He. RAMS Health Resources Availability Mapping System The Darfur Case Study SUDAN WHO Country Office Health Information Service Unit 1
Outline 1. 2. 3. 4. 5. What is He. RAMS Contextual Information Health Infrastructures Health Human Resources Health Services Availability 3/18/2018 2
What is He. RAMS
Background l l He. RAMS has been initiated and developed between February and December 2008 in the three States of Darfur, Sudan, to assess and monitor the availability of health sector resources provided by both the international and local response to the humanitarian crisis Based on this experience, He. RAMS evolved in a generic tool of the Global Health Cluster to be used in the roll out of the health clusters in the countries implementing the cluster approach, in order to assist Health Cluster Coordinators and partners in assessing and monitoring the availability of resources and services provided to population affected by humanitarian crisis. 4
What is it l He. RAMS (Health Resources Availability Mapping System) is an interactive software-based information system that aims to rapidly capture and process the information in order to assess and monitor the availability of health resources at health facility level and community levels He. RA M S Health Resources Availability; in terms of available health resources infrastructure, personnel, and provided services Mapping; in terms of assessment, monitoring, and georeferencing 3/18/2018 System; in terms of analytical framework and technical support tools 5
He. RAMS Aim and Objectives He. RAMS is developed to provide the decision makers with timely, relevant, and reliable information about the available health resources, , in order to support them: l l Enhancing coordination & accountability through the monitoring Who is Where, When and doing What Indentifying and measuring gaps Support priority settings Inform strategy development and planning of evidencebased health interventions in humanitarian areas 3/18/2018 6
System Components Standard Data Gathering Matrix Input He. RAMS Database System Output Summary & Analytical Reports 3/18/2018 7
Key Information Areas Health Resources' Availability has been disaggregate in three main information areas: – – – Health Facility Infrastructure & Mobile Clinics Health Personnel Health Services 3/18/2018 8
Health Facility Infrastructure This part is designed to collect set of information related to the health facility infrastructure, that is: l HF Location: precisely specify the location of the HF to the lowest possible level (i. e. , State Locality Administrative Unit Settlement/Village), plus the coordinates of the HF (longitude and latitude). l HF premises: provides information about the – – – l HF type with regards to the PHC classifications (i. e. , PHCU, PHCC, RH, etc. . . ), status of the HF (whether it is functioning or not), nature of the HF building (whether it is permanent or a temporary building), service coverage of the HF (whether the HF is serving an IDP camp or a settlement, or both) inpatient capacity of the HF (number of beds). Dees the HF reporting under EWARS? HF Management: indicates the health partners who run the HF, in terms of the main owner and manager of the facility, and the supportive partners, if any. 3/18/2018 9
Health Personnel This part provides information about the health staff work in the HF against the health staff work in the community with regards to certain facility. – HF based staff: is the medical cadre that run the HF, such as MO (Medical Officer), MA (Medical Assistant), Nurse, etc. . . – Community based staff: is categorized as voluntarily workers (e. g. , Village Volunteers), and paid workers (e. g. , Community Health Workers, Village Trained Midwives) 3/18/2018 10
Health Services l Health services are broken into three levels of care, where each one encompasses set of services related to different health sectors; as shown in the diagram below: 3/18/2018 11
Data Quality Assurance: (1) Many validity checks are performed to ensure consistency and reliability of the data: l Implementing the data collection sheet with: – Standard pre-defined lists for the data types of known parameters; (i. e. . , standard locations list, HF Types, …) – Validation rules for entered data types l Upon importing data from the data collection sheet to the Database system, other validation rules are performed to ensure consistency of data types l Performing local quality control check; coordinated editing and auditing process – Peer reviewing of the collected raw data; conducted by the data gathering team (field PHC officers) and developers, – Appraising & reviewing of generated reports before dissemination 3/18/2018 12
Data Quality Assurance: (2) Other procedures are applied to ensure quality data: l l Collecting data by personally interviewing partners and direct field mission, rather than sending partners a copy of the data collection sheet to be filled Developing data dictionary for clear definition of data elements; “use of meta-data” l l Unifying the reporting channel & maintaining one source of data to avoid duplication of reporting Providing hands-on training for the system users (i. e. , PHC officers); upto-date l Establishing a mechanism for frequent feedback to those collecting and using data 3/18/2018 13
CONTEXTUAL INFORMATION
Source : OCHA North Darfur - Contextual Map - July 2007
Humanitarian Space Dynamics Quantitative and qualitative evolution of the Population of Humanitarian Concern (North Darfur – January 07, July 07 & January 08) Evolution - in absolute numbers - of the Population of Humanitarian Concern (Total Population, IDPs and Resident Population) Evolution (%) of the Composition of the Population of Humanitarian Concern (IDPs vs Resident Population) IDPs January 2007 Resident population IDPs July 2007 Resident population IDPs January 2008 Resident population Source : OCHA
Humanitarian Space Dynamics Quantitative and qualitative evolution of the Population of Humanitarian Concern (El Fasher Locality – North Darfur - January 07, July 07 & January 08) Evolution - in absolute numbers - of the Population of Humanitarian Concern (Total Population, IDPs and Resident Population) Evolution (%) of the Composition of the Population of Humanitarian Concern (IDPs vs Resident Population) IDPs January 2007 Resident population IDPs July 2007 Resident population IDPs January 2008 Resident population
HEALTH INFRASTRUCTURES
i-He. RAMS – Infrastructure Characterization Functioning Health Facilities State Profile, North Darfur, March 2008 Absolute Numbers, by Health Facility Type, by Locality * Primary Health Care Centre ** Primary Health Care Unit
Functioning Health Facilities State Profile Absolute Numbers, by Type, by Locality North Darfur - March 08 * Primary Health Care Centre ** Primary Health Care Unit *** Primary Health Facilities (= Sum of RH and PHCCs)
Primary Health Care System Composition (%) March 2008 Darfur Region Comparison across States
Primary Health Care System Framework Average # of Persons per type of Health Facility, by State Darfur Region, June 2008 (PHCC: Primary Health Care Centre; PHCU: Primary Health Care Unit)
i-He. RAMS – Infrastructure Characterization PHCC Availability by Locality – (IDPs & Non IDPs) Average Number of Persons per PHCC North Darfur, March 2008
He. RAMS - PHCC Availability Average Number of Persons per PHCC – by Locality and for Major IDP Camps North Darfur - March 08
North Darfur: Functioning HFs, by Type, and by managing partner (SMo. H versus NGOs) North Darfur Case Study – Dec 2008 Total functioning HFs = 206 out of 250 existing North Darfur: no. of Functioning HFs managed by SMo. H vs. , NGOs - Dec-08 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 31 90 52 7 NGO SMo. H 7 44 65 PHCC PHCU 116 0 RH Out of the 7 RHs managed by SMo. H, 4 (57%) are supported by WHO, UNICEF, & UNFPA % of the PHCCs Management NGO; 41% SMo H; 59% Out of th 44 PH ose C Cent ers, 1 3 ones are s (30%) upp by W orted UNIC HO, EF UNF , & PA Mobile Clinic % of the PHCUs Management NGO; 44% SMo. H; 56% 3/18/2018 TOTAL Out o 65 PH f those C only Units, supp one is orted WHO by UNIC , EF UNF , & PA % of Total Functioning HFs NGO; 44% SMo H; 56% 25
Total functioning HFs = 194 out of 253 existing North Darfur Aug-09 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% North Darfur: No. of Functioning HFs managed by SMo. H vs. , NGOs - Aug 09 0 22 64 39 NGOs 3 SMo. H 8 45 130 76 1 RH PHCC Out of the 8 RHs managed by SMo. H, 5 (63%) are supported by WHO, UNICEF, & UNFPA % of the PHCCs Managment Out of th 45 PH ose C Cent ers, 1 6 ones are s (36%) upp by W orted UNIC HO, EF UNF , & PA PHCU Mob_clinic % of PHCUs Management Out o 76 PH f those 3 one C Units, s supp (4%) are orted (2 ar e W by UNIC HO, UNF EF, PA), IRC & % of Total Functioning HFs NGOs 34% NGO's 31% TOTAL SMo. H 66% SMo. H 69% 3/18/2018 NGOs 33% SMo. H 67% 26
North Darfur: Functioning PHCCs, per Locality, by managing partner Dec-08 versus Aug-09 % of Functioning PHCCs ND-Functioning PHCCs: SMo. H vs. , NGOs - Dec-08 120% 100% 80% NGO 17 SMo. H 60% 40% 0 1 4 9 10 7 Melleit Umm Keddada 27 20% 0% 0 El-Fashir 0 Kabkabya Kutum ND-Functioning PHCCs: SMo. H vs. , NGOs - Aug-09 % of Functioning PHCCs 120% 100% 0 1 9 1 80% NGO 2 60% SMo. H 2 40% 10 20% 6 Melleit 31 Umm Keddada 1 0% El-Fashir Kabkabya Kutum 3/18/2018 27
South Darfur: Functioning HFs, by Type, and by managing partner (SMo. H versus NGOs) Total functioning HFs = 326 out of 415 existing South Darfur Case Study – Dec 08 SD- no. of Functioning HFs: Managed by SMo. H vs. , NGOs - Dec-08 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 34 89 40 9 221 PHCC SMo. H 237 6 RH NGO 14 1 PHCU Mobile Clinic Out PHC of the 6 Cs by th managed one i e SMo. H , ss by C upported ARE (17% ) Out of the 9 RHs managed by SMo. H, 5 are supported by WHO % of the PHCCs Management SMo. H ; 13% TOTAL % of Total Functioning HFs NGO; 27% NGO; 87% SMo. H ; 73% 3/18/2018 28
Total functioning HFs = 334 out of 408 existing South Darfur Case Study – Aug 09 SD- No. of Functioning HFs: Managed by SMo. H vs. , NGOs – Aug-09 120% 100% 2 12 80% 60% 10 40% NGO 10 40 20% RH % of RH Managed by SMo. H vs. NGO 9% SMo. H 91% 50% of the 10 RHs managed by the SMo. H are supported by WHO 90 39 1 0% SMo. H 244 220 PHCC PHCU % of PHCC Managed by SMo. H vs. NGO Mobile Clinic % of PHCU Managed by SMo. H vs. NGO 15% SMo. H 23% NGO 77% One out of 12 PHCCs (8%) managed by the SMo. H is supported by FRC TOTAL % of Mobile Clinics Managed by SMo. H vs. NGO SMo. H 17% SMo. H 85% NGO 83% 3 out of 220 PHCUs (1%) managed by the SMo. H is supported by FRC 3/18/2018 29
South Darfur: Functioning PHCCs, per Locality, by managing partner Dec-08 versus Aug-09 SD: Functioning PHCCs: SMo. H vs. , NGOs- Dec-08 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 3 4 1 1 27 2 NGO 1 SMo. H 3 1 Buram 0 Ed Daein 1 Ed el Fursan 1 0 Kass 0 Nyala Sheiria Tullus SD: Functioning PHCCs: SMo. H vs. , NGOs- Aug 09 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 1 3 4 1 6 NGO 28 2 SMo. H 2 0 Belil 1 Buram 0 Ed Daein Ed el Fursan 0 Kass 1 1 2 Nyala 3/18/2018 Sheiria Tullus 30
West Darfur: Functioning HFs, by Type, and by managing partner (SMo. H versus NGOs) West Darfur Case Study – Dec 2008 Total functioning HFs = 167 out of 219 existing WD – No. of Functioning HFs: Managed by SMo. H vs. , NGOs - Dec 08 120% 100% 0 80% NGO 61 124 60% 6 41 SMo. H 22 40% 20% 37 43 0 0% RH Out of the 6 RHs managed by SMo. H, 5 are supported by WHO 0 PHCC PHCU Mobile Clinic % of PHCU Management NGO 62% TOTAL % of Total Functioning HFs SMo. H 26% SMo. H 38% NGO 74% 3/18/2018 31
Total functioning HFs = 165 out of 221 existing West Darfur Aug-09 WD - Functioning HFs: SMo. H vs. , NGOs - Aug-09 120% 100% 1 80% 60% 40% 61 29 112 21 5 20% 38 10 NGO SMo. H 53 0 0% RH PHCC PHCU Mobile Clinic Al PH l tho s s (W upp CCs e 10 or ar H =9 O, ted e P IA HC UNI by RA C CE , C s), & F AM Out of the 5 RHs managed by SMo. H, 4 are supported by WHO % of PHCC Management TOTAL Out o PHC f thos e 38 Us are sup 3 (8% por ) te W UN HO & d by ICE F, C AM % of PHCU Management SMo. H 38% SMo. H 26% NGO 62% NGO 74% 3/18/2018 32
West Darfur: Functioning PHCCs, per Locality, by managing partner. Dec-08 versus Aug-09 WD: Functioning PHCCs: SMo. H vs. , NGOs- Dec-08 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 17 9 1 3 2 5 4 0 El Geneina 0 Habila 0 Jebel Marra 0 Kulbus 0 Mukjar 0 Wadi Salih 0 Zalingei 5 3 NGO SMo. H WD: Functioning PHCCs: SMo. H vs. , NGOs- Aug 09 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 4 12 1 3 Jebel Marra Kulbus 2 NGO SMo. H 5 4 El Geneina Habila 0 0 Mukjar 3/18/2018 0 Wadi Salih 0 Zalingei 33
HEALTH HUMAN RESOURCES
100% Health Workers, by type, working in PHCCs and in the communities of their related catchment areas, North Darfur, December 2008 ND- no. of staff in the Functioning PHCCs (HF based & Community workers) -Dec 08 90% 80% 15 31 73 70% 9 80 72 16 41 40 60% 1155 50% 123 199 NGO 40% 30% SMo. H 25 44 97 20% 12 79 68 18 35 16 10% 0 0% Total HFs MO MA Nurse PHO MW Vacc Lab Person HF Based Personnel MO% VV 5 4 CHW TBA VTMW Community Based Personnel Nurses % %NGO; 38% % SMo. H ; 63% %NGO ; 50% % SMo H; 50% 52% of the overall community personnel are SMo. H, while 48% are NGOs supported. 3/18/2018 Only 2% of the overall community personnel are SMo. H, while 98% are NGOs supported. 35
120% Health Workers, by type, working in PHCCs and in the communities of their catchment areas, South Darfur, December 2008 SD- no. of staff in the Functioning PHCCs (HF based & Community corkers) NGOs vs. , SMo. HDec 08 100% 80% 60% 40 19 67 104 28 99 51 23 0 MO 4 7 2 7 5 2 MA Nurse PHO MW Vacc Lab Person 173 404 0 VV 6 CHW 1 TBA NGO 76 SMo. H 233 40% 20% 0% 6 Total PHCCs HF Based Personnel Nurses % %NGO ; 94% % SMo. H; 6% Only 6% of the overall community personnel are SMo. H, while 94% are NGOs supported. 0 VTMW Community Based Personnel Only 1% of the overall community personnel are SMo. H, while 99% are NGOs supported.
West Darfur: Health Workers by Type, working in PHCCs and in the communities of their catchment areas, Dec 08 Number and percentages of health personnel based on HFs and the community workers personnel; supported by NGOs vs. SMo. H WD- no. of staff in the Functioning PHCUs (HF based & Community workers) NGOs vs. , SMo. H -Dec 08 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 25 61 41 42 11 4 30 NGO MA Nurse 14 1 MO 3 SMo. H 16 37 Total PHCUs 3 0 PHO 0 MW Vacc Nurses % % SMo. H ; 39% %NGO; 61% %NGO; 58% % SMo. H ; 42% 26 39 0 Lab Person 0 VV CHW 0 TBA VTMW Community Based Personnel HF Based Personnel MA% 60 130 32% of the overall HF based personnel are SMo. H, while 68% are NGOs supported. 25% of the overall community personnel are SMo. H, while 75% are NGOs supported.
Health Workers, by type, working in PHCUs and in the communities of their catchment areas, West Darfur, December 2008 WD- no. of staff in the Functioning PHCUs (HF based & Community workers) NGOs vs. , SMo. H -Dec 08 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 25 61 41 42 11 4 3 60 130 3 NGO SMo. H 16 MA 37 30 Nurse 14 1 Total PHCUs MO 0 PHO 0 MW Vacc 0 Lab Person 0 VV HF Based Personnel MA% Nurses % % SMo. H ; 39% %NGO; 61% %NGO; 58% % SMo. H ; 42% 26 39 32% of the overall community personnel are SMo. H, while 68% are NGOs supported. CHW 0 TBA VTMW Community Based Personnel 25% of the overall community personnel are SMo. H, while 75% are NGOs supported.
He. RAMS - Health Workers, by type, by managing partner North Darfur, March 2008 Facility Based Staff Community Based Staff
He. RAMS - Health Workers, by type of Health Facility North Darfur, March 2008 Rural Hospitals vs PHCCs vs PHCUs
He. RAMS - Health Workers, by type, by Locality North Darfur, March 2008 Facility Based Staff Community Based Staff
HEALTH SERVEICES AVAILABILITY
Health Services examples Out of 62 health service monitored through the He. RAMS CHECK LIST, we have selected the following 5 services as examples of the service availability in Darfur 3 states: Level of Care Sublevel Community Care Level Child Health General Clinical Services Code Service C 23 Community mobilization for and support to mass vaccination campaigns and/or mass drug administration/treatments P 14 Referral Capacity: referral procedures, means of communication, transportation P 62 Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed and/or reported), advise/counsel on nutrition & breastfeeding, self care and family planning, preventive treatment(s) as appropriate P 65 Basic essential obstetric care (BEOC): parenteral antibiotics + oxytocic/ anticonvulsivant drugs + manual removal of placenta + removal of retained products with manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7 P 66 Post partum care: examination of mother and newborn (up to 6 weeks), respond to observed signs, support breast feeding, promote family planning PHC Level Maternal & Newborn Health
Availability of selected Health Services at PHCCs, North Darfur, December 08 ND - examples of some services provision at PHCCs -Dec 08 100% % NGOs 90% 81% 80% 70% 64% 63% 60% % SMo. H 50% 40% 30% 29% 20% 37% 32% 13% 12% 37% 36% 13% 10% 0% Community mobilization and support to mass vaccination campaigns % Child Health Service provided at community care level Referral capacity % Antenatal care % General Clinical Service provided at Primary Health Care Level Basic essential obstetric care (BEOC) % % Total PHCCs provide the Service/Total Functioning PHCCs Post partum care % Maternal & Newborn Health Services provided at Primary Health Care Level To interpret the graph; Antenatal care service example: 13% of the service is provided by the PHC Centers managed by the NGOs, while 64% of the service is provided by SMo. Hs. The overall percentage of the PHCCs providing the service out of the total functioning centers is 37%
Availability of selected Health Services at PHCCs, South Darfur, December 08 SD - examples of some services provision at PHCCs -Dec 08 65% 70% 65% 57% 60% 57% % SMo. H 50% 40% 28% 30% 20% 10% 4% 9% 33% 13% %NGO 9% 4% 9% 9% 9% 0% 0% Community mobilization and support to mass vaccination campaigns Child Health Service provided at community care level Referral Capacity Antenatal care General Clinical Service provided at Primary Health Care Level Basic essential obstetric care (BEOC) Post partum care % Total PHCCs provide the Service/Total Functioning PHCCs Maternal & Newborn Health Services provided at Primary Health Care Level To interpret the graph; Antenatal care service example: 9% of the service is provided by the PHC Centers managed by the SMo. H, while 57% of the service is provided by NGOs. The overall percentage of the PHCCs providing the service out of the total functioning centers is 65%
Availability of selected Health Services at PHCCs, West Darfur, December 08 WD - examples of some services provision at PHC Units -Dec 08 100. 0% 91% 90. 0% MOH% 80. 0% 70. 0% 60. 0% 56. 1% 55. 1% 61% NGO% 50. 0% 40. 0% 35. 7% 29. 6% 30. 0% 20. 0% C 42 Service provided at community care level %Total PHCUs provide the Service 8. 2% 8% 5. 1% 10. 0% P 62 0. 0% P 65 P 66 Service provided at Primary Health Care Level Please refer to slide#20 to have the services related to this codes To interpret the graph; Antenatal care service example: 5% of the service provided by the PHC Units managed by the SMo. H, while 56% of the service provided by NGOs. The overall percentage of the PHCUs providing the service out of the total functioning units is 61%
Trend Analysis example West Darfur: provision of Maternal & Newborn service at PHCCs P 62 P 63 PHC Level Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed and/or reported), advise/counsel on nutrition & breastfeeding, self care and family planning, preventive treatments) as appropriate Skilled care during childbirth for clean and safe normal delivery P 65 Basic emergency obstetric care (BEm. OC): parenteral antibiotics + oxytocic/ anticonvulsivant drugs + manual removal of placenta + removal of retained products with manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7 P 66 Post partum care: examination of mother and newborn (up to 6 weeks), respond to observed signs, support breast feeding, promote family planning 3/18/2018 47
He. RAMS - Availability of Health Services to address STI & HIV/AIDS by managing partner, North Darfur, March 2008
He. RAMS - Availability of Health Services to address STI & HIV/AIDS at PHCCs, PHCUs, and Rural Hospitals, North Darfur, March 2008 Rural Hospitals PHCCs & PHCUs
He. RAMS - Availability of Health Services to address Sexual Violence at PHCCs, by managing partner, North Darfur, March 2008
He. RAMS - Availability of Health Services to address Sexual Violence at PHCCs, by Locality, North Darfur, March 2008
i-He. RAMS – Health Sub Sectors and Key Services Gap Analysis Identification of Gaps* in the provision of Key Services & Sub Sectors at the level of Administrative Units Sexual Violence Package monitored : - Clinical Management of Rape Survivors - Emergency Contraception - PEP for STI & HIV Infections * None of the Primary Care Facilities of the Admin Unit in red provides the package of services to address sexual violence.
He. RAMS - Availability of Health Services to address Maternal & Newborn Health by managing partner, North Darfur, March 2008
He. RAMS - Availability of Health Services to address Maternal & Newborn Health at PHCCs, PHCUs, and Rural Hospitals, North Darfur, March 2008 Rural Hospitals PHCCs & PHCUs
He. RAMS - Availability of Health Services to address Maternal & Newborn Health at PHCC, by Locality, North Darfur, March 2008
i-He. RAMS – Gap Analysis of Basic Emergency Obstetric Care, by Locality, North Darfur, March 2008 Maternal & Newborn Health Service monitored: BEm. OC * None of the Primary Care Facilities of the Admin Units in red provides the Basic Emergency Obstetric Care Service
i-He. RAMS – Gap Analysis of CHild Health Key Service, by Admin Unit, North Darfur, March 2008 Child Health Service monitored: EPI * None of the Primary Care Facilities of the Admin Unit in red provides routine EPI
South Darfur Provision of Key Services – Proportion of PHF providing Key Services (%), March 2008
South Darfur Provision of Key Services – Proportion of PHF providing Key Services (%), March 2008
South Darfur Provision of Key Services – Proportion of PHF providing Key Services (%), March 2008
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