Strengthening Local Partner Organizations. Consejo de Salud Rural Xxxxxx has enhanced its organizational capacity as a result of the CS XIII Project. CSRA has developed an unprecedented reputation at the national level vis-à-vis the MOH, and excellent relationships with local governments due to continuous excellence in child survival and health programming. Both of these relationships have paved the way for two innovative and potentially sustainable strategies—shared management of local health systems and shared decision making through local health boards at the municipal level. During the past four years, CSRA has strengthened its capacity to mobilize funds and public resources. CSRA’s sustainability strategy is based on a sound financial plan that calls for increasing inputs from the MOH and Municipal Governments to support local health delivery systems. CS XIII assisted CSRA to demonstrate that the long-term involvement of an NGO as part of the public health sector system can make a huge difference in coverage, quality, and sustainability of preventive and curative service delivery. Successive CS grants (III, VI, IX and XIII) have assisted CSRA to transform the census-based impact-oriented methodology from the dream of a PVO visionary to a sustainable NGO model which is not only being implemented in Bolivia, but in other countries as well. Lessons learned from over 10 years of CS programming have not only strengthened CSRA, but have implications for public health administration and management on a much broader scale. CSRA Director, Xxxxxx Xxxxxxx, documented the following lessons showing how capacity has been built within CSRA as a direct result of CS funding. (Personal interview, November 2001) ▪ The integration of clinic based curative care and community-based primary care is essential for the sustainability of primary care programs. Curative care meets the felt needs of adults, who are the primary decision makers regarding the use of primary health care for their children. ▪ Mid-level health workers can be key elements in the provision of health services in isolated rural areas where continuous professional health leadership is lacking. ▪ Health problems vary among families and between geographic areas. The identification of people most at risk is made possible through the census methodology; hence interventions can be prioritized and delivered at the household level. ▪ Use of the census-based impact-oriented methodology has allowed CSRA to develop a relationship of trust between practitioner...
Strengthening Local Partner Organizations. The principal partner in this project is the Municipal Ministry of Health, which is responsible for public health services in 15 Health Posts located in urban neighborhoods and rural communities. The MOH jointly implemented the CS Project with CARE. The partner relationship between the two institutions is one of the highlights of this project. The integration of CARE staff and MOH personnel was such that outside observers could not discern who was who. The MOH was strengthened enormously due to the opportunity to implement a CS Project, hand-in-hand with a PVO. The MOH participated fully in the Final Evaluation and was the key presenter of the results to an audience with representatives from USAID, BASICS, Management Sciences for Health (MSH), the Ministry of Education, the Mayor’s Office and nurses, physicians, CHWs and community members. The MOH benefited from all the training activities and learned how to provide stewardship for a local health system management. The quality of care assessments have been institutionalized by the municipal MOH and are religiously undertaken with subsequent action planning. Areas addressed in the assessments include: infrastructure, equipment, supplies, personnel, training, monitoring and evaluation, community support, technical quality, and community outreach. The average ratings from the quality assessments have improved from 67.4% to 74.5% over the past year. The MOH has developed a questionnaire to evaluate client satisfaction during exit interviews that are done quarterly. The quality of care assessments and the exit interviews help health personnel to identify problem areas and come up with appropriate solutions based on the local context. The culture of continual improvement expressed by the Municipal MOH of Matagalpa is impressive. A concern during the MTE was the quality of Integrated Municipal Visits. The visits are planned by the Municipal Management Team and provide services to communities in concert with Health Posts. The visits include direct services and medical consultations, as many Health Posts do not have physicians. Although the visits have improved based on the recommendations of the MTE, the Final Evaluation team identified a need to improve the use of IMCI protocols when evaluating children, and suggested that the integrated visits be used for supervision of CHWs and Health Posts. This would be a better use of time and resources as both supervision and services could be provided during one visit. In ...
Strengthening Local Partner Organizations. The principal partner in this project is the Municipal level Ministry of Health (MINSA). XXXXX’s involvement in the project is exemplary, as it has been fully involved in project planning, implementation and evaluation as an equal partner with CARE. A self-assessment of needs for capacity building was made as part of proposal and DIP development. The activities outlined in the DIP were selected by XXXXX, based on this evaluation. During the MTE, the participation of MINSA staff greatly increased the quality of the evaluation, and hopefully, the commitment to put the recommendations into action. One of the main areas of weakness, based on activities outlined in the DIP, has been the progress so far in improving the quality of Integrated Municipal Visits. This was one area of analysis during the MTE, and several concrete recommendations resulted and were previously discussed. There has been more success in strengthening the visits made by local health facility staff to the communities, often accompanied by CARE Extensionists. The main limitation to further strengthening many aspects of the project is the ability of MINSA and CARE to bring on board other more reluctant MINSA staff to work towards putting the recommendations into action. Political will within MINSA will be the greatest challenge during the remainder of the project. While municipal level MINSA is fully motivated and engaged, they have encountered difficulty getting approval from SILAIS leadership to implement improvements and new programs.
