Multisectoral Collaboration and Woreda Transformation

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1. Key areas raised/discussed under the sub theme

• Concept , implementation status and  challenges of the WTA implementation
• Documented best experiences in implementing WT from model woredas
• Experience of Oromia Regional Health Bureau and Legehidha woreda health office in implementing the Woreda Transformation agenda
• Integration of WTA with other HSTP agendas
• Priority area to be considered in the next HSTP development

2. Major challenges raised/discussed  

1. Woreda leadership

• High turnover of leadership and staff at all levels,
• Limited capacity of WoHO  leadership and staff,-no motivation mechanisms/incentive , continuous training, inadequate structure and staff number and mix
• Lack of inter sectoral collaboration and fragmented approach even within the sector and no SOP for intersectoral collaboration
• Weak performance management system (indicators, measurement, improvement plan and evaluation)
• Weak accountability framework and commitment
• Limited financial capacity- shortage of budget and inefficient utilization at woreda level
• Lack of contextualized intervention to different settings (Urban, agrarian and pastoral)

2. Health service delivery Unit/center

• Inaccessibility of basic amenities (rooms, water, electricity, transport and computer)
• Interruption of essential medicines, supplies and equipment
• Low quality of service delivery ( due to lack of standards for each service packages, HR, infrastructure…)
• Shortage of budget at PHCU level
• Weak referral system and inefficient utilization of Ambulance 

3. Community

• Reduced momentum of the HEP and WDA (turn-over, motivation, workload, inadequate number per kebele, low male involvement in community health interventions, low attention for Urban HEP)
• Lack of clarity for model household training and graduation
• Lack of comprehensive community engagement approach
• Gaps in partnership and measurement criteria for model school
• Limited culture of  documenting local or community level innovations and scaling up

3. Consideration for EFY 2012 implementation and beyond to be considered in the next HSTP (in the following four categories)

Intervention/s that need to be dropped:

• • Top -down plan and target setting
  • Separate of the Health Insurance Agency/ CBHI scheme from the health sector

Intervention/s that need to be modified:

• • • Refine the indicators and performance improvement approach in line with the transformation agenda integration concept.
    • Continuous documentation and replication of best practices, local innovations; and implementation in phased approach as a solutions for local problems
    • Contextualized Woreda transformation intervention for different settings
    • Focus on health system building and household centered interventions.
    • Rigorous resource mobilization and efficient utilization of resources as the Woreda transformation initiative requires high budget
    • Merit based selection, training and appointment of the woreda leadership
    • Review and strengthen the linkage between Woreda health office and Primary Hospital
    • Improve ambulance management
    • Standardize medical equipment for facilities and strengthen preventive maintenances
    • Expand sanitation marketing to progress improved latrine coverage

Intervention/s that need to be continued as is:

• Mature the concept of transformation agenda Integration into strategy and assign a team or staffs for this role
• Multi-sectoral/holistic community development approach for woreda transformation
• Performance measurement initiative
• Woreda management standard
• Community score card initiative
• Accelerating the EPSA reform implementations

Intervention/s that need to be newly added:

• Reevaluate and redesign the woreda/PHCU level structures (Woreda Health office and health facilities)
• Tailored and comprehensive Human resource development plan/ appropriate competency for woreda/district health system (need based pre/in-service trainings, adequate in number and mix, motivation scheme, Women empowerment…)
• Empower/ encourage women for district health leadership role
• Design, test and scale up accountability framework at all levels
• Reform HEP (rural and urban) based on the available evidence- staffing, volume of work and others perspectives.
• Revise Model Household training and graduation approach and criteria
• Design and test new community engagement platforms