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Developing Sustainable RMNCH Solutions in Jordan

May 27, 2020

USAID is committed to supporting the Government of Jordan (GOJ) on its journey toward self-reliance (J2SR).

USAID defines self-reliance as the ability of a country—including the government, civil society, and the private sector—to plan, finance, and implement solutions to solve its own development challenges. In short, to end a country’s need for foreign assistance. Country commitment and capacity are two key elements to this journey.

The Abt-led USAID Health Service Delivery project aims to improve health outcomes for women of reproductive age and children under the age of five in Jordan by expanding access to quality integrated reproductive, maternal, newborn, and child health (RMNCH) services in the public and private health sectors.  To achieve its mission, project teams work with counterparts at all levels of Jordan's health care system to support innovative interventions to improve access to quality services. These include expanding health networks, promoting the integration of key RMNCH services, and fostering community accountability by engaging community members in collaborative sessions to advocate for their health needs and provide feedback on health services.

To ensure we aligned with USAID’s desire to increase the GOJ’s commitment to our activities, Abt developed a sustainability litmus test to apply across all of our interventions, from design to implementation, to hand over to the GOJ. The litmus test consists of three key pillars we use to determine which interventions to prioritize, including: Jordan’s need for the intervention, whether there are resources available to sustain it, and the effectiveness and scalability of the intervention. Together with Jordanian counterparts, we successfully applied this sustainability “test” to Jordan’s Maternal Mortality Surveillance and Response (JMMSR) system, which was implemented nationwide, and to the RMNCH Integrated Service Delivery Quality Improvement Program, which was implemented in over 140 health facilities, serving much of the population.

We also ensured GOJ’s commitment to quality RMNCH interventions by enabling the government to:

  1. Amend the Public Health Bylaw to support the implementation of essential programs. 
  2. Amend job descriptions to expand the role of midwives in providing family planning services and improving access to quality services.
  3. Develop and disseminate policies and procedures to support the uptake of quality health care services.
  4. Design and implement a “recognition program” to motivate providers and managers to maintain the provision and management of quality services.

Drawing further upon USAID’s definition of the J2SR, we incorporated key strategies to enhance the capacity of Jordanian government and nongovernment stakeholders.  One strategy included establishing a core group of government trainers at the national and district levels to further build the capacity of the public providers even after our activity ends.  We also built the capacity of health care providers and managers, using a competency-based approach and based on the latest evidence-based practices, to ensure continued leadership and pursuit of quality in facilities.  Finally, all capacity-building strategies included the development and wide dissemination of accompanying training tools and materials for future use by the Ministry of Health (MOH).

Most of our J2SR efforts to strengthen capacity and commitment happen in tandem, meaning you can’t have one without the other in any activity undertaken by USAID Health Service Delivery.  For example, the project established the JMMSR System to track all maternal deaths, identify their underlying causes, and stimulate a response process to prevent future deaths. We strategically built the commitment and capacity of the GOJ to sustain the JMMSR system from design through handover. Government commitment was established through an amendment in the public health by-law and intimate involvement of the MOH in designing policies and procedures. Capacity was strengthened by building technical competence in government staff and stakeholders at all levels, together with the establishment of the web-based JMMSR information system to provide decision makers with accurate and reliable data for decision making.

In addition, the project adapted quality improvement models to develop and implement the RMNCH Integrated Service Delivery Improvement Collaborative (ISDIC). ISDIC uses performance-based monitoring, analysis, and change implementation to improve integrated quality RMNCH+ services for women of reproductive age and children under five. We supported the transfer of capacity and responsibility through coaching health managers to apply the ISDIC approach. Public and private service delivery points (SDPs) now implementing ISDIC cover almost 70 percent of Jordan’s population. Moreover, the MOH and the Royal Medical Services established core groups of trainers to continue building the capacity of service providers to deliver quality RMNCH services. The MOH demonstrated its commitment to implementing ISDIC through a structured program that recognizes SDPs’ improved performance.

In these ways and more, the USAID Health Service Delivery project has paved the way for Jordan’s health sector to be self-reliant and continue improving services for women and children long after USAID’s support ends.

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