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SYSTEMS FOR BETTER HEALTH Project Implementation Working Paper Selection of Target Districts Revised Report March 2016 This project implementation working paper was produced for review by the United States Agency for International Development. It was prepared by Abt Associates for the USAID Systems for Better Health activity. Selection of Target Districts Contract/Project No.: Task Order No. AID611-TO-16-00001 Contract No. AID-OAA-I-14-00032 Submitted to: William Kanweka, Contracting Officer’s Representative USAID/Zambia Prepared by: Abt Associates In collaboration with: American College of Nurse-Midwives Akros Inc. BroadReach Institute for Training and Education Initiatives Inc. Imperial Health Sciences Save the Children DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government USAID Systems for Better Health ▌pg. i Selection of Target Districts USAID Systems for Better Health ▌pg. ii Selection of Target Districts Table of Contents Acronyms ...................................................................................................................................... iv 1. Introduction ......................................................................................................................... 5 1.1 Background regarding target districts ................................................................................................... 5 1.2 SBH activities at each level of the health system ............................................................................... 6 2. Approach to selection of target districts .......................................................................... 7 2.1 Factors proposed to guide selection of target districts ................................................................... 7 2.2 Method of identifying districts matching the selection factors ....................................................... 8 2.2.1 Donor Preference ..................................................................................................................... 8 2.2.2 Workforce in comparison to the establishment list ......................................................... 8 2.2.3 Facilities ........................................................................................................................................ 9 2.2.4 Comparison of Key HMIS Indicators. ................................................................................... 9 2.2.5 Stakeholders working in the district. .................................................................................. 10 2.2.6 Total scores .............................................................................................................................. 10 3. Central Province selection of target districts ................................................................. 11 4. Copperbelt Province selection of target districts .......................................................... 13 5. Eastern province selection of target districts ................................................................. 15 6. Lusaka Province selection of target districts .................................................................. 16 7. Southern province selection of target districts .............................................................. 17 USAID Systems for Better Health ▌pg. iii Selection of Target Districts Acronyms DATIM Data for Accountability, Transparency, and Impact DHIS2 District Health Information System Version 2 DMO District Medical Officer or District Medical Office EHT Environmental Health Technician GRZ Government of the Republic of Zambia HMIS Health Management Information System HRH Human Resources for Health MOH Ministry of Health PEPFAR United States President’s Emergency Plan for AIDS Relief PMO Provincial Medical Officer or Provincial Medical Office SBH Systems for Better Health Project USAID United States Agency for International Development ZISSP Zambia Integrated Systems Strengthening Project USAID Systems for Better Health ▌pg. iv Selection of Target Districts 1. Introduction The United States Agency for International Development’s (USAID) five-year Systems for Better Health (SBH) in Zambia activity seeks to improve health outcomes for Zambians, SBH will be implemented by Abt Associates Inc. (Abt) and its partners Akros Inc., American College of Nurse-Midwives, BroadReach Institute for Training and Education, Imperial Health Sciences, Initiatives Inc., and Save the Children from October 2015 to October 2020. The goal of USAID’s five-year Systems for Better Health activity is to improve health outcomes for Zambians by strengthening systems that underpin the delivery of high quality health services. The activity also seeks to increase the utilization of high impact health interventions. In twenty target districts within five provinces, Systems for Better Health will assist the Ministry to: Increase retention of HIV patients on antiretroviral therapy to 85 percent, Increase the use of modern contraceptives by 10 percent, Increase the proportion of deliveries assisted by a medically trained provider by at least 20 percent, Increase the proportion of fully immunized children aged 12 to 23 months to at least 80 percent, and Reduce the prevalence of stunting among children under five by 15 percent. To achieve these objectives, the Systems for Better Health project will provide technical, financial, logistical and administrative assistance to the Government of the Republic of Zambia (GRZ) at the national level and in five provinces and twenty target districts. The project will also work to strengthen the capacity of non-governmental and community-based organizations (NGOs and CBOs) to foster healthy behaviors and to deliver selected health services in remote areas. The purpose of this implementation working paper is to describe the process which the SBH project followed to reach agreement with the Provincial Medical Offices regarding selection of the target districts. 1.1 Background regarding target districts SBH activities will contribute to improvements at all levels of the health system. Task One activities prioritize national level improvements and systems strengthening. Tasks Two and Three prioritize the provincial, district, and facility levels. SBH will work in a total of five provinces (Central, Copperbelt, Eastern, Lusaka, and Southern). Within each selected province, SBH will target four districts, for a total of 20 target districts. SBH worked in collaboration with the Provincial Medical Offices (PMOs) to select the target districts in late January and early February 2016. SBH intends to implement district activities using a phased approach – SBH will initially begin its work intensively in ten districts. This initial phase of assistance will last 18 to 24 months and will culminate in a gradual withdrawal of intensive support and “transition,” when agreed-on performance targets are met and DMOs and facilities demonstrate improved capacity to maintain a high level of performance. As SBH reduces support from the initial set of target districts, we begin intensive support to the second set of ten districts. Phasing support for the SBH districts will allow for cost-effective, targeted use of project resources to strengthen health systems performance and health outcomes in all targeted districts during the life of the project. 5 Selection of Target Districts Once SBH target districts are selected, SBH will focus on approximately 15 targeted health facilities and their catchment communities within each district, and will reach about 300 health facilities and communities. 1.2 SBH activities at each level of the health system The Systems for Better Health project will focus on three tasks as described below. Tasks Two and Three will be performed in the target provinces and target districts. Task One: Design and implement national level interventions to strengthen health stewardship by the Ministry of Health (MOH) The project will provide technical assistance to strengthen MOH systems and skills to plan, implement, monitor health programs and evaluate performance. Project support under this task includes: strengthening human resource planning and management; improving health care financing and public financial management; and strengthening MOH systems for assuring the delivery of high quality health services and for coordinating stakeholders. Task Two: Design and implement effective interventions to strengthen program management at provincial and district levels The project will assist the Ministry to strengthen linkages between the central MOH and the Provincial Medical Offices (PMOs); between PMOs and District Medical Offices (DMOs); and between DMOs and health facilities. The project’s support focuses on strengthening the leadership and management systems, tools and skills of the PMO and DMO teams in order to improve planning, implementation, supervision, monitoring and evaluation. In addition, Systems for Better Health will strengthen clinical skills with a focus on high-impact health interventions including: maternal, neonatal, child, and adolescent health, family planning, HIV, and nutrition. Task Three: Assist the GRZ and local organizations to increase the quality, availability and use of priority health services at the community level In line with Zambia’s decentralization plan, the Systems for Better Health team will work to increase the skills of district
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