Table 2 Key constraints and operational solutions within the health care system
Level | Constraint | Cause | Solution |
|---|---|---|---|
1. Health service delivery level (demand-side) | Shortage of appropriately qualified staff | Inadequate training | Strengthen pre-service and in-service training, develop standardized training plans, use cascade training and increase supervision |
Provide sufficient per diem for supervision | |||
On-the-job training and mentoring | |||
Limited number of ethnic group healthcare staff | Human-resource plans including specific affirmative action policies and strategies to attract men and women from different ethnic groups | ||
Limited number of staff with appropriate language skills | Provide additional education to identified men and women from ethnic groups to facilitate entry into formal training programs | ||
Poor understanding of some policies and standards | Simple, standardized policies, training and supervision and feedback loops for staff | ||
Reliance on VHVs | Creation of more paid positions, provide remuneration, per diem for outreach, training and supervision, on-the-job training and mentoring | ||
VHVs struggle to balance health duties and livelihood needs | |||
Insufficient basic supplies, drugs and equipment | Weak supply system an poor financial planning | Strengthen management and supply and provide supervision | |
Pre-service and in-service training, supervision and mentoring | |||
Standardized procurement and disbursement mechanisms | |||
Distant location of facilities | Deploy trained staff to peripheral health units | ||
Establish and maintain waiting homes | |||
Insufficient budget | Insufficient budget allocation | Advocate for increased government budget allocation to health | |
2. Community and household level (supply side) | Low demand, delayed use of services and poor compliance with treatment | Inadequate affordable transport | Develop community transport schemes |
Household resources and willingness/ability to pay | Develop and promote appropriate finance schemes | ||
Limited cash flow/livelihood demands – associated with seasonality | Strengthen social health insurance (SHI) and social health protection (SHP) schemes which are inclusive of the poor | ||
Delayed decision making | Promote birth and emergency preparedness plans | ||
Language | Strengthen education for ethnic groups | ||
Recruit from ethnic populations | |||
Cultural norms | Integrate cultural appropriateness into MNCH program planning and design | ||
3. Policy and strategic management | Weak management, administration and coordination | Few managers | Strengthen district level management capacity |
Limited management training | Clear guidelines and manuals | ||
High administrative burden relative to skills | Streamline reporting | ||
4. Cross-sectoral, | Limited infrastructure (e.g. electricity, roads, communication networks) | Insufficient cross-sectoral action | Promote cross-sectoral collaboration and strengthen coordination with different technical working groups |
Limited access to education for ethnic groups and women |