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Boresha Afya Lake and Western Zone Health Services Integration Boresha Afya Lake and Western Zone Health Services Integration

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Boresha Afya Lake and Western Zone Health Services Integration Boresha Afya Lake and Western Zone Health Services Integration BORESHA AFYA LAKE AND WESTERN ZONE HEALTH SERVICES INTEGRATION BORESHA AFYA LAKE AND WESTERN ZONE HEALTH SERVICES INTEGRATION Contract Number: AID-OAA-M-16-00006 SUBMITTED TO: ROSE KYANDO, AOR, USAID This report was made possible by the support of the American People through the United States Agency for International Development (USAID) under the terms of the Coordinating Implementation Research to Communicate Learning and Evidence (CIRCLE) contract AID- OAA-M-16-00006. CIRCLE is implemented by Social Solutions International, Inc., in partnership with Forum One. Views expressed are not necessarily of USAID or other affiliated institutions. Cover photo credit: USAID CIRCLE ACKNOWLEDGMENTS The authors are especially indebted to the Boresha Afya Lake and Western Zone implementing partners for their collaboration and flexibility to accommodate developmental evaluation activities. Special thanks are due to all the regional and district council health authorities, as well as to health service providers from the 12 health facilities in Musoma Municipal, Butiama, Tarime and Bunda districts for their collaboration and contributions, which was critical to this work. We are also indebted to the President’s Office Regional Administration and Local Government (PORALG) and Ministry of Health, Community Development, Gender, Children and Elderly (MOHCDGEC) in facilitating the evaluation and continuing to provide vital support. USAID.GOV BORESHA AFYA LAKE AND WESTERN ZONE EVALUATION OF HEALTH SERVICES INTEGRATION | 3 CONTENTS ACKNOWLEDGMENTS ............................................................................................. 3 ABBREVIATIONS ........................................................................................................ 6 EXECUTIVE SUMMARY ............................................................................................. 7 INTRODUCTION ........................................................................................................ 9 EVALUATION METHODS AND LIMITATIONS .................................................. 10 DATA COLLECTION METHODS .............................................................................................................. 10 SAMPLING AND SELECTION OF PARTICIPANTS ..................................................................................... 10 DATA ANALYSIS METHODS .................................................................................................................... 10 METHODOLOGICAL LIMITATIONS ......................................................................................................... 10 FINDINGS ................................................................................................................... 12 EQ1: HOW WELL DOES THE IMPLEMENTATION OF THE INTEGRATED SERVICES PACKAGES OFFERED WITHIN HIV CARE AND TREATMENT AND ANC-PNC PLATFORMS CONFORM TO THE PLANNED APPROACH? ............................................................................................................................................. 12 Mapping of current health service integration at health facilities ......................................... 12 Planned Versus Actual Implementation ...................................................................................... 14 FP integration within CTC and ANC-PNC platforms ............................................................ 14 NACS integration within CTC and ANC-PNC platforms ..................................................... 16 Observations from NACS integration within CTC and ANC-PNC platforms ................. 17 Malaria integration within CTC and ANC-PNC Platforms .................................................... 17 Observations from Malaria integration within CTC and ANC-PNC platforms ............... 18 Intra-facility Referrals for FP, NACS and malaria ..................................................................... 18 EQ2: WHAT ARE THE HSP KNOWLEDGE, VIEWS AND MOTIVATION TOWARD PROVISION OF INTEGRATED HEALTH SERVICES AND INTRA-FACILITY REFERRALS? ..................................................... 19 Knowledge about provision of health service integration ...................................................... 20 Health Service Providers’ Motivation.......................................................................................... 21 EQ4: ARE CURRENT DATA RECORDING TOOLS APPROPRIATE FOR CAPTURING INTEGRATED HEALTH SERVICES DATA? ........................................................................................................................ 21 Characteristics of existing data recording tools ....................................................................... 21 OPPORTUNITIES TO IMPROVE DOCUMENTATION OF FP INTEGRATION WITHIN CTC AND ANC- PNC ........................................................................................................................................................ 22 CHALLENGES AND EXISTING EFFORTS IN DOCUMENTING FP INTEGRATION .................................... 23 BARRIERS TO OPTIMIZING INTEGRATION OF FP AND NACS IN CTC AND ANC-PNC ............... 24 High provider’s workload .............................................................................................................. 24 Shortage of nutrition commodities .............................................................................................. 25 Lack of informational materials and registers ........................................................................... 26 Intra-facility referral challenges and opportunities ................................................................... 27 IMPLICATIONS .......................................................................................................... 29 BIBLIOGRAPHY ......................................................................................................... 31 ANNEX I: PRIORITY AREAS AND CROSS CUTTING QUESTIONS ............... 32 ANNEX II: RAPID RECONNAISSANCE ACTIVITIES ......................................... 33 ANNEX III: FINDINGS TABLES .............................................................................. 35 USAID.GOV BORESHA AFYA LAKE AND WESTERN ZONE EVALUATION OF HEALTH SERVICES INTEGRATION | 4 FIGURES FIGURE 1. STRUCTURE OF INTEGRATED FP SERVICES WITHIN CTC AND ANC-PNC ........................ 13 FIGURE 2. STRUCTURE OF INTEGRATED NACS WITHIN CTC AND ANC-PNC ................................ 13 FIGURE 3. STRUCTURE OF INTEGRATED MALARIA SERVICES WITHIN CTC AND ANC-PNC ............. 14 FIGURE 4. NUMBER OF CTCS THAT REFER FP CLIENTS TO RCH, BY FP METHOD .............................. 15 FIGURE 5. ROOT CAUSE ANALYSIS: INCONSISTENT PROVISION OF INTEGRATED FP AND NACS WITHIN CTC AND ANC-PNC ....................................................................................................... 24 FIGURE 6. AVERAGE NUMBER OF HSP AVAILABLE IN HEALTH FACILITIES AGAINST MINIMUMS RECOMMENDED BY GOT ................................................................................................................... 25 TABLES TABLE 1. COMPARISON OF PLANNED VERSUS CURRENT FP INTEGRATION MODEL ............................. 14 TABLE 2. COMPARISON OF PLANNED VERSUS CURRENT NACS INTEGRATION MODEL ...................... 16 TABLE 3. COMPARISON OF PLANNED VERSUS CURRENT MALARIA INTEGRATION MODEL ................... 17 TABLE 4. CHARACTERISTICS OF DATA RECORDING TOOLS AT VARIOUS SERVICE OUTLETS ................ 22 TABLE 5. KEY FINDINGS AND IMPLICATIONS ............................................................................................ 29 TABLE 6. DESEGREGATED RAPID RECONNAISSANCE ACTIVITIES ............................................................ 33 TABLE 7: PARTICIPANTS RECRUITED FOR FOCUS GROUP DISCUSSION AND IN-DEPTH INTERVIEWS ... 33 TABLE 8: LIST OF VISITED HEALTH FACILITIES IN MARA REGION ............................................................ 34 TABLE 9. AVAILABILITY OF FP COMMODITIES AND SUPPLIES .................................................................. 35 TABLE 10. AVAILABILITY OF NUTRITION COMMODITIES AND ASSESSMENT TOOLS .............................. 35 TABLE 11. AVAILABILITY OF MRDT .......................................................................................................... 35 TABLE 12. FP SCREENING .......................................................................................................................... 35 TABLE 13. NUTRITION ASSESSMENT ......................................................................................................... 35 TABLE 14. MALARIA SCREENING ............................................................................................................... 35 TABLE 15. INTRA-FACILITY REFERRALS FOR FP ........................................................................................ 36 TABLE 16. INTRA-FACILITY REFERRALS FOR NACS ................................................................................. 36 TABLE 17. INTRA-FACILITY REFERRALS FOR MALARIA ............................................................................. 36 TABLE 18. AVAILABILITY OF FP INFORMATIONAL MATERIALS ................................................................ 36 TABLE 19. AVAILABILITY OF NACS INFORMATIONAL MATERIALS ......................................................... 37 TABLE 20. AVAILABILITY OF MALARIA INFORMATIONAL MATERIALS ...................................................... 37 USAID.GOV BORESHA AFYA LAKE AND WESTERN ZONE EVALUATION OF HEALTH SERVICES INTEGRATION | 5 ABBREVIATIONS
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