Technical convening, August 15, 2017 on Scaling up health and development outcomes Spreading high-impact interventions M. Rashad Massoud, MD, MPH, FACP Director, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project Chief Medical and Quality Officer/ SVP, Quality & Performance Institute University Research Co., LLC – Center for Human Services 1
Three Key Questions • What do we want to spread? • To whom do we want to spread? By when? • How are we going to spread? USAID Applying Science to Strengthen and Improve Systems
Many possible ways to spread • Natural diffusion • Extension agents • Emergency mobilization • Spread through a collaborative • Spread through a virtual collaborative • Campaign spread • Wave sequence spread • Hybrid models Institute for Healthcare Improvement, Cambridge, MA USAID Applying Science to Strengthen and Improve Systems
Improvement in newborn and infant health outcomes in Tver Oblast, Russia Tver-neonatal mortality Tver-infant mortality Tver-early neonatal mortality 25 19.5 20 14.4 15 Deaths per 1,000 live births 13.4 10.3 10 8.4 7.6 6.0 5 3.9 2.8 Demonstration Spread QAP no longer providing technical Phase Phase assistance to Tver Oblast 0 1994 1996 1998 2000 2002 2004 2006 2008 2010 USAID Applying Science to Strengthen and Improve Systems
Improvement in newborn and infant health outcomes in Tver Oblast and Russian Fed. National-neonatal mortality National-infant mortality Tver-neonatal mortality Tver-infant mortality Tver-early neonatal mortality 25.0 19.5 20.0 19.4 16.1 Deaths per 1,000 live births 14.4 15.0 13.4 11.6 11.6 9.9 10.3 10.0 8.4 7.6 6.0 7.5 5.0 3.9 Demonstration Spread QAP no longer providing technical 2.8 Phase Phase assistance to Tver Oblast 0.0 1994 1996 1998 2000 2002 2004 2006 2008 2010 USAID Applying Science to Strengthen and Improve Systems
Principles of Spread 1. Begin with scale-up in mind If you can reach all-at-once – you should! 2. 3. If you cannot, then consider a phased approach: – Look for nested systems – Test prototypes & expand in multiples of 5-10 4. Information systems 5. Communication needs 6. Oversight needs with scale-up USAID Applying Science to Strengthen and Improve Systems 6
Wave Sequence Spread USAID Applying Science to Strengthen and Improve Systems
Rwanda - Comparison of Demonstration vs. Spread site for the % Partners of Women in ANC Tested for HIV Rwanda: percentage of partners tested 100% 90% 80% 70% % of partners tested 60% 50% 40% 30% 20% 10% 0% J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J Old Sites: % (16) New Sites: % (20) USAID Applying Science to Strengthen and Improve Systems 8
Niger - Comparison of Demonstration vs. Spread IMCI Sites for the % Children Triaged on Arrival Niger: Percent of children triaged on arrival 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% r n l t c b r n g t c b n g t c r y p v c c c u p p a e e u u e e u u e a a e o O O O J A A M D F J A D F J A D J M S N Old sites New sites USAID Applying Science to Strengthen and Improve Systems 9
Percentage of deliveries where Active Management of Third Stage of Labor -AMTSL- was implemented in accordance to standards. Three groups of hospitals (started 2003-2004, n=55; 2005, n=21; 2007, n=10) . Total 86 hospitals reporting 2003-2009. Ecuador. 100 90 80 70 60 Percentage 50 40 30 20 10 0 Jl-0 AgSpOt NvDcEn FbMr AB MyJn Jl AgSpOcNvDcEnFb MrAbMyJn Jl AgSpOcNvDcEnFb MrAbMyJn Jl AgSpOcNvDcEn FbMr AbMyJn Jl AgSpOcNvDcEnFb MrAbMyJn Jl AgSpOcNvDcEnFb MrAb 2003 2004 2005 2006 2007 2008 2009 % 2003-2004 0. 1514 1621 3237 3739 4142 4048 5159 5755 55 5857 6565 6168 6665 6966 6571 6463 6771 73 7681 8080 8579 7679 8679 8683 9095 9495 9795 93 8990 9495 9796 9692 9793 9391 9594 9697 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1538 5559 4367 6277 8481 8474 7878 7984 82 8889 9389 8277 8182 8079 8487 8892 9084 8892 88 8991 8592 9592 9693 8889 9492 8891 9192 % 2005 % 2007 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21 4044 5156 8879 9485 7693 90 8985 8987 8596 9795 9497 10 1010 9810 USAID Applying Science to Strengthen and Improve Systems 10
Uganda: At what scale are we working? 2- Northern Uganda 1- Main Uganda Program Program MOH, MGLSD, 12 IPs 13 out of 13 regions 65/112 districts 280 facilities 634 communities - HIV/AIDS - Maternal and newborn - DREAMS care - PMTCT - Child health 928 QI teams - OVC - TB, TB/HIV - VMMC - Malaria - Lab hubs - Nutrition 9.8 million out of - Leadership & - QI institutionalization governance Support to MoH 36 million - Reproductive health - Human resources USAID Applying Science to Strengthen and Improve Systems 11
Scaling up: Saving Mothers Giving Life spread Wave 2: Wave 3: Oct 2015 38 Demonstration Wave 1 60 2012- 2014 health Feb 2015 health SMGL learning facilities 20 health facilities collaborative facilities 30 health facilities USAID Applying Science to Strengthen and Improve Systems 12
Scaling up: SMGL process results USAID Applying Science to Strengthen and Improve Systems 13
Scaling up: SMGL outcome results Malaria Epidemic Seasonal Malaria Shift USAID Applying Science to Strengthen and Improve Systems 14
Key Lessons Learned • Results are the key drivers • Enabling people to make changes in their work – Systems thinking – Equip with PDSA’s – Assistance to the teams in the form of site visits – Leadership Support – Role Modeling – Normative/regulatory support • People working under constraints can be very creative • Scale-up efforts require meticulous attention to detail • Champions who developed the prototypes are critical for leading the scale-up in wave sequence spread • Leadership from within the system USAID Applying Science to Strengthen and Improve Systems 15
Recommend
More recommend
