development in Mozambique drgs Developing, Sustaining, and Managing - - PowerPoint PPT Presentation

MOASIS and Jembi: a sustainable multi-national PPP for National HMIS development in Mozambique

Developing, Sustaining, and Managing a Competent Global Health Workforce

April 2014, Dr. Alessandro Campione and Prof. Chris Seebregts

drgs

Universidade Eduardo Mondlane

Mozambican Open Architectures, Standards and Information Systems

Contents:

• 1. HIS in Low Resources Setting
• 2. Jembi and Moasis model (as possible solution)
• 3. Main achievements

HIS in Low Resource Settings

Increased interest in sustainable national HIS at scale Lack of in-country funding for HIS workforce in the MOH Fragmented projects funded by multiple donors ​Lack of harmonization and standards for multiple projects Too high expectations and lack of visible and early results challenge of implementing technologies without ensuring adequate support/capacity to ensure sustainability

SOME CHALLENGES OF PUBLIC HEALTH HIS

HIS WORKFORCE IN MOZAMBIQUE, A CHALLENGING HR ENVIRONMENT

 Lack of health IT skills and training  Unpredictable personnel supply and demand  Competition in the private sector for scarce personnel, including:

• Abnormally high salaries and lack of

benchmarks

• High turnover of staff

 Lack of professional commitment and exaggerated importance of the role of developers in HIS  Dependency on external consultants

BANK

• SUPP. PATNERS

MINING COMPANIES MOBILE COMPANIES

IT SPECIA CIALI LIST

High challenging to manage the National health Information System

Uncertainty in the leadership and Health IT specialists unaffordable for the public health system

HIS WORKFORCE WITHIN THE MOH

Weak MOH H le leader ersh ship p resul ults ts in in:

• Susp

spendi ending ng curre rent nt in init itiat atives es – embargo argo / mora ratori

• rium

um

• Pro

rojec ects ts based d on perso sonal nal theorie

• ries/i

s/int nter erests ests

• Pro

rojects ects unsust stainable nable, , not reproduci ucible ble or scalab able

• Depen

ende dent nt on an in indiv ividual ual suppo port

Planning Governance Regulatory M&E

MISAU MOH

INVOLVED IN OPERATION INCREASE DEMAND ON TECHNOLOGY AND IT COMPLEXITY

St Strong rong MOH H le leader ershi ship results ults in in:

• Less

s turno nover er of staff

• Positi

sitive envir iron

• nment

ent stim imul ulates es in inve vestm stment ent in in HIS IS

• Big

ig im improvem ement ent in in short t tim ime

JEMBI AND MOASIS MODEL

(AN POSSIBLE AND EFFECTIVE SOLUTION)

JEMBI/MOASIS MODEL RESPOND TO THE NEED OF CRITICAL MASS INSIDE AND OUTSIDE THE GOVERNAMENTAL STRUCTURE

Positive, extended, sustainable, locally

• wned results

A local PPP, trusted by the MoH, linked to the public, academic and private sector, honest broker, supported by Int. ORG in a south th-south south-nor north th collaboration

N EED TO G UARANTEE C ONTINUIT Y A ND S USTAINABILIT Y I NDEPENDENTLY FO RM T HE L I DERSHIP A ND H R T URNOVER

 MOASIS is a non-profit organization of UEM, Living Lab created and supported entirely by JEMBI with support of IDRC, CDC, WHO, Rockefeller and others ORG. We aims to:

• Strengthen HIS local capabilities involving the public, private and

academic sectors

• reference and link between the MOH and public/private partners

JEMBI/MOASIS: 50 PROFESSIONAL IN 4 COUNTRY

JEMBI/MOASIS MODEL

 Employ/develop local HR and build critical mass and network  joint team and work plans (gov. & partners)  Helps for Project continuity/sustainability  Helps to manage expectations  Multidisciplinary (IT experts, analyst and developers, public health specialist and epidemiologist)  Project Management culture

 Country offices (Moasis) focus on deliverables and not on macro planning, fund rising and grant management (Jembi)  single organizational infrastructure for all country programs, (Mozambique, South Africa and Rwanda): becoming a REGIONAL e-health HUB  Reproduce successful projects and reuse of knowledge  Shared senior technical and grant management resources  business intelligence system that combines software, communication, persons, well-established methods and procedures and single initiatives full CDC, USAD, WHO, EU compliant

JEMBI/MOASIS MODEL

For MoH support as honest broker and risk taker:

• Assessments, ToR, Requirements, Evaluations, Procurements, project and

contract management, development of innovations/pilot projects and deployment/maintenance

For academic sector support:

• Support the training of future Mozambicans and e-health software and

system engineers

• Develop and maintain curriculum in HIS trainings
• Training/lectures in various branches (IT, clinicians, nurse, statisticians,

HIS technicians etc.)

• Publication and conferences

For private sector support:

• Reference and repository of HIS information
• Management of public projects and resource mobilization in non

competitive way

PUBLIC, ACADEMIC AND PRIVATE SECTOR

MITIGATE HIGHLY COMPETITIVE WORK FORCE ENVIRONMENT

Human Resources:  Pairing technical and program staff  Redundancy across country offices  Core Jembi Senior Staff supporting every nodes:

epidemiologist, specialist in Public health and HIS, grant and projects management

 constant on the job/formal training and mentoring  Share the most expensive HR Governance:  Diplomacy, deep knowledge of local culture and dynamics  Create a critical mass and network to support the PPP  technical advising /oversight for other Organizations  Responsive to governance needs and crises

MINISTR Y OF HEALTH MINISTR Y OF JUSTICE MINISTRY OF INTERIOR

NATIONAL INSTITUTE OF STATISTIC

UNIVERSI TY EDUARDO

MONDLANE

(UEM)

NGO AND PRIVATE SECTOR mOASIS

DEVELOP THE NATIONAL HIS NETWORK

CRITICAL MASS AND NETWORK

• Moasis supported by Jembi
• Jembi supported by CDC building

network

• Inter-ministerial
• Inter-institutional
• National NGO/ORG
• International community

National NGO/ORG International NGO/ORG HONEST BROKER

• Facilitate partners negotiation
• Convening/coordinating

stakeholders

• Not deciding, support the decision
• Catalize resurces for PPP
• Not focus on specific products but
• n process and tangible outcome

One main/major project with public sector

Year 1 Year 1 Year 1

• Frustrating
• Expensive
• Possibility of

inactive time

• Possibility of ONE

BIG FAILURE

• Sustainable
• More results in

short time

• Learning process
• Success and failures
• Rational use of

team

• MESURABLE AND

TANGIBLE OUTCOME MANY SIMPLE PROJECTS IN PARALLEL

?

MITIGATE PROJECT CHALLENGES

SPECIFIC HIS KNOWLEDGE AND FOCUS ON THE RIGHT PROBLEM OF HIS

IT PROBLEM & TECHNOLOGY

MANY FOCUS HERE

CLINIC/PUB LIC HEALTH PROBLEM

NEED ASSESSMENT PROJECT, AGREEMENTS FUNDRISING COMMITMENT

REQUIREMENTS DEVELOPMENT TRAINING DEPLOYMENT INTEGRATION DATA QUALITY PUBLICATION AND USE MAINTENANCE SUPPORT AND SUSTAINABILITY

JEMBI/MOASIS FOCUS ON THE WHOLE SYSTEM

Main achievements

(23 projects at national level)

Mortality system (SIS-ROH) and VITAL STATISTIC reform National M&E system (SIS-MA) Individual based electronic system (SIBI) national ​Master Facility List

Mortality data before 2006: census, surveys/ad hoc studies only Support of WHO and CDC:

MORTA TALITY REGISTRAT ATION IN MOZAMBIQUE

• Analysis of death

certification process

• New national regulation
• New death certificate

ICD-10 adopted as national standard FULL AND REDUCED LIST

• Set up of

ELEC ECTRON ONIC IC Intra ra- hospi pital mortal tality y regist ister er (SIS (SIS- ROH)

• Training

>300 STAFF

• n ICD-10

and death registration

First national mortality analysis based

• n routinely

collected data

2007 - 2008 2008 2008 2008 - 2013 2013-2014 14

Expansion to 60% of all hospitals

• Expansion to

75% % HOSPIT SPITALS

• extra-hospital

deaths Expansion

• Update of

analysis

• SIS-ROH

APPLICATION VERSION 2.0

SIS-ROH DATA

5000 10000 15000 20000 25000

2008 2009 2010 2011 2012 Intr ntra-hosp

• hospital

tal Ext xtra ra-hos

• hospi

pita tal

> 8 80,000 records

71.9% 11.2% 5.0% 4.2% 2.9% 2.5% 0.4% 0.2% 0.3% 1.1% 0.4% HIV not specified HIV + TB HIV + multiple infections HIV + encephalopathy HIV + bacterial infections HIV + Kaposi sarcoma HIV + mycotic infections HIV + Burkitt lynphoma HIV + other malignant neoplasm 5000 10000 15000 20000 25000 30000

2009 2009 2010 2010 2011 2011 2012 2012 Other causes

CRVS REFORM IN MOZAMBIQUE

• cooperation with STAT-SA
• active member of WHO-FIC community
• Inter-institutional Vital Statistics

Working Group (MoU)

• Members: MOH, MOJ, UEM/MOASIS, INE
• In-depth assessment of CRVS and plan of action for

CRVS Reform in Mozambique

STATSA WHO-FIC CONFERENCE

NATIONAL M&E SYSTEM (SIS-MA)

 Jembi/MOASIS with support of USG partners on behalf of MOH:

• evaluated older system
• requirements definition
• funds mobilization
• International tender
• Contract management
• Project management
• Quality control
• Training and handover

 System based on DHIS2  140 district, 11 provinces and MoH  Constant participatory work with MoH  Change management plan elaborated and implemented

EVALUATION, ANALYSES , REQUIREMENTS AND PROJECT DEFINITION DONE NE INTERNATIONAL TENDER and CONTACT NEGOTIATION DONE STARTING OF OPERATIONS February 2013

IMPLEMENTATION phase 5 of 6 End on September – Nov. 2014

SUPPORT THE DEVELOPMENT OF A NATIONAL ​MASTER FACILITY LIST

2007 first national infrastructure, resources and services assessment List included in the M&E system, developed procedures and GIS module for routine update (IEESS) 2014: start development of a integrated and interoperable master facility list across systems and institutions

National NGO/ORG Internation alNGO/OR G

1. 1. First ever National Regulation for Systems Based on Individual (SIS-BI):

• standardize, regulate and integrate systems

including HIV

• certification of existing systems by MoH with

Jembi/Moasis support

INDIVIDUAL BASED INFORMATION SYSTEM SETTING NATIONAL STANDARDS

2. 2. Development of the reference SIS-BI:

• Assessment and project proposal
• Requirements, development and deployment
• Support the integration of the USG systems in

place

• Support the Mozambican OpenMRS community

activities

LEARNING, CAPACITY BUILDING AND DISSEMINATION

To Jembi/Moasis staff:  Internal formal and on the job training  External certificate trainings and support academic career To the public and private partners  Trained >600 staff of MoH at all levels  participation at > than 60 relevant conference/public presentations  Development of posters, papers, articles, reports  National regulation, data publications and manuals/protocols

CDC-COAG NORTH –SOUTH COLLABORATION

 Effective and productive relationship with CDC  Ongoing technical assistance  Support for the Jembi/Moasis model  Share long term vision and technical strategy  High number of outputs and products at national level  High presence in international forum and scientific community  90% FUNDS SPENDING RATE, COST EFFECTIVE

mOASIS-Jembi

Authors of the abstract: Alessandro Campione, Jembi Health Systems, South Africa and MOASIS, Mozambique Christopher J Seebregts, Jembi Health Systems, South Africa and MOASIS, Mozambique Antonio Sitoi, MOASIS, Mozambique Mindy Hochgesang, Centrers for Disease Control, Mozambique Mark DeZalia, Centers for Disease Control, Atlanta Starley B Shade, University of California, San Francisco, USA Leopoldo Nhampossa, University of Eduardo Mondlane and MOASIS, Mozambique