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Global Funding Mechanism in Support of All Women and All Children

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Global Funding Mechanism in Support of All Women and All Children GLOBAL FUNDING MECHANISM IN SUPPORT OF ALL WOMEN AND ALL CHILDREN INVESTMENT CASE PROPOSAL - Version IV April, 2017 Foreword Message ACKNOWLEDGEMENTS The preparation of this Investment Case proposal is the result of the involvement of a long list of entities and individuals, between June 2016 and April 2017. Technicians of the National Public Health Directorate and other National Directorates of the Ministry of Health participated in consultations and provided indispensable documentation. Several technical experts from UN technical agencies, bilateral cooperation offices and international NGOs in Maputo provided time, comments and documentation and carried out specific analyzes. Officers of the Ministries of Education and Human Development, Youth and Sports, Gender, Children and Social Welfare and the Ministry of Justice and Constitutional and Religious Affairs participated in consultations on mulitsector programs. Several public and private entities provided time and documentation to carry out the auscultation exercise. We are also grateful for the collaboration of the sector development partners that financed the hiring of technical and secretarial assistance for the elaboration of the IC. The GFF-IC secretariat allowed for continuity between the various phases of the preparation. 2 ABBREVIATIONS A&Y Adolescents and Youth ACA Avaliação Conjunta Anual (Annual Joint Evaluation) ANC Antenatal Care ART Antiretroviral Treatment AVNP Anos de Vida Não Perdidos (Life Years Not Lost) CCS Consulta da Criança Sadia (Healthy Child Consultation) CDC Centres for Disease Control and Prevention CMAM Central de Medicamentos e Artigos Médicos (Central Medical Stores) CO Central Organs CONEm Cuidados Obstétricos e Neo-Natais de Emergência (Emergency Obstetric and Neonatal Care) CPR Contraceptive Prevalence Rate CR Civil Registry CRVS Civil Registry and Vital Statistics CSO Civil Society Organizations CUSd Cobertura Universal de Saúde (Universal Health Coverage) DAF Direcção de Administração e Finanças (Administration and Finance Directorate) DH District Hospital DHS Demographic Health Survey DNRH Direcção Nacional de Recursos Humanos (National Human Resources Directorate) DNSP Direcção Nacional de Saúde Pública (National Public Health Directorate) DPS Direcção Provincial de Saúde (Provincial Health Directorate) EFS External Funds Survey EPAs Elementary Polyvalent Agents EPI Expanded Program on Immunisation FP Family Planning G/O Gynaecology and Obstetrics GDP Gross Domestic Product HBS Household Budget Survey HC Health Center HF Health Facility HIS Health Information System HIMES Health Information, Monitoring & Evaluation System HIV-SIDA Human Immunodeficiency Virus (and its respective Syndrome) HRH Human Resources for Health IC Investment Case IMASIDA Inquérito de Indicadores de Imunização, Malária e HIV/SIDA (Survey on Vaccination, Malaria and HIV/AIDS Indicators) IMCI Integrated Management of Childhood Illness INE Instituto Nacional de Estatística (National Institute of Statistics) INS Instituto Nacional de Saúde (National Institute of Health) IPT Intermittent Preventive Therapy IUD Intra-uterine Device L-B Life Births M&E Monitoring and Evaluation MCH Maternal and Child Health MCHN Maternal and Child Health Nurse MDG Millennium Development Goals 3 MEDH Ministry of Education and Human Development MEF Ministry of Economy and Finance MJ Ministry of Justice MM Maternal Mortality MMR Maternal Mortality Rate MOH Ministry of Health NAC National AIDS Council NB Newborn NGOs Non Governmental Organizations NHS National Health System PED Paediatrics PEF Performance Evaluation Framework PMTCT Prevention of Mother to Child Transmission PNC Postnatal Care PNDRHS Plano Nacional de Desenvolvimento de Recursos Humanos (National Human Resources Development Plan) RMNCAH Reproductive, Maternal, Neonatal, Child and Adolescent Health SADC Southern African Development Community SDGs Sustainable Development Goals STD Sexually Transmitted Diseases TB Tuberculosis TDR Total Dependency Ratio UNFPA United Nations Fund for Population Activities UNICEF United Nations Infant, Children and Education Fund USD American Dollars VTP Voluntary Termination of Pregnancy WHO World Health Organization YFHS Youth Friendly Health Services 4 CONTENTS ACKNOWLEDGEMENTS ................................................................................................................. 2 ABBREVIATIONS ............................................................................................................................ 3 EXECUTIVE SUMMARY ................................................................................................................ 10 I. INTRODUCTION ................................................................................................................... 14 II. OBJECTIVES .......................................................................................................................... 14 III. VISION ............................................................................................................................. 14 IV. PRINCIPLES AND ASSUMPTIONS ..................................................................................... 16 V. PROGRESS MADE TO DATE .................................................................................................. 16 VI. CHALLENGES, INSUFFICIENCIES AND OBSTACLES ........................................................... 22 VII. LESSONS FROM INTERNATIONAL EXPERIENCE ............................................................... 24 VIII. BENEFITS OF INVESTING IN RMNCAH ............................................................................. 25 IX. THEORY OF CHANGE ....................................................................................................... 26 Matrix – 1: Theory of Change – the perspective of the intelligent interventions in the Health System 29 X. INVEST IN “WHAT”? ............................................................................................................ 30 EQUITY AND EXPANSION OF COVERAGE ................................................................................ 30 Provinces and Districts: potential results and deficits in the initial situation ..................... 30 Population Dispersion and Accessibility Strategies: Elementary Polyvalent Agents and Mobile Teams/ Brigades .................................................................................................................. 34 REDUCTION OF BARRIERS IN DEMAND AND SUPPLY: TO CARRY OUT HIGH-IMPACT INTERVENTIONS ...................................................................................................................... 37 High-impact interventions: plenty of international evidence ............................................. 37 MATERNAL HEALTH ............................................................................................................. 38 HEALTH OF THE NEW-BORN................................................................................................ 45 CHILD MORTALITY (0 – 4 YEARS) ......................................................................................... 47 CHILDHOOD AND ADOLESCENT MALNUTRITION ................................................................ 51 ADOLESCENT: SEXUAL AND REPRODUCTIVE HEALTH ......................................................... 55 FAMILY PLANNING .............................................................................................................. 59 INCREASE DEMAND AND CONTINUITY OF CONTACTS WITH PROVIDERS AND CHANGE BEHAVIOURS ........................................................................................................................... 61 Increase in the demand for services ................................................................................... 61 Common Strategy on Health Promotion and Behavior Change ......................................... 61 Recovery of losses of continuity of care: communication between MCHN and EPAs ........ 62 STRENGTHENING OF THE HEALTH SYSTEM ............................................................................ 62 The critical level of the healthcare network pyramid - the Health Facilities equipped for Obstetric and Neonatal Emergency Care ............................................................................ 63 5 Human Resources for Health: Competent professionals to attend to complex situations 64 Goods and products ............................................................................................................ 67 Improve the organization of service delivery: in each HF; between local Levels I-II .......... 67 Funding ................................................................................................................................ 68 Use of the information: monitoring and evaluation, accountability. Information System for Health Management and Civil Registry and Vital Statistics ................................................ 70 XI. LEADERSHIP AND GOVERNANCE ..................................................................................... 70 Private Sector and Civil Society ........................................................................................... 72 Adolescents and Young People ........................................................................................... 73 XII. OPERATIONALIZATION OF THE INVESTMENT CASE IMPLEMENTATION STRATEGY: INSTITUTIONAL CAPACITY ..........................................................................................................
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