Nov’2011 1

Background In Bangladesh a number of maternal, neonatal and child health programmes and initiatives in existence – MNHI, a joint Government of Bangladesh-WHO, UNICEF and UNFPA initiative expanded to 11 districts. – MNCH supported by DFID through UNICEF and BRAC implemented in 10 districts. – MNCS supported by AusAid through UNICEF and NGOs is being implemented in 40 upz of 8 districts. – SMPP supported by JICA through GoB in 3 districts – MaMoni by Save the Children in 2 districts – TMNCP supported by KOICA through unicef in 1 district These programmes aim to provide a continuum of care by integrating the efforts of these three interconnected areas Programme managers, therefore, need to be equipped with programme planning and management skills to deal with this. 2

Objectives of Programme Management guidelines To equip managers with essential knowledge and it’s execution to improve programme management. To develop skills of the managers for advocacy, planning, management, monitoring and resource mobilization for effective implementation of interventions. 3

Adaptation of Generic WHO Training Package To adapt the generic WHO training package for Bangladesh, two 1-day consultation workshops were organized. The technical workshops involved the input and participation of a number of experts and programme managers. It was decided to change the title from “Managing programmes to improve child health” to “Managing programmes to improve maternal, newborn and child health” Relevant information on maternal health incorporated within the 5-day training course. 4

Target Audience Programme managers working in maternal, newborn and child Health sector at national/ district/ sub- district levels both from DGHS and DGFP. 5

Adaptation process in Bangladesh Time periodActivities Nov 27 to Dec 01, 2010International workshop to adapt the WHO generic modules for Bangladesh and conduct TOT Sept 20 to Orientation workshop for the health and family planning managers from district and three Sub-districts in Tangail 6

Participants in the International Workshop in 2010 From Government side: Director Primary Health Care and Line Director (Essential Service Delivery) Programme Manager from – IMCI – Reproductive Health, DGHS – In- service training, DGHS – (CA & SS), DGFP Deputy Programme Manager from – Maternal Health – Neonatal Health – In- service training Deputy Chief, MIS Civil Surgeons from Moulavibazar, Narail and Bandorban districts UH& FPO from Bandarban, Shirajganj, Rangpur and Dhaka( Dhamrai) 7

Participants in the workshop_continued From Non Government organizations: Health Specialists and Programme experts and scientists from WHO, UNICEF, UNFPA and icddr,b Facilitators: Programme Manager, IMCI, DGHS Coordinator, Country Support team Child and Adolescent Health and Development, WHO, HQ Medical officer, SEARO, WHO Medical Officer, Child Health, WHO-Bangladesh 8

International Workshop

10

11

Observations from the International Workshop Duration: 5 days. However, the duration was perceived as too long by GoB managers Course Content: – Inclusion of maternal section was commended – Reading section perceived as rather large and monotonous – Texts comprising bullets or diagrams were recommended – Inclusion of more ‘role play’ and examples was proposed – Bangladesh specific examples, goals, objectives and targets was suggested 12

Further adaptations following the International Workshop Duration : Duration reduced to 3 days from 5 days Course contents: Incorporation of: – Bangladesh related health System information – Country specific health service provider information – Goals and objectives of ongoing Maternal, Newborn and Child Health Programmes of Bangladesh – Current status, targets and achievements of ongoing MNCH programmes – Coverage indicators of these MNCH programmes 13

Orientation workshop for 3 sub-district managers in 2011 Target audience: Programme managers, Upazila Health and Family Planning Officer (UH&FPO) under DGHS and Upazila Family Planning Officers (UFPO)under DGFP from three sub-districts of Tangail District. Medical Officers from these sub-Districts 14

Orientation workshop in

16

Observations from the 2011 orientation Workshop Duration: – 3 days. Well accepted by the programme managers – However, covering course content was a challenge Course Content: – Some of the reading sections had to be facilitated instead of self-reading – All ‘role play’ and examples could not be covered – Some exercises in the “workbook” e.g. resource mobilization, had to be skipped 17

Comparison of the course contents Topic5 days package3 days package Module 1: Introduction Duration: 2 and half hours Content: Review MNCH Epidemiology Review Intervention Packages and the continuum of care Review Planning terms and concepts More focus given on understanding the planning cycle Module 2: Planning implementat ion Duration: 2 days Content: Preparation for planning Review programme goals and objectives Review coverage of interventions and compare it to targets Review status of indicators Duration: 1 day Content: summarized as; Review preparation for planning Review implementation status Decide on programme activities Plan activities to implement intervention packages and set a priority 18

Comparison of the course contents Module5 days package3 days package Module 2: Implementation Planning (Cont.) Review major activities and assess how well they are implemented Review implementation Status Review coverage of interventions and compare it to targets Set a target to improve quality of care Plan activities to implement intervention packages List tasks in activities and types of resources needed Choose priority indicators for monitoring results of activities Plan monitoring of implementation of activities Plan for next review of implementation Decide how to scale up implementation. Review resources available, work plan and timetable List tasks in activities and types of resources needed Planning for next review of implementation Decide how to scale up implementation Review resources available, work plan and timetable Write a work plan and budget 19

Comparison of the course contents Module5 days package3 days package Module 3: Managing implementation Duration: 2 days Content: Advocacy for Maternal, Newborn and Child Health Assessment of potential strategic partnerships and ask for support Mobilization of funds from donor How to manage medicines and supplies How to manage financial supports How to improve organization of supervision Analysis of common problems Feedback and solve problems Duration: 1 day Content: summarized as Advocacy for Maternal, Newborn and Child Health Mobilization of funds from donor How to manage medicines and supplies How to improve organization of supervision Feedback and solve problems 20

 Manage implementation  (Ongoing) Advocate Mobilize resources Manage human, material and financial resources Manage supervision Monitor progress and use results  Manage implementation  (Ongoing) Advocate Mobilize resources Manage human, material and financial resources Manage supervision Monitor progress and use results Develop implementation plan (every 1-2 years) Prepare for planning Review implementation status Decide on programme activities Plan monitoring of implementation of activities Plan for the next review of implementation status Write a workplan and budget Develop implementation plan (every 1-2 years) Prepare for planning Review implementation status Decide on programme activities Plan monitoring of implementation of activities Plan for the next review of implementation status Write a workplan and budget Prepare for the review of implementation status (every 1–2 years) Prepare for the review of implementation status (every 1–2 years) Develop strategic plan (every 5-10 years) Prepare for planning Do situation analysis Prioritize and package interventions Decide how to deliver interventions Select indicators and set targets for evaluation Write and disseminate plan Mobilize resources Develop strategic plan (every 5-10 years) Prepare for planning Do situation analysis Prioritize and package interventions Decide how to deliver interventions Select indicators and set targets for evaluation Write and disseminate plan Mobilize resources Evaluate programme (every 5-10 years) Eg. DHS, MICS including coverage and health impact ( e.g. using DHS, MICS surveys) Evaluate programme (every 5-10 years) Eg. DHS, MICS including coverage and health impact ( e.g. using DHS, MICS surveys) Strategic planning is usually performed at the national level. It is taught in the WHO guidelines: Strategic Planning For Child Health This implementation planning cycle is taught in these guidelines: Managing Programmes to Improve Maternal, Newborn and Child health 21