A Ministry of Health (MOH) official (R) works with the district environmental health officer in Machinga to develop an individual performance work plan. The SSDI-Systems project, led by Abt Associates, helped the MOH improve its in-person and remote supervision programs. Abt Associates, a leader in health systems strengthening for decades, continues to build on that reputation in Malawi through a project that strengthened Malawi’s health care system through new and improved policies, more effective management and leadership, and increased fiscal responsibility.
The work was part of the USAID-funded Malawi Support for Service Delivery Integration – Systems (SSDI-Systems) Project, which Abt Associates led for its duration, from 2011 to 2016. The project worked in 15 districts across all five zones of Malawi.
“From the president and Cabinet to the Ministry of Health, Malawi now is committed to implementing evidence-based policies, better supervisory tactics and tools, and sustainable health financing mechanisms,” said Lisa Nichols, SSDI-Systems portfolio manager.
Better Policies, Better Health CareWorking with SSDI-Systems and its partners, the Malawi Ministry of Health (MOH) established a Policy Development Unit. The unit developed guidelines to standardize policy development. This led to the creation of five major strategies, including the first-ever National Health Financing Strategy.
“I commend the Ministry of Health for taking the lead in developing guidelines on policy development and analysis specific to the public health sector,” said Saulos Nyirenda, director of planning, Office of the President and Cabinet. “The Office of the President and Cabinet has developed the generic framework on policy development and analysis and yet they do not provide detailed processes like the one the Ministry of Health has done … You are the only ministry that has done this.”
Saulos Nyirenda, director of planning, Office of the President and Cabinet of Malawi. Nyirenda complimented the Ministry of Health’s policy development work, which was assisted by the SSDI-Systems project, led by Abt Associates. The Health Financing Strategy supports the generation of evidence for bold new financing methods, including performance-based financing, development of a health fund, and national health insurance. The health fund would use an initial investment to expand priority health services, the proceeds from which would sustain the fund.
“Once implemented, these strategies will go a long way toward improving access to quality health services,” Nichols said.
Improving Supervision and Efficiency"It’s like I acquired a third eye. I am now more strategic in my approach. I am able to see the connections among the elements of the health system and understand enabling and impeding forces in the alignment of resources and my key objectives."
— Janet Kaboko
District nursing officer, Chitipa SSDI-Systems also helped transform how Malawi manages its health system.
Malawi established the first systematic, six-month leadership and management capacity building program, with 135 central, zonal, and district manager graduates so far. The program has been fully institutionalized within the Malawi Institute of Management, so that it can continue past the end of SSDI-Systems.
“It’s like I acquired a third eye,” said Janet Kaboko, district nursing officer, Chitipa, and graduate of the program. “I am now more strategic in my approach. I am able to see the connections among the elements of the health system and understand enabling and impeding forces in the alignment of resources and my key objectives.”
Improving Health Technology and InfrastructureBut supervisors need the right tools and information to be effective.
Participants in the Leadership and Management Program Executive Seminar for the public health sector, including directors, deputy directors, and program managers. So SSDI-Systems helped the MOH create a web-based integrated Human Resource Information System, now in use in all 34 MOH cost centers – organizations such as hospitals and health districts who are authorized to receive funding directly from the MOH. Using the human resource system, the MOH now is able to identify where 27,698 MOH health workers are in real time and can reallocate their human resources to address vacancies and critical shortages.
Abt also helped develop an integrated, smart phone-based, supportive supervision system. This allows the MOH to conduct regular supportive supervision visits and on-site coaching of service providers. The system, now in use in all of Malawi’s 28 districts, covers a population of more than 16 million people. The system has greatly increased the number and quality of supervision visits; before the system was implemented, only 20 percent of health facilities received a supportive supervision visit. Between October and December 2015, 99 percent of all targeted facilities received a visit.
“Supervising staff is handled in a supportive way now, not through a ‘top-down’ policing or inspection system,” Nichols said.
And to ensure that local priorities are addressed, the MOH established district stakeholder forums that have led to multi-year district implementation plans in the 15 SSDI-Systems-supported districts.
“Through soliciting stakeholder input, using existing data sources, and taking a bottom-up approach to planning, the districts now can address some of their health facilities’ and communities’ unique needs,” Nichols said.