interventions M. Rashad Massoud, MD, MPH, FACP Director, USAID - - PowerPoint PPT Presentation

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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

USAID Applying Science to Strengthen and Improve Systems

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

13.4 8.4 3.9 19.5 14.4 7.6

10.3 6.0 2.8

5 10 15 20 25 1994 1996 1998 2000 2002 2004 2006 2008 2010

Deaths per 1,000 live births

Tver-neonatal mortality Tver-infant mortality Tver-early neonatal mortality

Demonstration Phase Spread Phase QAP no longer providing technical assistance to Tver Oblast

Improvement in newborn and infant health

• utcomes in Tver Oblast, Russia

USAID Applying Science to Strengthen and Improve Systems

11.6 9.9 7.5

19.4 16.1 11.6 13.4 8.4 3.9 19.5 14.4 7.6

10.3 6.0 2.8

0.0 5.0 10.0 15.0 20.0 25.0 1994 1996 1998 2000 2002 2004 2006 2008 2010

Deaths per 1,000 live births

National-neonatal mortality National-infant mortality Tver-neonatal mortality Tver-infant mortality Tver-early neonatal mortality

Demonstration Phase Spread Phase QAP no longer providing technical assistance to Tver Oblast

Improvement in newborn and infant health

• utcomes in Tver Oblast and Russian Fed.

USAID Applying Science to Strengthen and Improve Systems

Principles of Spread

1. Begin with scale-up in mind 2. If you can reach all-at-once – you should! 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

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USAID Applying Science to Strengthen and Improve Systems

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

8 Rwanda: percentage of partners tested

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 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 % of partners tested Old Sites: % (16) New Sites: % (20)

USAID Applying Science to Strengthen and Improve Systems

Niger - Comparison of Demonstration vs. Spread IMCI Sites for the % Children Triaged on Arrival

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Niger: Percent of children triaged on arrival

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% O c t D e c F e b A p r J u n A u g O c t D e c F e b A p r J u n A u g O c t D e c J a n M a r M a y J u l S e p N

• v

Old sites New sites

USAID Applying Science to Strengthen and Improve Systems

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.

10 20 30 40 50 60 70 80 90 100 Percentage

% 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 % 2005 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 % 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 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

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USAID Applying Science to Strengthen and Improve Systems

Uganda: At what scale are we working?

280 facilities 634 communities MOH, MGLSD, 12 IPs 9.8 million out of 36 million 928 QI teams 13 out of 13 regions 65/112 districts 1- Main Uganda Program 2- Northern Uganda Program

• HIV/AIDS
• DREAMS
• PMTCT
• OVC
• VMMC
• Lab hubs
• Leadership &

governance

• Reproductive health
• Maternal and newborn

care

• Child health
• TB, TB/HIV
• Malaria
• Nutrition
• QI institutionalization

Support to MoH

• Human resources

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USAID Applying Science to Strengthen and Improve Systems

Scaling up: Saving Mothers Giving Life spread

Demonstration 2012- 2014 SMGL learning collaborative 30 health facilities

Wave 1 Feb 2015 20 health facilities Wave 2: Oct 2015 60 health facilities Wave 3: 38 health facilities

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USAID Applying Science to Strengthen and Improve Systems

Scaling up: SMGL process results

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USAID Applying Science to Strengthen and Improve Systems

Scaling up: SMGL outcome results

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Seasonal Malaria Malaria Epidemic

Shift

USAID Applying Science to Strengthen and Improve Systems

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

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