Health Resources Availability Mapping System The Darfur Case Study HeRAMS SUDAN WHO Country Office Health Information Service Unit 1

Outline What is HeRAMS Contextual Information Health Infrastructures Health Human Resources Health Services Availability 19 April 2017 2

What is HeRAMS

Background HeRAMS has been initiated and developed between February and December 2008 in the three States of Darfur, Sudan, to assess and monitor the availability of health sector resources provided by both the international and local response to the humanitarian crisis Based on this experience, HeRAMS evolved in a generic tool of the Global Health Cluster to be used in the roll out of the health clusters in the countries implementing the cluster approach, in order to assist Health Cluster Coordinators and partners in assessing and monitoring the availability of resources and services provided to population affected by humanitarian crisis. 4

What is it HeRAMS (Health Resources Availability Mapping System) is an interactive software-based information system that aims to rapidly capture and process the information in order to assess and monitor the availability of health resources at health facility level and community levels HeRA M S Health Resources Availability; in terms of available health resources infrastructure, personnel, and provided services Mapping; in terms of assessment, monitoring, and geo-referencing System; in terms of analytical framework and technical support tools 19 April 2017 5 5

HeRAMS Aim and Objectives HeRAMS is developed to provide the decision makers with timely, relevant, and reliable information about the available health resources,, in order to support them: Enhancing coordination & accountability through the monitoring Who is Where, When and doing What Indentifying and measuring gaps Support priority settings Inform strategy development and planning of evidence-based health interventions in humanitarian areas 19 April 2017 6

HeRAMS Database System Summary & Analytical Reports System Components Standard Data Gathering Matrix HeRAMS Database System Input Output Summary & Analytical Reports 19 April 2017 7

Key Information Areas Health Resources' Availability has been disaggregate in three main information areas: Health Facility Infrastructure & Mobile Clinics Health Personnel Health Services 19 April 2017 8

Health Facility Infrastructure This part is designed to collect set of information related to the health facility infrastructure, that is: HF Location: precisely specify the location of the HF to the lowest possible level (i.e., State Locality Administrative Unit Settlement/Village), plus the coordinates of the HF (longitude and latitude). HF premises: provides information about the HF type with regards to the PHC classifications (i.e., PHCU, PHCC, RH, etc...), status of the HF (whether it is functioning or not), nature of the HF building (whether it is permanent or a temporary building), service coverage of the HF (whether the HF is serving an IDP camp or a settlement, or both) inpatient capacity of the HF (number of beds). Dees the HF reporting under EWARS? HF Management: indicates the health partners who run the HF, in terms of the main owner and manager of the facility, and the supportive partners, if any. 19 April 2017 9

Health Personnel This part provides information about the health staff work in the HF against the health staff work in the community with regards to certain facility. HF based staff: is the medical cadre that run the HF, such as MO (Medical Officer), MA (Medical Assistant), Nurse, etc... Community based staff: is categorized as voluntarily workers (e.g., Village Volunteers), and paid workers (e.g., Community Health Workers, Village Trained Midwives) 19 April 2017 10

Health Services Health services are broken into three levels of care, where each one encompasses set of services related to different health sectors; as shown in the diagram below: 19 April 2017 11

Data Quality Assurance: (1) Many validity checks are performed to ensure consistency and reliability of the data: Implementing the data collection sheet with: Standard pre-defined lists for the data types of known parameters; (i.e. ., standard locations list, HF Types,…) Validation rules for entered data types Upon importing data from the data collection sheet to the Database system, other validation rules are performed to ensure consistency of data types Performing local quality control check; coordinated editing and auditing process Peer reviewing of the collected raw data; conducted by the data gathering team (field PHC officers) and developers, Appraising & reviewing of generated reports before dissemination 19 April 2017 12

Data Quality Assurance: (2) Other procedures are applied to ensure quality data: Collecting data by personally interviewing partners and direct field mission, rather than sending partners a copy of the data collection sheet to be filled Developing data dictionary for clear definition of data elements; “use of meta-data” Unifying the reporting channel & maintaining one source of data to avoid duplication of reporting Providing hands-on training for the system users (i.e., PHC officers); up-to-date Establishing a mechanism for frequent feedback to those collecting and using data 19 April 2017 13

CONTEXTUAL INFORMATION

North Darfur - Contextual Map - July 2007 Source : OCHA

Humanitarian Space Dynamics Quantitative and qualitative evolution of the Population of Humanitarian Concern (North Darfur – January 07, July 07 & January 08) Evolution - in absolute numbers - of the Population of Humanitarian Concern (Total Population, IDPs and Resident Population) Evolution (%) of the Composition of the Population of Humanitarian Concern (IDPs vs Resident Population) IDPs January 2007 Resident population IDPs July 2007 Resident population IDPs January 2008 Source : OCHA Resident population

Humanitarian Space Dynamics Quantitative and qualitative evolution of the Population of Humanitarian Concern (El Fasher Locality – North Darfur - January 07, July 07 & January 08) Evolution - in absolute numbers - of the Population of Humanitarian Concern (Total Population, IDPs and Resident Population) Evolution (%) of the Composition of the Population of Humanitarian Concern (IDPs vs Resident Population) IDPs January 2007 Resident population IDPs July 2007 Resident population IDPs January 2008 Resident population

HEALTH INFRASTRUCTURES

i-HeRAMS – Infrastructure Characterization Functioning Health Facilities State Profile, North Darfur, March 2008 Absolute Numbers, by Health Facility Type, by Locality * Primary Health Care Centre ** Primary Health Care Unit

Functioning Health Facilities State Profile Absolute Numbers, by Type, by Locality North Darfur - March 08 * Primary Health Care Centre ** Primary Health Care Unit *** Primary Health Facilities (= Sum of RH and PHCCs)

Primary Health Care System Composition (%) March 2008 Darfur Region Comparison across States

Primary Health Care System Framework Average # of Persons per type of Health Facility, by State Darfur Region, June 2008 (PHCC: Primary Health Care Centre; PHCU: Primary Health Care Unit)

i-HeRAMS – Infrastructure Characterization PHCC Availability by Locality – (IDPs & Non IDPs) Average Number of Persons per PHCC North Darfur, March 2008 i-HeRAMS – Infrastructure Characterization

HeRAMS - PHCC Availability Average Number of Persons per PHCC – by Locality and for Major IDP Camps North Darfur - March 08

North Darfur Case Study – Dec 2008 North Darfur: Functioning HFs, by Type, and by managing partner (SMoH versus NGOs) Total functioning HFs = 206 out of 250 existing North Darfur Case Study – Dec 2008 Out of the 7 RHs managed by SMoH, 4 (57%) are supported by WHO, UNICEF, & UNFPA Out of those 44 PHC Centers, 13 ones (30%) are supported by WHO, UNICEF, & UNFPA Out of those 65 PHC Units, only one is supported by WHO, UNICEF, & UNFPA 19 April 2017 25

Total functioning HFs = 194 out of 253 existing North Darfur Aug-09 Total functioning HFs = 194 out of 253 existing Out of the 8 RHs managed by SMoH, 5 (63%) are supported by WHO, UNICEF, & UNFPA Out of those 45 PHC Centers, 16 ones (36%) are supported by WHO, UNICEF, & UNFPA Out of those 76 PHC Units, 3 ones (4%) are supported by (2 are WHO, UNICEF, UNFPA), & IRC 19 April 2017 26

North Darfur: Functioning PHCCs, per Locality, by managing partner Dec-08 versus Aug-09 19 April 2017 27

South Darfur Case Study – Dec 08 South Darfur: Functioning HFs, by Type, and by managing partner (SMoH versus NGOs) South Darfur Case Study – Dec 08 Total functioning HFs = 326 out of 415 existing Out of the 9 RHs managed by SMoH, 5 are supported by WHO Out of the 6 PHCCs managed by the SMoH, one is supported by CARE (17%) 19 April 2017 28

South Darfur Case Study – Aug 09 Total functioning HFs = 334 out of 408 existing 50% of the 10 RHs managed by the SMoH are supported by WHO One out of 12 PHCCs (8%) managed by the SMoH is supported by FRC 3 out of 220 PHCUs (1%) managed by the SMoH is supported by FRC 29 19 April 2017

South Darfur: Functioning PHCCs, per Locality, by managing partner Dec-08 versus Aug-09 19 April 2017 30

Total functioning HFs = 167 out of 219 existing West Darfur: Functioning HFs, by Type, and by managing partner (SMoH versus NGOs) West Darfur Case Study – Dec 2008 Total functioning HFs = 167 out of 219 existing Out of the 6 RHs managed by SMoH, 5 are supported by WHO 19 April 2017 31

Total functioning HFs = 165 out of 221 existing West Darfur Aug-09 Out of the 5 RHs managed by SMoH, 4 are supported by WHO All those 10 PHCCs are supported by (WHO, UNICEF =9PHCCs), & IARA, CAM Out of those 38 PHCUs 3 (8%) are supported by WHO & UNICEF, CAM 19 April 2017 32

West Darfur: Functioning PHCCs, per Locality, by managing partner West Darfur: Functioning PHCCs, per Locality, by managing partner. Dec-08 versus Aug-09 19 April 2017 33

HEALTH HUMAN RESOURCES

Community Based Personnel Health Workers, by type, working in PHCCs and in the communities of their related catchment areas, North Darfur, December 2008 HF Based Personnel Community Based Personnel 52% of the overall community personnel are SMoH, while 48% are NGOs supported. Only 2% of the overall community personnel are SMoH, while 98% are NGOs supported. 19 April 2017 35

Community Based Personnel Health Workers, by type, working in PHCCs and in the communities of their catchment areas, South Darfur, December 2008 HF Based Personnel Community Based Personnel Only 6% of the overall community personnel are SMoH, while 94% are NGOs supported. Only 1% of the overall community personnel are SMoH, while 99% are NGOs supported.

Community Based Personnel West Darfur: Health Workers by Type, working in PHCCs and in the communities of their catchment areas, Dec 08 Number and percentages of health personnel based on HFs and the community workers personnel; supported by NGOs vs. SMoH HF Based Personnel Community Based Personnel 25% of the overall community personnel are SMoH, while 75% are NGOs supported. 32% of the overall HF based personnel are SMoH, while 68% are NGOs supported.

Community Based Personnel Health Workers, by type, working in PHCUs and in the communities of their catchment areas, West Darfur, December 2008 HF Based Personnel Community Based Personnel 32% of the overall community personnel are SMoH, while 68% are NGOs supported. 25% of the overall community personnel are SMoH, while 75% are NGOs supported.

HeRAMS - Health Workers, by type, by managing partner North Darfur, March 2008 Facility Based Staff Community Based Staff

HeRAMS - Health Workers, by type, by type of Health Facility North Darfur, March 2008 Rural Hospitals vs PHCCs PHCCs vs PHCUs

HeRAMS - Health Workers, by type, by Locality North Darfur, March 2008 Facility Based Staff Community Based Staff

HEALTH SERVEICES AVAILABILITY

Health Services examples Out of 62 health service monitored through the HeRAMS CHECK LIST, we have selected the following 5 services as examples of the service availability in Darfur 3 states: Level of Care Sublevel Code Service Community Care Level Child Health C23 Community mobilization for and support to mass vaccination campaigns and/or mass drug administration/treatments PHC Level General Clinical Services P14 Referral Capacity: referral procedures, means of communication, transportation Maternal & Newborn Health P62 Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed and/or reported), advise/counsel on nutrition & breastfeeding, self care and family planning, preventive treatment(s) as appropriate P65 Basic essential obstetric care (BEOC): parenteral antibiotics + oxytocic/ anticonvulsivant drugs + manual removal of placenta + removal of retained products with manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7 P66 Post partum care: examination of mother and newborn (up to 6 weeks), respond to observed signs, support breast feeding, promote family planning

Availability of selected Health Services at PHCCs, North Darfur, December 08 Maternal & Newborn Health Services provided at Primary Health Care Level Child Health Service provided at community care level General Clinical Service provided at Primary Health Care Level To interpret the graph; Antenatal care service example: 13% of the service is provided by the PHC Centers managed by the NGOs, while 64% of the service is provided by SMoHs. The overall percentage of the PHCCs providing the service out of the total functioning centers is 37%

Availability of selected Health Services at PHCCs, South Darfur, December 08 General Clinical Service provided at Primary Health Care Level Maternal & Newborn Health Services provided at Primary Health Care Level Child Health Service provided at community care level To interpret the graph; Antenatal care service example: 9% of the service is provided by the PHC Centers managed by the SMoH, while 57% of the service is provided by NGOs. The overall percentage of the PHCCs providing the service out of the total functioning centers is 65%

Availability of selected Health Services at PHCCs, West Darfur, December 08 Please refer to slide#20 to have the services related to this codes Service provided at Primary Health Care Level Service provided at community care level To interpret the graph; Antenatal care service example: 5% of the service provided by the PHC Units managed by the SMoH, while 56% of the service provided by NGOs. The overall percentage of the PHCUs providing the service out of the total functioning units is 61%

Trend Analysis example West Darfur: provision of Maternal & Newborn service at PHCCs PHC Level P62 Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed and/or reported), advise/counsel on nutrition & breastfeeding, self care and family planning, preventive treatments) as appropriate P63 Skilled care during childbirth for clean and safe normal delivery P65 Basic emergency obstetric care (BEmOC): parenteral antibiotics + oxytocic/ anticonvulsivant drugs + manual removal of placenta + removal of retained products with manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7 P66 Post partum care: examination of mother and newborn (up to 6 weeks), respond to observed signs, support breast feeding, promote family planning 19 April 2017 47

HeRAMS - Availability of Health Services to address STI & HIV/AIDS by managing partner, North Darfur, March 2008

HeRAMS - Availability of Health Services to address STI & HIV/AIDS at PHCCs, PHCUs, and Rural Hospitals, North Darfur, March 2008 Rural Hospitals PHCCs & PHCUs

HeRAMS - Availability of Health Services to address Sexual Violence at PHCCs, by managing partner, North Darfur, March 2008

HeRAMS - Availability of Health Services to address Sexual Violence at PHCCs, by Locality, North Darfur, March 2008

i-HeRAMS – Health Sub Sectors and Key Services Gap Analysis Identification of Gaps* in the provision of Key Services & Sub Sectors at the level of Administrative Units Sexual Violence Package monitored : - Clinical Management of Rape Survivors - Emergency Contraception - PEP for STI & HIV Infections * None of the Primary Care Facilities of the Admin Unit in red provides the package of services to address sexual violence.

HeRAMS - Availability of Health Services to address Maternal & Newborn Health by managing partner, North Darfur, March 2008

at PHCCs, PHCUs, and Rural Hospitals, North Darfur, March 2008 HeRAMS - Availability of Health Services to address Maternal & Newborn Health at PHCCs, PHCUs, and Rural Hospitals, North Darfur, March 2008 Rural Hospitals PHCCs & PHCUs

HeRAMS - Availability of Health Services to address Maternal & Newborn Health at PHCC, by Locality, North Darfur, March 2008

i-HeRAMS – Gap Analysis of Basic Emergency Obstetric Care, by Locality, North Darfur, March 2008 Maternal & Newborn Health Service monitored: BEmOC * None of the Primary Care Facilities of the Admin Units in red provides the Basic Emergency Obstetric Care Service

i-HeRAMS – Gap Analysis of CHild Health Key Service, by Admin Unit, North Darfur, March 2008 Child Health Service monitored: EPI * None of the Primary Care Facilities of the Admin Unit in red provides routine EPI

South Darfur Provision of Key Services – Proportion of PHF providing Key Services (%), March 2008

South Darfur Provision of Key Services – Proportion of PHF providing Key Services (%), March 2008

South Darfur Provision of Key Services – Proportion of PHF providing Key Services (%), March 2008