maryland county health team -...

MARYLAND COUNTY HEALTH TEAM

2017 ANNUAL REVIEW PRESENTATION

PRESENTED BY: CYRUS B. SNEH

OVERVIEW OF THE COUNTY HEALTH SYSTEM

Maryland has a current population of 163,898

25 health facilities (1 hospital, 4 health centers, 20 clinics)

Private: 3 Public: 22

Six(6) health districts (Harper, Pleebo , Karluway 1&2 and Barrobo

Whojah and Farjah) currently combined to form 4 District Health

Teams (DHTs)

57% of the population has access to healthcare within 5km or 1

hour walk

Health facility per 10,000 population ratio is 2.5 (Global target is 2)

513 health workers (26% core clinicians)

8.5 clinicians per 10,000 population (Global target is 23)

Private sector contribution/involvement:

This sector contributes to availability of drugs where drugs are

stocked-out or unavailable in county depot or at health facility via

transport of medicines from NDS or direct provision of these

medicines and supplies

INVESTMENTS IN ALL LEVELS OF THE MARYLAND HEALTH SYSTEM AT

ONCE TO SAVE WOMEN’S LIVES

JJ Dossen Hospital

Primary health facilities

Community (CHAs, CHVs, TTMs)

CHT/DHT

• Functioning ambulance in

each health district for

emergency transfers to JJ

Dossen

• Active MNDSR Committee

consisting of staff from all

levels of health system

• County-wide Maternal

Health Conferences

Equipped, trained, motivated, supervised

• Active

surveillance

• Referrals to

health facilities

for skilled

deliveries

• Investments in ongoing

clinical mentoring in

EmONC

• Health professionals

assigned to all primary

facilities

• Provision of equipment

and supplies/ buffer stock

• Ultrasound

• Emergency

capacity via

trained and

equipped staff

Maternal

waiting

homes

National Pilot Testing for Revised Maternal and Neonatal Death Surveillance Forms with FHD/NPHIL team

•GETTING RESULTS– ZERO (0) maternal deaths reported in August, September, October 2017

2016/2017 KEY ACHIEVEMENTS • Launching of National Community Health Assistant Program

• 20 CHSS and 114 CHA recruited, trained and compensated and 208 active Community Health Committees holding monthly meetings(UNICEF support)

• Rollout of CBIS (reporting started since August 2017) through current partnership with PIH (through UNICEF support)

• Launching of NCD clinic at JJ Dossen Hospital as proof of concept for national NCD program

• 170 active patients followed through twice weekly clinic for diabetes, hypertension, sickle cell disease, splenomegaly, CHF, COPD, epilepsy, etc; growing wait list of patients

• Strengthening of Mental Health Services

• 669 patients actively in care and support for mental illness at JJ Dossen, Pleebo Health Center, and Harper Prison

• 40 homeless and formerly homeless patients with mental illness currently in ongoing treatment; a few patients who’ve made dramatic recovery are currently working with PIH

2016/2017 KEY ACHIEVEMENTS

Surveillance: Surveillance is functional at all levels beginning with the community/HF, district and county levels in all 4 health districts.

--CHA,CHSS operate at the community/ HF,

--Surveillance officers at district and county levels.

--CHSS function as surveillance focal persons at the health facility

• Quality of health services: Improvement in the quality of care at facilities by :

• Provision of regular staff capacity building and on-the-job coaching and mentoring

• Formalization of Standard Operating Procedures, protocols and treatment guidelines

• HMIS: Through regular monthly review meetings and timely submission of HMIS reports, health information is being utilized in programmatic decision making

Provision of drugs and medical supplies

Drugs were received from the following programs thru NDS: ARV Products, Anti-TB & Leprosy Products,

Antimalarial, Reproductive Health products, Mental Health products, Nutritional products and other

essential medicines for ICCM.

These health products were distributed based on health facilities’ consumption records.

Surgical Instruments, Dental Instruments, Blood Bank, Ultrasound, Incubators and other Laboratory

Materials were provided from World Health Organization (WHO) for JJD hospital

Reduction in stock-out of essential medicines and supplies through buffer stock provided by PIH and IRC;

transport of medicines and supplies from NDS (when available) through support from PIH


2016/2017 KEY ACHIEVEMENTS • Strengthening of Emergency Referral Pathway

• 1 Ambulance stationed in each of 4 health districts

• Referrals for specialized care via ambulance or flight via direct partnership with Jackson F Doe Hospital in Tappita

and JFK and ELWA in Monrovia through partnership between JJ Dossen Hospital leadership and PIH

• 1 surgeon at JJ Dossen providing emergency and elective surgeries along with JJ Dossen team

• 1 OB/GYN was present through beginning of 2017; another arriving next week

• Major improvements in TB case detection and treatment outcomes-

• 67 trained, supervised and compensated CHVs focused on TB/HIV/Leprosy active case finding, treatment support,

and linkages to clinical care, psychosocial support, monthly food packages in Harper and Pleebo districts

• Thanks to their strong efforts 774 patients were newly enrolled in TB treatment between June 215 and June 2017,

with 95% treatment success

• Establishment of MDR-TB treatment ward and rollout of Genexpert for regional testing and treatment for MDRTB in

the Southeast (part of NLTCP Decentralization strategy) at JJ Dossen


• Karloken clinic renovated to become Edith Wallace Health Center

• Improved Laboratory and Diagnostics capacity and Biomedical Technology Services

• CBC, Chemistry, GeneXpert, EID PCR, Viral Load, RPR, Hepatitis viral markers currently available; on-the-job

coaching and mentoring of JJ Dossen and PHC lab teams

• Digital x-ray, ultrasound

• New partnership launched November 2017 with GIZ, MOH, NPHIL and PIH to establish regional laboratory

capacity at JJ Dossen and develop a biomedical workshop hub for the Southeast

counties for teaching and regional servicing of equipment

LAB BEFORE LAB AFTER

NEW MATERNAL WAITING HOME

0

50

100

150

200

250

2015 2016 2017

Nu

mb

er

of

De

live

rie

s

YEAR

Glofaken Delivery 2015-2016

unskilled Delivery

Skilled Delivery


• Investments in HRH-- Recognition of JJ Dossen as a National Teaching Hospital

• Students from Tubman University (nursing and soon-to-be midwifery) and the Midwifery School of the

Southeast conduct clinical rotations and preceptorships

• Engineering and Public Health students also conducting internships with CHT and hospital staff

• Family Medicine Residents from LCPS post-graduate medical education program will start rotating in January

2018

• Improvements in Quality of Care- focus on clinical excellence via multi-disciplinary team daily rounds, QI

committees

O.R. BEFORE O.R. AFTER Emergency Room

COUNTY PERFORMANCE 2016/2017

Maternal and Child Health

• Increase in % of Skilled Deliveries from 41% to 52% and drop in number of maternal deaths by 50%

• Increase in the immunization coverage from 47% fully immunized previous year to 56.7%

• Decrease in the dropout rates from 32% to 27%

• Human Resource for Health: 7 midwives hired for selected facilities

• Improved Timeliness of LMIS and HMIS Reports submission of 100%

47.2%

56.7%

70.2%

77.6%

32.7% 27%

0

10

20

30

40

50

60

70

80

90

2015/16 2016/17

Immunization Coverage and Dropout Rates

Fully Immunized Coverage

Penta 3 Coverage

Penta 3 Dropout Rate

Period Targets

Penta 3 Fully

Immunized

Coverage Dropout Rate

Jul 2015 to Jun 2016 6354 4460 3001 47.20% 32.70%

Jul 2016 to Jun 2017 6486 5031 3672 56.70% 27.00%


Period Target Total skilled deliveries reported Percent Coverage

Jul 2014 to Jun 2015 7008 2127 30.35%

Jul 2015 to Jun 2016 7152 2936 41.05%

30.35%

41.05%

52.43%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Jul 2014 to Jun 2015 Jul 2015 to Jun 2016 Jul 2016 to Jun 2017

Pe

rce

nt

Ach

ieve

m,e

nt

Year

Skilled Delivery Achievement

Percent Skilled Delivery


COUNTY PERFORMANCE 2006-2017

The Health Management Information System (HMIS) is one of

the vital components of the health system, in order to have

good Health Care Delivery, data must be collected and used

effectively in the various facilities

Data compiled in this report was received from the 25

functional health facilities within the county.

This information covers the period under review

0

50

100

150

200

250

300

350

400

450

500

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Nu

mb

er

of

He

alt

h W

ork

ers

Year

Maryland County Human Resource for Health

Non Clinician

Clinician

Cadre 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Clinician 35 43 57 69 87 107 122 131 153 167 191 186

Non

Clinician 206 219 233 248 276 276 279 279 283 284 293 287

Total 241 262 290 317 363 383 401 410 436 451 484 473

Year ANC Target 4th+ ANC visit IPT2

2008 6785 1876 1341

2009 6931 2483 2060

2010 7079 2330 1516

2011 7231 5024 2215

2012 7386 5050 2953

2013 7541 5063 3457

2014 7611 4331 3263

2015 7700 3406 2180

2016 8026 5417 3827

2017 8195 3834 2664

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

ANC 4+ , IPT2, from 2008-Sept. 2017 for Maryland County

ANC Target 4th+ ANC visit 2nd IPT Achievement

0

1000

2000

3000

4000

5000

6000

7000

8000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

13% 17% 20% 34% 32% 34% 34% 27% 48% 40%

Inst. Delivery Achievement from 2008-Sept. 2017

for Maryland CountyHealth Team

Skilled Del. Target Skilled Del. Achieve

Year Skilled Del.

Target Skilled Del.

Achieve Skilled Del.

Percentage %

2008 6106 822 13%

2009 6237 1034 17%

2010 6371 1260 20%

2011 6508 2236 34%

2012 6647 2095 32%

2013 6787 2293 34%

2014 6850 2295 34%

2015 6930 1892 27%

2016 7224 3441 48%

2017 7375 2940 40%

Year Target measles

Achievement Fully

immunized

2008 5428 2522 0

2009 5544 2561 2263

2010 5663 3443 3187

2011 5785 3618 2921

2012 5908 3961 4637

2013 6033 3799 3452

2014 6160 3666 3185

2015 6089 2932 2468

2016 6421 4166 3955

2017 6556 3003 2673 0

1000

2000

3000

4000

5000

6000

7000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Penta 3, Measles, Fully immunized from 2008-Sept. 2017 for Maryland County

Health Team

Target measles Achievement Fully immunized Penta 3 doses given

KEY DRIVERS OF CHANGE

• Recruitment and assignment of professional staff to all health facilities across the county including the

introduction of the CHSS with a mandate to perform at both health facility and community and CHA/CHW at

community

• The establishment of a functional DHT with primary mandate to supervise health activities at the district

level

• Increase in the frequency of meetings with supervisors and program- leads on issues relevant to their

programs

• Weekly surveillance report and monthly IDSR bulletin of diseases collected across the county through

surveillance officers

• Regular Health Partners coordination meetings, community engagement meetings and quarterly County

Health Board meetings

• Concerted investments in all levels of the Maryland health system (community, primary care, secondary

care) all at the same time allowing for fully functioning referral pathway leading to better patient outcomes

and trust in health system

CHALLENGES

Operational

• Delay in receiving operational support from Government

Programmatic

• Failure of some partners to be transparent on various aspects of program activities

• Failure of Program Unit to furnish CHT with documents signed with partners in a timely manner so as to guide

program implementation

CHALLENGES

Systemic

Supply:

• Difficult terrain in rainy season making receipt and distribution of materials challenging

• Failure of SCMU and NDS to fully utilize consumption data in supplying Maryland leading to inadequate

supplies of some antimalarial and other ICCM commodities

• Stock-out of Reproductive Health Products (Depo provera injectables, Jadell (Implant) and Microgynon pills)

Human Resources:

• Difficulty in recruiting or replacing staff due to freeze placed by MOH personnel, though Civil Service says otherwise.

PRIORITY ACTIONS/RECOMMENDATIONS

Short term actions (within 6 months) • Program strengthening: Mental Health, Emergency Services, Supply Chain and Surveillance System

• Maternal Health: Increase delivery by SBA, Increase IPT2 and FP uptake and establish youth friendly services in 7 health

facilities

and 4communities.

• Strengthen our community health program

• Quality Improvement: Clinical mentoring and supportive supervision

• Health information:Improve in information utilization at all levels of the CHT

Medium term actions ( 1- 2 years) • Increase facility-based deliveries with a skilled birth attendance from 57% to 68%

• Increase children under 1 year who received PENTA 3 from 63% to 76 %

• Reduce the Penta 3 Dropout rates from 27% to 18%

• Increase the facilities with at least 1 midwife from 65% to 80%

• Maintain LMIS and HMIS reporting rate 100%

• Expand TB services, and strengthen Mental Health services

•

•

PRIORITY ACTIONS/RECOMMENDATIONS

Long term actions ( 3- 5 years)

• Increase facility-based deliveries with a skilled birth attendant from 57% to 80%

• Increase children under 1 year who received PENTA3 from 63%to 95%

• Reduce the Penta 3 Dropout rates from 27% to 5%

• Increase the facilities with at least 1 midwife from 65% to 100%

• Maintain LMIS and HMIS reporting rate 100%

• Improve our health infrastructures and build new ones

PARTNERS 2016/2017

Thank you!!!!!!

maryland county health team -...

Documents