Class Clinical Module RS/RHMT Version REVISED 29 Sept 2011
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ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011
Please note:
· The Regional Health Management Team (RHMT), while being a part of the Regional Secretariat (RS) for all administrative and financial matters, is accountable to the Ministry of Health and Social Services (MOHSW) on all technical/clinical matters.
· The Regional Medical Officer (RMO) heads the RS/RHMT and a Medical Officer In-Charge heads the Regional Referral Hospital.
· The term “District Health Management Team” has been replaced by the more current term “Council Health Management Team” (CHMT). In practice, these might be used interchangeably.
· The RS/RHMT is responsible for providing technical and clinical supervision of Regional Referral, District and Designated District Hospitals.
· The District Hospital has its own District Hospital Management Team (DHMT) which is accountable to both its CHMT and the Regional Referral Hospital (if one exists in the Region)
INTRODUCTION TO THE TOOL
The Clinical Module for RS/RHMTs of the ClASS Toolkit is a guide, not a checklist, for reviewers conducting assessments of RS/RHMTs or organizations supporting health care services. This module will be used for understanding the RS/RHMTs’ capacity for coordination and supervision of HIV and AIDS services in selected regions.
Subject to guidance from CDC-Tanzania, key interviewees for the Clinical Module discussions may include:
i) Regional Medical Officer (RMO);
ii) Regional Nursing Officer (RNO);
iii) Regional Health MIS Coordinator;
iv) Regional AIDS Control Coordinator (RACC)
The Module is divided into five sections:
ClASS Clinical Module | Version 3.5 | May 2011
1. RS/RHMT Supportive Supervision and Mentoring at CHMT level
2. RS/RHMT Supportive Supervision and Mentoring at District/designated Hospital Level (with 3 sub-sections)
3. RS/RHMT Health Management Information System (HMIS)
4. RS/RHMT Monitoring and Evaluation Systems (M&E for evidence-based strategic planning)
5. RS/RHMT Communications
ClASS Clinical Module | Version 3.5 | May 2011
ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 2
Each section begins with a set of core competencies followed by a series of questions that can be used to facilitate discussions with different stakeholders. Verification criteria for the most important core competencies and questions follow along with space for reviewers to make notes. Reviewers should not feel compelled to complete the tool sections in the order presented, but should proceed with flexibility to accommodate the time and availability of RS and RHMT staff.
It is assumed that there will be at least XX hours available to reviewers at each RS/RHMT in order to allow for completion of all sections of the tool. When time is limited, reviewers should determine which sections to prioritize. The choice on which sections to prioritize should be made after the opening presentation and in consultation with the team lead. In such a rapid visit, the highlighted elements in bold-face type can be addressed; est time: XX hrs.
ClASS Clinical Module |RS/RHMT version | REVISED 29 Sept 2011 2
Reviewers may find that not all sections of the tool will apply to all RS/RHMTs. As applicable, these should be noted as such for future use of the tool.
CLINICAL ASSESSMENT FOR SYSTEMS STRENGTHENINGClASS / Clinical Module: RS/RHMTs
REVIEWERS: ______
DATE: ______
RHMT: ______
KEY: Rapid visit items=Bold | Extended visit items=AllSECTION 1: RS/RHMT COORDINATION & SUPPORTIVE SUPERVISION FOR CHMTs
Core Competencies
q The RS/RHMT has a clearly defined, participatory plan to progressively build the capacity of CHMTs and other sub-grantees in the region for all essential health services including a response to the HIV/AIDS epidemic
q The RS/RHMT has the capacity to strengthen the capacity of regional and council health care systems to provide quality comprehensive, sustainable prevention, care, and support services
q The RS/RHMT implements a woman- and girl-centered approach in its planning, technical and monitoring support to CHMTs
q The RS/RHMT has the capacity to provide technical assistance to CHMTs regarding MOHSW policies and guidelines concerning HIV service delivery
q The RS/RHMT has the capacity to hire or has processes to train program staff on monitoring guidelines and technical assistance options for CHMTs and sub-grantees
q The RS/RHMT can demonstrate that all of its CHMTs have comprehensive council health plans (CCHPs) which are compliant with and address relevant elements of the MOHSW Health Sector Strategic Plan III (2009 – 15)
q There are RS/RHMT policies with appropriate documents for CHMTs or sub-grantees to understand program reporting requirements and program monitoring policies and procedures.
q The RS/RHMT has the capacity to carry out two (2) supervisory support visits annually to each CHMT and any other regional sub-grantees
q RS/RHMTs have the capacity to prepare CHMT supervisory site visit reports which includes dissemination to CHMTs themselves
Open-Ended Questions
q What processes does the RS/RHMT have in place to build the capacity of CHMTs (and other sub-grantees) in the region to respond to the epidemic? Is it a clearly defined, participatory plan to progressively build capacity of CHMTs?
q What are the key planning documents used by the RS/RHMT to strengthen the capacity of CHMTs and any other regional sub-grantees to in turn plan and implement HIV/AIDS treatment and care activities? When last were they updated? Approved by whom?
q How does the RS/RHMT operationalize and implement these plans?
q What processes does the RS/RHMT use to inform CHMTs regarding MOHSW policies and guidelines concerning HIV service delivery?
q What processes does the RS/RHMT have in place to hire or train one (1) regional staff to perform management and oversight of program activities, including those at CHMT level, in the region?
q Do all of the region’s CHMTs have comprehensive council health plans (CCHPs) which are compliant with MOHSW Health Sector Strategic Plan III (2009 – 15)?
q How regularly does the RS/RHMT support the CHMTs update their CCHPs?
q What RS/RHMT documents explain program monitoring policies and procedures at CHMT, Regional Referral Hospital, District Hospital and Designated District levels? Is that document disseminated to CHMTs (or sub-grantees)? How often are the documents reviewed, updated?
q What RS/RHMT documents explain women-and girl-centered approaches in public health to CHMTs and health facility levels? How is the document disseminated to CHMTs or facilities? How often are the documents reviewed, updated? What processes does the RS/RHMT use to verify that these approaches are used?
q Over the past year, how often has the RS/RHMT been able to provide supportive supervision visits to each of its CHMTs? What is the process to conduct monitoring visits for CHMTs or sub-grantees?
o How are scheduled, or random monitoring, visits conducted? How often are they conducted?
o What program or service areas are covered during the visits? How are these visits coordinated between departments?
o What advance notice is provided to CHMTs or sub-grantees?
o What feedback/findings of visits are shared with the CHMT (or sub-grantee) after the visit? With RS or RHMT management?
o How are findings addressed and tracked following the visits?
o How can CHMTs or sub-grantees access technical assistance to remedy findings?
o Where have CHMTs been able to get prioritized technical assistance from? (which agencies?)
o How is follow-up to visits conducted, if needed?
q What is the mechanism to provide feedback to CHMTs and/or sub-grantees on supervisory site visit reports?
q How are results of supportive supervisory visits to CHMTs or sub-grantees documented and shared with the MOHSW, RS and, where applicable, external donor(s)?
Performance Criteria / Verification Information / Comments
1. / CHMT or sub-grantee reporting to the RS/RHMT: / a. Is required every (how often?):
b. Follows required format and content:
c. Is a combination of program and finance information:
d. Feedback is shared with:
2. / Capacity building plans for use by RS/RHMTs for CHMTs (and other regional sub-grantees): / a. Are created in consultation with:
b. Have a stepwise progression for capacity building
c. Are approved by:
d. Are reviewed and modified every:
e. Are shared with CHMTs every:
3. / Quality of RS/RHMT Annual Plans / a. Evidence based
b. Realistic
c. Achievable
d. Measurable
e. Culturally appropriate
f. Consider underserved populations
g. Include reasonable estimates of outcome targets, eg., number of sites to support, number to clients to reach
h. Are collaborative
4. / CCHPs: / a. Are in place for all CHMTs:
b. Are updated by:
c. Are updated how often:
d. Cover the following areas:
treatment facility space assessments, patient flow, commodities supply chain management, and capital equipment management
5. / RS/RHMT monitoring visits to CHMTs or sub-grantees: / a. Are conducted by:
b. Are conducted every:
c. Include the following areas: treatment facility space assessments, patient flow, commodities supply chain management, and capital equipment management:
d. Are documented by:
e. Quality of documentation:
f. Recommendations are shared with:
g. Follow-on actions to recommendations:
h. Desired changes achieved?
If not, factors for this?
6. / CHMTs or sub-grantees can access capacity building or technical assistance: / a. Through the RS/RHMT.
b. Through the local funding donor.
c. On their own.
d. Other:
7. / RS/RHMT hiring or training one regional staff to perform management and oversight
of program activities / a. Is included in current RS/RHMT budget;
b. Requires external funding;
c. If training is feasible, RS/RHMT already has a candidate to recommend;
d. Other:
8. / RS/RHMTs strengthen regional and council health care systems through these actions: / a. Advise the Regional Secretariat on promoting and improving health related interventions
b. Advise and provide technical backstopping to the CHMT in their roles and responsibilities to plan and deliver quality health care services
c. Technical back stopping for CHMTs for planning and reporting.
d. Support CHMTs to develop Health Center and Dispensaries annual plans
e. Advice on construction and rehabilitation of health facilities
f. Assess the distribution of health facilities within the Councils in order to avoid duplications and promote use of existing FBO facilities
g. Monitor the distribution of and construction of additional health facilities within the Councils to ensure equity of access and efficient use of available resources which includes existing health facilities
h. Monitor the staffing and equipping of all health facilities
i. Support CHMTs on financial and material resource management
j. Supportive supervision of the CHMT for the implementation of their CCHPs.
k. Review, analyze and comment CCHP and Regional Referral Hospital Plans (RRHP) and give feedbacks to the Councils as well as to the RS.
l. Facilitate the identification of training needs of Council health staff
m. Technical and clinical supervision of District (incl. Designated) Hospitals
n. Monitor the equitable distribution of medicines, medical supplies and equipment among the Councils
o. Support CHMTs in managing health financing options that ensure sustainability and equity in health services provision (NHIF, CHF, exemption & waiver, use of funds collected at health facilities level)
p. Advise Local Government Authorities (LGAs) directly and provide technical backstopping to the CHMTs on the correct and timely implementation of national policies, guidelines, and standards for both public and private health service providers within the LGAs
q. Monitor advice and ensure that delivery of quality health care services is conducted within the frameworks of accessibility, affordability, equity and gender mainstreaming within all LGAs.
9 / Promote research, development and innovation / a. HIV/AIDS service delivery
b. Nursing
c. PMTCT
d. Pharmaceutical services
e. Dental services
f. Radiology services
g. Laboratory services
h. Supply chain management
i. Other Action/Operational research:
10 / Implement a woman-and girl-centered approach / a. Collaboration with non-health sector on gender issues affecting health
b. Women and girls participate in community health meetings
c. Train HCW on gender perspectives
d. Increase women and girls’ access to care
e. Encourage male involvement in women and girls’ health
f. Data is segregated by age and sex
g. Analyze data using gender and age lenses
Notes:
SECTION 2: RS/RHMT SUPPORTIVE SUPERVISION AND MENTORING AT HOSPITAL LEVEL
SUB-SECTION 2.1: CLINICAL/TECHNICAL SUPPORT CAPACITY
Core Competencies
q The RS/RHMT provides clinical/technical support to various types of the health care facilities in the region (Regional Referral Hospital, District/Designated hospitals, other private/public facilities) on a regular basis.
q The RS/RHMT directly supports a comprehensive range of integrated HIV care and treatment services at both Regional and District hospitals.
q The RS/RHMT has the clinical/technical capacity in key service areas [(e.g., continuous quality improvement (CQI), laboratory, pharmacy, supply chain management (SCM), monitoring and evaluation (M&E), use of data and strategic information (SI), costing analysis, etc.)] to support HIV care and treatment in the region’s hospitals.
q RS/RHMT has used or had access to USG or other funder resources or expertise in providing clinical/technical oversight to the region’s hospitals.
q RS/RHMT supervisory visits includes support to Regional Referral Hospital, District and other Designated District
Hospital Management Teams to carry out treatment facility operational reviews (re space assessments, patient
flow, commodities supply chain management, and equipment logistics)
q RS/RHMTs have the capacity to prepare health facility (Regional Referral Hospital, DHMT or Designated District
Hospital) supervisory site visit reports which includes dissemination to CHMTs and health facilities which are
reviewed
Open-Ended Questions
q What support is provided by the RS/RHMT to various types of the health care facilities (Regional Referral Hospital, District/Designated hospitals, other private/public facilities)?
q What does the RS/RHMT do to support of HIV care and treatment in the region? Provide examples.
q What collaborations are there between the RS/RHMT and other MOHSW or PMORALG structures at District, Zonal, Regional and national level, other donors and/or implementing partners?
q Does the RS/RHMT possess the clinical/technical capacity (e.g., staffing, equipment, and infrastructure) in key service areas to support HIV care and treatment (e.g., CQI, laboratory, pharmacy, SCM, M&E, use of data and SI, costing analysis, etc.)?
q To what extent has the RS/RHMT used or had access to USG or other funder resources or expertise in providing clinical/technical oversight in the region?
Performance Criteria / Verification Information / Comments
1. / Current beneficiaries of RS/RHMT clinical/technical support include: / a. National/Regional/Council government (policy, guidelines development, advocacy)
i. MOHSW at various levels: district/council, regional, zonal
ii. Regional/District HIV/AIDS Control Program and/or related offices
iii. Other regional administrative bodies (e.g. Regional Secretariat, PMORALG)
b. Other local organizations: faith-based networks, universities, NGOs, PLWHA groups, CBOs, etc.
i. Clinical sites: Regional Referral Hospital, District/Designated Hospitals, Health Centers and/or Dispensaries.
ii. Community-based service providers.
2. / Clinical/technical areas of support includes:
(specify the type of support provided in each of the areas) / a. Primary health care, including preventive oral/dental care.
b. Care and treatment and related services: HIV counseling and testing (HCT); voluntary counseling and testing (VCT); provider-initiated counseling and testing (PICT); adult and pediatric TB/HIV care.
c. Prevention, including sexual health especially STIs, male circumcision, PwP, OIs, and abstinence-based programs.
d. Maternal, neonatal, and child health (MNCH), family planning (FP), prevention of mother-to-child transmission (PMTCT).
e. Other support: home-based care, community-based care, orphans and vulnerable children (OVC) support, psycho-social care, and people living with HIV (PLHIV) empowerment.
3. / The RS/RHMT has capacity to support and supervise the following: / a. CQI, laboratory, pharmacy, SCM, M&E, SI/data use, costing analysis, facility operations including space assessments to ensure appropriate patient flow and commodities management etc.
b. Direct support versus support-through-subcontracts for several or all areas identified in 3a.
c. Clinical HIV care at: Ward, District, Region health facilities
d. There is adequate RHMT staffing (i.e., levels and expertise/experience) to meet beneficiary needs.
4. / RS/RHMT utilizes, or has a. Discussion/confirmation of purpose, type, scale &
utilized, USG resources relevant date(s)
and/or expertise.
Notes: