The project “Governance in health: technical cooperation for reproductive health services in Yemen” (or RHPP II) incorporated the experience and lessons learned from previous EU assistance to Yemen. It continued innovative ideas such as strengthening the Health Development Councils (HDC – established under the Health Sector and Demography Support Programme, HSDSP), built upon successes in Reproductive health (RH) in the three governorates targeted in the current Reproductive Health and Population Programme (RHPP I), and moreover took a more comprehensive, integrated view on health sector reform as in the previous HSDSP.
Overall objective of the project:
The overall objective of the EU assistance under which this programme formed part was ‘to reduce the population growth rate and fertility rate per woman in Yemen and to contribute to the fight against malnutrition in the three targeted Governorates: Hajja, Al-Baida and Al-Mawheet”.
Specific objectives of the project:
The specific objectives of the technical assistance was as follows:
- To support and facilitate the capacity building process of the GHOs, DHOs (District Health Offices) and HDCs in Hajja, Al-Mahweet and Al-Baida;
- To support capacity building and standard operating procedures formulation allowing the HDCs to play their coordination, facilitation and supervision role for the implementation of RH services;
- To support the formulation of a governorate health profile, to be used for future benchmarking of the activities as well as for planning further support;
- To support the planning exercise in the 3 Governorates with a 5 years time span;
- To promote twinning mechanisms between Governorates;
- To support the units and departments at central level, technically linked with HDC work, in their stewardship role vis-à-vis to the peripheral needs;
- To effectively support the decentralization of authority and resources at the peripheral level.
- To encourage community participation and civil society/non-state actors involvement in the work of the HDCs.
RHPP II addressed system governance, i.e. planning, management, coordination and stewardship, leading to better service delivery outcomes in the area of RH and Maternal and Child Health (MCH) and eventually to a 'higher level impact', namely the improvement of the Millenium Development Goals (MDGs) 4 and 5.
Capacity development of HDCs, Governorate and District Health Offices, and the MoPHP at national level was the core element of RHPP II. The programme should endeavour to organise these health systems along 'six building blocks': (1) governance (stewardship) and leadership, (2) service delivery, (3) health workforce, (4) information, (5) financing, and (6) medical products, and vaccines and technologies. As an overall approach, the expert team should work towards institutionalised capacity development that established long-term collaboration with international and national academic institutes and national professional organisations. Twinning arrangements between the previous recipients of technical assistance and the new governorates should also be created to share lessons learnt and best practices. Finally, technical working groups should be tasked to support the HDCs and GHOs by providing evidence to guide priority setting and inform policy making. Specific activities under the project were as follows:
Improve governance and leadership. Good governance should be the aim not only for the HDCs but also for all the layers of the decentralised health system and involved planning and budgeting, M&E and sector coordination. Developing a health profile and review of current planning and budgeting mechanisms were the initial steps and were followed through with technical support in planning and drawing community participation. HDCs were capacitated to take on the stewardship role and coordinate all stakeholder activities in the health sector.
Improve service planning and delivery. Support to Governorates in improving the quality of health service delivery lie along three axes: improvement in the use of standards/protocols in promoting health care at primary and referral facilities through training and strengthened integrated supervision; promotion of an integrated health service delivery and rational referral mechanism; and, introduction of a standard quality Improvement model.
Improve human resources for health. The project focused on areas that represent the most urgent priorities for the governorates and that could be reasonably addressed within the scope of the RHPP II - taking into account that HRH was also addressed in another EU-funded project. The RHPP II and HRH projects benefited from close collaboration during workforce assessment and planning, policy development, performance management mechanisms and creating an HRH structure.
Develop an HMIS plan. A situational analysis preceded this activity followed by the identification of capacity needs of policy makers and managers in HMIS planning and management. A consequent training plan was expected to equip the HDCs as well as GHOs and DHOs to develop their respective HMIS plans.
Health financing innovations. The expert team should assist the HDCs in analysing and identifying supplementary financing options to reduce financial barriers to accessing RH services by the poor. A training plan was developed to transfer knowledge and skills in health financing and also pilot schemes that finance services for the poor and exempts them from paying user fees.