5.2 Reliable supply, access and availability of commodities

The UN Commission on Life-Saving Commodities highlighted how supply of essential commodities for health services remains a major barrier to service delivery. Countries can continue to implement the recommendations and use tools of the UN Commission (see Resources, below). Key issues for focus include, but are not limited to:

• strengthening public sector and private supply chains (e.g. in tendering and inspection, manufacturing processes, audit standards, warehousing, personnel and transport)
• implementing better commodity tracking systems
• improving regulatory mechanisms (e.g. harmonization of guidelines, support for joint manufacturer inspections and prioritization and fast track registration of WHO prequalified commodities)
• fiscal space and national supply financing assessments
• timely release of funding to prevent procurement delays
• enhanced quality assurance efforts to enhance post-market surveillance and pharmacovigilance
• preparedness for surge capacity
• establishment of clinical protocols.

The private sector and NGOs have expertise to strengthen supply chains, especially when it comes to reaching the last mile and developing effective interfaces between different segments of the supply chain.  Efforts here might include providing technical support to strengthen supply chains, developing innovative models to overcome challenges and providing training in cutting-edge forecasting and inventory practices.

5.3 Effective health management information systems (HMIS)

Health systems in all countries require valid and disaggregated data on components and performance to facilitate improved coverage. Countries can assess the quality and completeness of facility- and community-based health management information systems. They can also implement strategies to address reported shortcomings (e.g. training, revisions of forms or reporting mechanisms) and/or to take advantage of electronic reporting via SMS, tablets or the internet, depending on the country context (e.g. cell phone coverage, current HMIS platform).

One priority will be to build the capacity of district health management teams and programme staff to utilize HMIS data for timely management decisions on resource allocation and service delivery. Countries can review existing sector-specific assessment tools and management information systems to better capture information on under-represented groups, such as adolescents and minorities. They can also utilise technological platforms and innovations to improve data availability, quality and timeliness. To do so, there is a need to establish standards, common terminologies and minimum data sets, promoting the interoperability of systems. Policies can be developed on health-data sharing to ensure data protection, privacy and consent, and SMS-based technologies can be used to improve accuracy and timeliness of data and information reporting. The work of the Health Data Collaborative resulting from the 2015 Measurement 4 Health Summit will be a key resource.

Other priorities include developing and using geographic information systems to map health system resources (including health workers), community needs and priority areas (not just limited to health sector considerations e.g. prioritizing areas with severe malnutrition or poor development indices); and optimization of HMIS data collection and use for quality improvement, performance measurement, and reporting/accountability.

5.4 Quality health services delivered at scale with resilience

Of the many innovations and advancements in RMNCAH, only a sub-set have been implemented “at scale” to reach large percentages of target populations and/or geographic areas within countries. In spite of this, it is increasingly recognized that scaling up quality services is fundamental for reducing discrimination and inequities; meeting the health needs of the most vulnerable, marginalized and excluded; and achieving overarching targets.

Country governments and their partners can support scale up of quality services with attention to both a transparent, inclusive, systematic, evidence-based decision-making process and a participatory, rights-based policy process. Specific issues for particular attention include:

• establishing evidence of effectiveness and efficiency of the intervention(s)
• building capacity of sub-national government and partners to implement the intervention(s)
• identifying existing bottlenecks and barriers to effective implementation (considering enabling environment, supply, demand and quality of care determinants of coverage)
• monitoring and reporting on progress and impact as the intervention(s) are replicated and expanded
• adapting global service delivery standards and protocols to country conditions
• developing policies, strategies and systems for quality improvement and sustainability at national and subnational levels
• measurement of health service outcomes and quality and client satisfaction
• developing and supporting use of tools and quality assurance methods e.g. perinatal or near-miss audits and tools for monitoring quality of care
• implementing guidelines, training and monitoring mechanisms for the provision of respectful and compassionate care, in particular for stigmatized and marginalized groups
• providing essential services to health facilities, including clean water, sanitation and energy.

Despite increasing attention to the need to make health systems more resilient, the exact measures required to do so, particularly in weak health systems, need further consideration. One priority is to strengthen the resilience of community health systems – where most people receive health services. Particular attention should be paid to strengthening supply chains, empowering and protecting health workers who deliver services in the community and ensuring they are recognized and institutionalized into national health systems. Key influencers in communities should be identified and trained in advance for roles in disease outbreaks.