PATHS Final programme report: "Togetherness in Health" the Enugu ...

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•••Working to an agreed timeframeWorking to an agreed set of performance indicators and targetsProvide a monitoring tool to review the performance of each of the constituent bodies.The form and scope that the six-month DHA and SHB business plans took were agreed and developedon the basis of common objectives for all the DHBs.The plans included the actions necessary toestablish the DHS and were informed by asituational analysis. Six-monthly plans wereproduced in line with the PATHS planning cyclestarting formally with the January - June 2005business plan. This was continued throughout2006; annual plans were then produced for 2007and 2008 and costings were added.A significant weakness of the first six month plan,was the lack of a performance managementmechanism. Therefore, an implementationplanning template was created utilising amonthly activity form. This resulted in sufficientlycomprehensive plans that served as the basis ofthe business plan review process and facilitatedfuture co-ordination among health donors.With the inauguration of the Local HealthAuthorities in September 2005, the LHAs wereincluded in the business plans for 2006. Initiallyplanning was undertaken by the LHAs’ respectiveDistrict, but over time the LHAs became moreactively engaged in the planning process. Byearly 2008 plans were being produced at facilitylevel and costings had been added. At the timeof writing, the 2009 costed business plans werenearing completion.A donor forum provided an opportunity for donoragencies to input into the respective businessplans. However, by early 2008 harmonisation ofdonor activities with state health plans remainedweak, with donors continuing implementation ofparallel health programmes.“Before we can have successful delivery ofhealth services, we must plan well. This isnot like before. We must get informationfrom the areas we serve in order to knowwhat is needed.”Content of Business Plans• service delivery (with a focus onachieving MDGs)SHB member• systems development (focusing on DHSimplementation)••human resourcesinfrastructureDHS Constituent BodiesReview ProcessesPDPD, SHB and DHBs are subject to amedium and end of term (i.e. quarterly)business planning review which is chairedby the Commissioner for Health. Eachorganisation presents a progress reporton the implementation of their respectivebusiness plans. Following this, eachorganisation faces questioning by theCommissioner and other Districts regardingissues that require clarification or defending.By early 2008 business planning was sufficiently institutionalised for it to have become a year on yearactivity. The Planning, Research and Statistics Directorate located within PDPD played a vital role inleading the planning process.32 PATHS Final Programme Report
Health Management Information System (HMIS)When PATHS commenced there was a near absence of proper record keeping at any level of the healthsystem. Both the quantity and quality of data were extremely poor and no management decisionswere informed by an analysis of health data. In response, an HMIS pilot scheme (utilising the DistrictHealth Information System - DHIS) was introduced in five of the 17 Local Government Areas in early2003 with the aim of improving the quantity andquality of data. The scheme went state-wide in2004; all 17 M&E officers across the states wereinvolved in capacity building initiatives. Withthe introduction of the DHS the HMIS formatwas adapted to reflect the new institutionalarrangements.“I now have an information system that canshow performance changes from 2005 to2008.”DHB CEOThe HMIS process is managed by a core HMIS management team of five officers at state level; sevenDistrict Information Teams; and 17 technical M&E LGA officers who collect and collate the data.A data set of 122 data elements derivedfrom 42 basic state indicators was selectedfrom the myriad of report forms and sundryparallel health programmes.Extensive training was conducted for morethan 1,000 staff from PDPD level right down tofacility level. Appropriate feedback mechanismswere introduced, both on the quality of the data(completeness, correctness and consistency) andthe interpretation of the analysed data.By early 2008 more than 98% of facilities were returning data on a regular basis. In addition, efforts toimprove the quality of HMIS data were being made through the double-blind checking of 42 sentinelsites.Core Enugu HMIS team and the 17 LGA M&E officers“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 33
Page 3 and 4: "Togetherness in Health"the Enugu E
Page 5 and 6: FORWARDI am very pleased on behalf
Page 8 and 9: 6 PATHS Final Programme Report
Page 11 and 12: Section 1:Setting the Enugu Context
Page 13 and 14: KEY FACTSHealth Indices: Comparison
Page 15 and 16: PHC centres and cottage hospitals i
Page 17 and 18: Section 2:Overview of the PATHSProg
Page 19: Stakeholder initiatives supported b
Page 22 and 23: PATHS ApproachEngagement Process wi
Page 24 and 25: Pro-poor FocusPATHS pro-poor focus
Page 26 and 27: “PATHS has indeed impacted very p
Page 28 and 29: the 56 Executive Secretaries of Loc
Page 30 and 31: Health Board and the Districts. The
Page 32 and 33: it was agreed that the original ide
Page 36 and 37: PATHS provided much of the infrastr
Page 38 and 39: to access for the Ministry of Healt
Page 40 and 41: and the core DRF models used in oth
Page 42 and 43: Enabling Service DeliveryDeveloping
Page 44 and 45: Procurement of Drugs and EquipmentT
Page 46 and 47: equired in order to ensure that mor
Page 48 and 49: Training in the laboratory of Annun
Page 50 and 51: The services to be delivered were a
Page 52 and 53: Where care is givenEnugu’s health
Page 54 and 55: Enugu State Total Deliveries in Pub
Page 56 and 57: The selection process resulted in t
Page 58 and 59: Reduced maternal andinfant mortalit
Page 60 and 61: By the conclusion of the second ser
Page 62 and 63: With the advent of the DHS it was a
Page 64 and 65: Inter-Personal Communication and Co
Page 68 and 69: Intermediate Outputs1) The DHS stru
Page 70 and 71: 5) A culture of business planning a
Page 74 and 75: 4) The tendency for politicians to
Page 76 and 77: Abbreviations and AcronymsANCBCCBEO
Page 78 and 79: AcknowledgementsThe PATHS programme
Page 80 and 81: Master trainersSMoH/faith based sec
Page 82: 80 PATHS Final Programme Report

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