USING EQUIST FOR BOTTLENECK ANALYSIS

Cameroon’s experience.

Dr.  AMANI  Adidja  MD  MPH  ENAP  FORUM  Dakar,    31Oct-­‐5th  Nov  2016  

PROCESS

•  2013-2014 Bottleneck analysis based on the 6 pillars of the health system and the key interventions

•  More of a shopping list – Severity of bottleneck not quantified

•  2015- GFF initiative: Investment case •  2016-Capacity building on Equist for the

situational analysis=è>> Sharpened analysis •  Review and update the newborn operational

About EQUIST

•  EQUIST : The EQUitable Impact Sensitive Tool Medium-term analysis and strategic planning tool to improve child and maternal health as well as nutrition equity in developing and middle-income countries

•  Assessing coverage determinants for deprived populations

•  Prioritizing bottlenecks to be addressed

PARTICIPANTS

•  The process was highly consulative and

participative

•  MoH: Different Departments, EPI, HIV

•  Consultants

•  National Institute of Statistics

•  Partners: WHO, UNICEF, UNFPA, UNAIDS, WB

Bilateral: GIZ

•  Professional associations

•  Civil Society

Coverage Bottleneck Framework

Social  Norms    

     

Availability  of    essenFal  commodiFes  Geographic  access  Financial  affordability  

Social  Acceptability  

Enabling  Environment  Policies/  legislaFon    

Budget/  expenditures    

Governance      

Ini9al  U9lisa9on  dis-­‐con9nui9on  

Poor  Quality    

Effec9ve  coverage  Adequate  coverage    

Non-­‐U9lisa9on  

In-­‐accessibility  

Un-­‐affordability  

Un-­‐availability  

Un-­‐acceptability  

Coverage  Determinant   Absolute  BoDleneck  

Quality  of  care  

Con9nuity  &  9ming  

poor  quality/adequate  coverage    

discon9nui9on/u9liza9on  

Contribu9ng  BoDleneck   Rela9ve  BoDleneck  

BoRle  Neck  analysis    e  service  

ADDED  VALUE  OF  THE  EQUIST  

1.  Définir  les  populaFons  prioriFaires  

2.  Prioriser  les  sujets  de  santé  

3.  Prioriser  les  intervenFons  

4.  Prioriser  les  goulots  

5.  Analyser  les  causes  des  goulots  

6.  SélecFonner  les  stratégies    

7.  EsFmer  l’impact  et  le  coût-­‐efficacité  

CHALLENGES

•  Availability of updated validated data for the tool to generate information needed ( Source: DHS, MICs, Child Mortality estimates, coverage surveys,…)

•  Ability to select the relevant the information generated by EQUIST for the investment plan

•  Proper use of the tool at the regional and district levels •  High speed internet connection needed to use the tool

easily

•  Adolescents: data needed •  CRVS : Comprehensive evaluation ongoing

Lessons learned

•  Garbage in , garbage out= the quality of data used to populate the tool is very important

•  Availability of updated validated data for the tool to generate information needed ( Source: DHS, MICs, Child Mortality estimates, coverage surveys,…)

•  Need to associate districts and stakeholders in the field

•  enough time for bottleneck analysis and development of scenarios

•  The technical support should continue countries need to be accompanied all along the process

Lessons learned

•  Adolescents health- bottleneck analys was done aside

•  Improving data quality and completeness upfront should be at the center of the GFF preparation in countries

•  Search and gather all existing required data well in advance to optimize the time.

•  Need to collect disaggregated data to have an impact