The Abt Associates-led Health Systems 20/20 – USAID’s flagship project for strengthening health systems worldwide – deals with the most important questions about health care as it builds capacity in 50 countries around the world.
How can a country increase its supply of health care professionals?
How can a national plan for community-based health insurance be financed?
What systemic improvements are needed to put health care within reach?
What difference can technology make in improving treatment of infectious disease?
Health Systems 20/20, working with local partners, designs and implements projects that answer these questions and improve health system oversight, effectiveness, and responsiveness.
“By working hand in hand with our partners, we build their capacity to strengthen their own health systems and, at the same time, boost their ownership of this complex process. As a result, these health systems are more resilient and better able to provide the health care people need,” said Ann Lion, director of Health Systems 20/20.
Cote d’Ivoire Trains More Health Care Workers, Improves Rural Access to Care
Nursing students study at the National Institute of Health Workers’ Training in Aboisso, C’ote d’Ivoire. Health Systems 20/20 supported the emergency hiring of 35 teachers at the college and other efforts to increase the pool of health care workers in the country.
Photo Credit: Trevor Snapp, DDC - International
Training an adequate supply of doctors, nurses, health technicians and other health care workers has proven difficult in Cote d’Ivoire, especially for rural areas. This need was exacerbated when more than 20 percent of physicians and 25 percent of nurses fled Cote d’Ivoire in 2002 during the country’s political upheavals.
A multifaceted health system strengthening effort by Health Systems 20/20 in cooperation with country partners improved the number of health care workers, the quality of the training they receive, and their distribution around the country.
Health Systems 20/20 supported the emergency hiring of 35 teachers at the National Institute of Health Workers’ Training (INFAS), which had produced an average of 1,200 nurses, midwives, and health technicians each year. The additional teachers allowed INFAS to lower its student-to-teacher ratio even though INFAS enrollment increased by approximately 1,400 students between 2007 and 2010. Curriculum was revised to match local health care needs.
To increase access to care, Health Systems 20/20 also helped implement an incentive plan to reward health care workers who locate in rural areas. Cities such as Ferkessedougou, in northern Cote d’Ivoire, benefited. Thousands of patients in the city received HIV counseling and testing as a result, plus other health care.
Stabilizing Health Insurance Coverage in Mali
A doctor accepts an insurance card for the Koulikoro Community Health Center in the Koulikoro region of Mali. Health Systems 20/20 conducted a workshop in Mali that led to an action plan to stabilize health insurance coverage in Mali.
Photo Credit: Colby Gottert, DDC - International
Health Systems 20/20 has been working with the Malian government since 2007 to increase health care access through community-based health insurance (CBHI) plans. Such policies allow members to pay small monthly fees to cover the cost of doctors’ visits and other primary care. But CBHI plans, which have existed in Mali since 1997, often struggled to expand, have been fragile, and have been prone to bankruptcy, despite the fact that 80 percent of Malians have no health insurance.
Health Systems 20/20 led a workshop in 2010 that led Malian stakeholders, including Mali’s Ministry of Health and Social Welfare and Ministry of Health, to devise a national CBHI plan. The policy will extend health insurance coverage by creating one CBHI per commune in Mali, a much larger territory than many of the previous village-level CBHIs, which should provide more financial stability. The Malian government adopted the plan in February 2011.
Health Systems 20/20 has been assisting with the piloting of CHBIs in three regions in Mali. The pilots are expected to cover 1.2 million people, approximately 40 percent of the population in these regions. Health Systems 20/20 also has been advising the ministries on building the management structures to oversee the pilots, which are expected to inform the planned nationwide CBHI expansion.
More Efficient Egyptian Medical Practices Leads to Higher Quality Health Care
Dr. Mahmoud Mostafa, director of Nasr City Hospital in Cairo, Egypt. Health Systems 20/20 improved the efficiency of health care in Egypt by training more than 100 staff in four hospitals, including Nasr City Hospital, to review medical records. The reviews reduced the number of unnecessary procedures and prescriptions.
Photo Credit: Colby Gottert, DDC - International
Egypt’s Health Insurance Organization (HIO) – which provides health coverage to approximately half of all Egyptian people – has significantly increased the quality and efficiency of health care provided with the help of Health Systems 20/20. The project worked with HIO to introduce better medical management practices, which has improved the efficiency and quality of health care in Egypt.
Health Systems 20/20 trained 88 HIO medical staff to conduct audits – or evaluate the health facilities with which HIO contracts – to ensure they are providing the services stipulated in their contracts. Health Systems 20/20 also trained and certified more than 100 HIO staff in four hospitals to review medical records. The training improved the staff’s ability to ensure that medical care is of high quality, necessary, appropriate, safe, and efficient.
One hospital in Egypt reduced its number of tonsillectomies by 50 percent after determining most were not medically necessary. Another hospital saw a 36 percent decline in medication use in one year.
HIO’s gains in efficiency and lower costs could allow it to offer universal coverage to all Egyptians, according to the head of HIO.
Nigeria Improves Tuberculosis Care Through Smartphone System
Smartphones are being used in Nigeria to improve tuberculosis treatment, the supply of drugs to treat TB, and the consistency of TB care.
Photo Credit: Trevor Snapp, DDC - International
Health clinics across Nigeria are using an electronic data reporting system developed with the help of Health Systems 20/20 to reduce their frequency of TB drug shortages and generally improve their tuberculosis treatment.
TB patients follow a strict treatment program in which many of them take three pills a day. This treatment must be monitored to ensure that patients do not skip doses and develop drug-resistant TB, which requires different, more costly drugs that have more side-effects.
Different states in Nigeria had used a variety of paper checklists to monitor how well clinics were providing TB treatment. Analyzing the data was difficult and time consuming.
Now many supervisors – who monitor health clinics’ TB care – are entering data into smartphones through a standardized application, which gathers the information for a central database. The application quickly analyzes the data, highlighting weaknesses at a health facility. The system has enabled government managers to reduce the frequency of TB drug shortages, which has improved the reliability of health clinics’ TB care.
Homepage Photo Credits
- Upper left: a mother and her children in Lagos, Nigeria wait outside a clinic where smartphones are being used to improve the reliability of tuberculosis treatment. Photo credit: Trevor Snapp, DDC - International.
- Upper right: a Malian man shows off his membership card for the Koulikoro Community-based Health Insurance group. Photo credit: Colby Gottert, DDC - International.
- Lower left: a nurse in Cairo at Nasr City Hospital, which implemented better medical management practices with the help of Health Systems 20/20. Photo credit: Colby Gottert, DDC - International.