Short Programme Review on Child Health Experience from Sri Lanka Family Health Bureau Ministry of Health Sri Lanka 1 Regional Programme Managers Meeting CH Kathmandu

Planning and implementation cycle Develop strategic plan (5-10 yearly) Prepare for planning Evaluate health impact and intervention coverage Evaluate program outputs and outcomes; Manage implementation (Ongoing) implementation plan (1-2 yearly) WHO Managing program to improve Child health Maternal and Newborn health SP Child Health SP Medium Term MCH/FP Plan (5yrs) District National District Plan Health Master Plan MCH Policy School and Adolescent Health 2 Regional Programme Managers Meeting CH Kathmandu

Programme Review Local & monthly conferences Medical Officer of Health (MOH) area Biannual district MCH reviews National district MCH review EPI review District 3 Regional Programme Managers Meeting CH Kathmandu

Need and the opportunity Need for organized reviewing of the Programme implementation Three National Programme Officers (Government &WHO) attended Regional Training Progrmme on SPR on Child Health at Nepal Regional Programme Managers Meeting CH Kathmandu

IMPROVED SURVIVAL AND HEALTH INCREASED POPULATION- BASED COVERAGE of key effective Interventions Quality Equity PROGRAMME OUTPUTS Increased availability/access of services Increased demand for services Improved quality of services/care Improved information to / knowledge of families PROGRAMME ACTIVITIES Advocacy Mobilizing human, material and financial resources Capacity development Programme communication Health system supports Monitoring progress using data 5 Regional Programme Managers Meeting CH Kathmandu

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Are interventions reaching women and children? How well are program activities Being implemented? What are the main problems? What are solutions and recommendations? What are next steps for taking action? Where are we going? WS 1 WS 2 WS 3 WS4 WS 5 WS 6 WS 7 6 Regional Programme Managers Meeting CH Kathmandu

National GoalsDistrict Goals National objectivesDistrict objectives Worksheet 1 7 Regional Programme Managers Meeting CH Kathmandu

Worksheet 2 Indicators Baseline data (year & source) Most recent data (year & source) Targets Inter district/With in district / division differences Comments Maternal mortality ratio 8 Regional Programme Managers Meeting CH Kathmandu

Pregnancy Birth & immediate post-natal Neonatal Infants & Children Home & community First-level facilities Referral Continuum of care for the health system Continuum of care Field clinics Work sheet 3 9 Regional Programme Managers Meeting CH Kathmandu

Worksheet 4 Interventio n Population Coverage Indicator Baseline data (year and source) Most recent data (year and source) TargetDifference s by region or group (highest/lo west) Data availability and quality of data, 10 Regional Programme Managers Meeting CH Kathmandu

Human Worksheet 5 sources development Discussion pointsStatus of implementation (fully, partly or not at all) Reasons for observed implementation Performance StrengthsWeaknesses Policy, planning and management Human resources/training Development of community support Strengthening Health Systems Communication/IEC Monitoring and evaluation 11 Regional Programme Managers Meeting CH Kathmandu

Worksheet 6: Identify the main problems Interventions where more action is needed (from coverage data):__________________________ Activity areaproblem Policy, planning and management Human resources/training 12 Regional Programme Managers Meeting CH Kathmandu

Worksheet 7: Develop solutions and recommendations ProblemCausesSolutionrecommendations 13 Regional Programme Managers Meeting CH Kathmandu

Follow up action of the training - Pilot testing at the District of Matale Child Health  Adaptation of the worksheets  Limited success - intervention and activities  Opportunities - Familiarizing with the overall process - Identified the short-comings 14 Regional Programme Managers Meeting CH Kathmandu

Interventions Interventions are treatments, technologies, and key health behaviors that prevent or treat illness and reduce deaths or improve health status 15 Regional Programme Managers Meeting CH Kathmandu

Lessons learnt Child health alone – not cost effective - time consuming - deviated from overall MCH planning - District /Divisional staff deliver integrated package of Overall MCH Need for combined MCH/FP/Nutrition 16 Regional Programme Managers Meeting CH Kathmandu

Pilot testing at the District of Puttlam Identification of interventions - maternal and newborn Implementation level Evidence based effective interventions – all possibleall possible - in place Four levels – home community, Field clinic, First referral, Tertiary care Maternal Newborn and Child Health (MNCH) Groundwork- preparation of worksheets 17 Regional Programme Managers Meeting CH Kathmandu

18 Regional Programme Managers Meeting CH Kathmandu

Data for WS 1 & 2 – data available But data to address equity gap was not available at district level Routine – RG, HMIS,IMMR, H 830 Periodic survey – DHS, Nutrition Surveys Data lacking – WS 3,4 & 5 Surveys – data extraction H 512,CHDR,BHT LQS - data extraction - Exit interviews Identify information gaps Learn to use different data sources Possibility of them included into the routine system Groundwork ct. - Identification of data sources 19 Regional Programme Managers Meeting CH Kathmandu

Data collection formats for each MOH area and summary sheets Could be used later Groundwork ct. – preparation of data collection formats Groundwork ct. – preparation of data collection formats 20 Regional Programme Managers Meeting CH Kathmandu

Advocacy meeting – PD/RD/Hospital administrators, clinicians, Ward sisters, District MCH planning team, other public health Groundwork ct – Preparatory meetings Convinced them of the importance – Methodically looking at issues rather than adhoc activities Data collector training – Public Health Staff Future use - Availability of data Data collection methods Facilitator training 21 Regional Programme Managers Meeting CH Kathmandu

Working Groups Team 1 – Antenatal, Postnatal care and Family planning Team 2 - Intra partum and Newborn care Team 3 – Infant and Child care for each group Facilitator – programme managers 22 Regional Programme Managers Meeting CH Kathmandu

Process and learning points Step 1 WS 1 &2 Plenary some targets are realistic ? Step 2 WS 2 & 4 Group work Good participation of Field and ward staff 23 Regional Programme Managers Meeting CH Kathmandu

Process and learning points Step 3 WS 5 Group work Understanding the important of all categories of activity Step 4 WS 6 Group work Step 5 WS 7 Remixed- Group work Route course identification and recommendations 24 Regional Programme Managers Meeting CH Kathmandu

Process and learning points Step 6 Next step Present recommendations to the district team Step 7 25 Regional Programme Managers Meeting CH Kathmandu

Advantages Convinced the importance of scaling up of intervention to get the universal coverage Implementation of all categories of activities order to have intervention coverage. Provided forum to use the available data and review the district MCH Plan Staff is well aware of the process,improve the participatory approach in reviewing data Make baseline data available for review in another programme cycle Recommendations for both district and national level 26 Regional Programme Managers Meeting CH Kathmandu

Way forward Further amendments to the worksheets – live Introduce the methodology for other districts - have next in line as observers Incorporate other life stage interventions e.g. school and adolescent health 27 Regional Programme Managers Meeting CH Kathmandu

Thank WHO SEARO Office – Dr Rajesh Mehtha Dr Aravind Mathur WHO CO SL – Dr anoma Jayathilake/NPO 28 Regional Programme Managers Meeting CH Kathmandu

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