Health Policy and Global Health Course Masters of Public Health (MPH) Programme

Transcription

1 Analysis of Bottleneck towards Effective Coverage of Interventions for Children in Bangladesh Health Policy and Global Health Course Masters of Public Health (MPH) Programme May, 2013 UNICEF Bangladesh

2 Introduction The United Nations Children Fund (UNICEF) is the lead UN agency that advocate for the right of children as contained in the Convention for the Rights of the Child (CRC). Globally, UNICEF work for the realization of the survival, development, protection and participation right of children in both stable and un-stable situation. UNICEF as part of the United Nations (UN) System in Bangladesh is committed to supporting the Government of Bangladesh (GOB) to achieve the Millennium Development Goals (MDGs) with equity, by providing technical support and mobilizing partnership and results towards effective coverage of basic social services through geographic targeting. Within the United Nations Development Assistance Framework (UNDAF) and the broader context of the Sixth Five Year Development Plan of the GOB, UNICEF as well as the UN has placed major emphasis on decentralized and participatory planning and monitoring across different programme components in 20 districts where the social indicators and development situation of children and other vulnerable populations illustrate a wide disparity compared to other parts of the country 1. Towards the realization of the commitment of the Government of Bangladesh for monitoring for development results as highlighted in the Sixth Five Year Development Plan, UNICEF is promoting a decentralized approach for the identification and removal of bottlenecks to effective coverage 2 of proven interventions for the realization of the rights of children. This approach is undertaken as part of a programme improvement initiative to bring about efficient allocation of programme resources to address major gaps in programme coverage as well as address bottlenecks that impair effective coverage of intervention. The purpose of this programme is to provide on-site exposure to MPH students of the James P. Grant School of Public Health to interact with UNICEF Bangladesh zone office activities in the analysis of bottlenecks towards effective coverage of essential services for children at community level in Bangladesh. Learning Objectives The learning objectives for this field work and course are: a) Understand the concept behind equity based monitoring of effective coverage of social services for children b) Understand and able to apply the Tanahashi Framework for bottleneck analysis to (a) above 1 UNICEF Bangladesh 2010, A case for geographic targeting of basic social services to mitigate inequalities in Bangladesh 2 Effective coverage is defined as the proportion of intended beneficiary who have received effective interventions or services

3 c) Visit and observe the field level engagement and data collection exercises on a) and b) above and; d) Therefrom, prepare group presentation on the analysis of bottleneck in an assigned tracer intervention Equity Based Monitoring for Children In 2010, UNICEF launched a re-focus on equity under the premise that equity focused programming is not only right in principle but that it is right in practice. The UNICEF framework for Monitoring Results for Equity Systems (MoRES) outlines four level of programme monitoring. Level 1 monitoring involve disaggregated and equity based analysis of the situation of children, including review of policies, strategies and plans in all sectors as they affect the realization of the right of the child. Level 2 monitoring involves the monitoring of programme inputs (cash, supplies and contracts) and outputs as part of routine monitoring of activities / interventions. Level 3 monitoring involves the identification and removal of bottlenecks (in enabling environment, supply, demand and continuity of use) towards effective coverage of intervention. Level 4 monitoring involves periodic surveys and impact evaluation of programme / intervention. Figure 1: UNICEF Framework for Monitoring Results for Equity Systems (MoRES) To analyze bottleneck in coverage of intervention, Tanahashi ( ) outlined different stage from resource allocation to achievement of desired result. Other relevant information especially by the World Health Organization 4 on the concept of effective coverage, its definitions and application in the measurement and management of health systems and services performance are available for reference. Within a defined geographic group / target 3 Tanahashi, Health service coverage and its evaluation. Bulletin of the World Health organization 56 (2): WHO, 2001 Background paper for the Technical Consultation on Effective Coverage of Health Systems.

4 population, the classification of different coverage stages thus allow for the measurement of gaps in coverage levels across five levels Availability: The relationship of the volume and type of existing services to the volume of clients and their needs Accessibility: The relationship between the location of services and the location of clients Utilization: The relationship between the volume of initial contacts with the service and the volume of clients Adequate Coverage: The relationship between the volume of full services provided and the volume of clients Effective Coverage: The relationship between the volume of full services provided with quality and the volume of clients The framework above thus allows further classification of bottlenecks into four domains under ten determinants, adopted from the UNICEF global MoRES 5 framework, as below. 5 Provide link to the global MoRES reference and or website.

5 Domains Determinants Social norms Enabling Environment Legislation/policy Budget/Expenditure Management/Coordination Supply Availability of essential inputs Access to adequately staffed services, facilities and information Financial access Demand Cultural practices and beliefs Continuity of use Quality Quality Course Outline The course is implemented in three phases as follows: Phase 1: Presentation of Concept by a faculty from UNICEF Bangladesh through technical presentation on the equity based monitoring for children. The Faculty will present the application of the equity based monitoring framework in programme planning and monitoring from two Unions (communities) in Bangladesh as a case study. Phase 2: Field Visit by students of MPH programme at JPG to communities where field level identification of bottlenecks towards effective coverage of interventions for children is being undertaken. The field exercise is aimed at exposing the students to the different level of data collection, service delivery units and local level actors as part of the identification of bottlenecks to essential services for children in the communities. Phase 3: Group presentation on the application of Tanahashi framework in the analysis of bottlenecks in assigned thematic areas for the students based on their field exposure at the Tanahashi Rounds of June, The presentation is both a synthesis of the findings from the field with additional review of relevant literature. There is the future potential for a few interested students to take forward their dissertation of limited scope in the analysis of bottlenecks towards effective coverage of essential services for children at community levels in Bangladesh.

6 Key Definitions Deprivation: Refers to the actual breach of child rights, such as mortality, sickness, malnutrition, lack of education, exposure to violence and abuse, etc. Intervention: Interventions are the specific services, systems and practices which address the immediate causes of deprivation (preventive and curative services, adequate caring practices, education, protection systems, etc.). Effective coverage: reflects proportion of the target population or population in need that is actually benefiting from a complete (effective) package of interventions. It measures systemic efforts in terms of providing the population with a set of interventions services that are believed to be effective if individuals use them Bottleneck/barrier: reflect the determinant or determinants which at a given point in time represent the most constraining factors to increase effective coverage of a given intervention. Bottlenecks and barriers are a relative concept as they are defined by comparing the relative fulfillment of each of the conditions for effective coverage. Determinant: Represents each of the key conditions that are required for effective coverage of any given intervention. The main categories of determinants are: - An enabling environment Governments, institutions, political and social leaders, as ultimate duty bearers, need to create the basic conditions for these interventions, services and practices to take place. - Systems and services (supply) even when the enabling environment exists the capacities and effectiveness of the delivery of services and promotion of practices and behaviours often fail, due to capacity gaps and problems of organization. - Financial or socio-cultural factors even when systems and services are available, some families and communities may fail to use these services or adopt these practices due to financial or socio-cultural factors. - Quality of services and practices finally, the services and practices that benefit deprived children, sometimes fail to comply with the minimum quality standards to be effective. Conclusion This initiative is a joint collaboration between UNICEF Bangladesh and James P. Grant School of public health as part of capacity development in health policy and equity. Aside the exposure for the student, it is hoped that additional interest will be generated among the post-graduate students to further contribute to the national and global evidence base on the analysis of bottlenecks towards effective coverage of interventions for children.

7 While UNICEF is committed to facilitating this knowledge partnership with James P. Grant School of Public Health, this partnership is at no financial or administrative cost to UNICEF including for safety and security of the students and faculty members of James P. Grant School of Public Health. However, UNICEF will avail JPG with up-to-date information and support for the successful implementation of this partnership. References and Further Information Following the integration of the Tanahashi approach into the global UNICEF monitoring of results for equity systems (MORES), as stated above, James P Grant School of Public Health and UNICEF Bangladesh initiated the Tanahashi Rounds platform that discourses emerging knowledge. News and reports of the previous Tanahashi Rounds are available from the following link: tanahashinews or for further information, contact: Isa Achoba Chief, Social Policy iachoba@unicef.org Tajudeen Oyewale Chief, Field Operations (a.i) toyewale@unicef.org UNICEF Bangladesh 1, Minto Road, Dhaka, Bangladesh Mymensingh office Md. Omar Farooq Head of Mymensingh office Mobile: Contact Address of UNICEF Zone Offices in Bangladesh Barisal Office Khulna Office AH Towfique Ahmed Mohammad Badrul Hassan Head of Barisal Office Head of Khulna Office Mobile: Mobile: UNICEF Zone Office, Mymensingh Bashat Vitta, 7 No. Amirabad Residential Area Maskanda Mymensingh 2200 Telephone & Fax : Chittagong office Madhuri Banerjee Head of Chittagong Office Mobile: UNICEF Barisal Zone Office UN Office Complex Hakim Mansion (Near Nuria School) South Alekanda, Barisal Phone: Fax: Bogra Office Irene Perveen Head of Bogra Office Mobile: UNICEF Zone Office, Khulna House # 335 Road # 5 Sonadanga R/A (2nd Phase) Khulna-9100 Sylhet office Kazi Dil Afroza Islam Head of Sylhet Office Mobile: UNICEF Chittagong Zone Office House # 87/C, Road # 6, Khulshi Residential Area Chittagong. UNICEF Zone Office, Bogra "Bagicha Mahal" 379 Maloti Nagar (Beside the Civil Surgeon Office) Bogra. Fax: UNICEF Sylhet Zone Office House # 57, Road # 3, Block-G, Shahjalal Upashahar, Sylhet, Bangladesh. Tel: ( ) Fax: ( )