Leadership, Management and Sustainability (LMS) Program

Participant in the Leadership Development Program presenting her team's challenge model and action plan. Photo by Michael Paydos, 2008.

Since 2002, Afghanistan has made remarkable advances in health care and indicators. However, despite these marked improvements, Afghanistan still registers some of the worst health statistics in the world, especially among women and children. Nevertheless, past projects and current work in country demonstrate the tremendous spirit of the Afghan people to unite around the issue of health.

RESULTS

Building on USAID’s successful REACH Project, completed in 2006, LMS is strengthening the leadership and management capacities of the Ministry of Public Health (MOPH) at the central and provincial levels, as well as ensuring reliable access to high-quality pharmaceuticals throughout 13 USAID-supported provinces through the Tech-Serve project, a five-year Associate Award initiated in July 2006. Major accomplishments to date include:

More than 1,800 health professionals, including senior Ministry of Public Health and NGO managers, were trained in leadership and management development, and other priority public health subjects to equip them with the necessary skills to achieve better health outcomes.
As a result of training community health supervisors and community health workers (CHWs), two-thirds of all family planning services are conducted by CHWs at the community level. The Contraceptive Prevalence Rate increased to 40.6% (up 10% from the start of the project), as reported in a household survey conducted by the health service delivery organizations.
The Tech-Serve Project supplied a total to $11.9 million of essential drugs and contraceptives since its inception.
The MOPH is now certified to administer USAID funds, and manages 17 health service provision contracts with local and international NGOs, thereby increasing access and equity to health care across the 13 provinces.

EXPERIENCE IN COUNTRY

Technical Support to the Central and Provincial Ministry of Public Health (Tech-Serve) Project

Tech-Serve works with the Ministry of Public Health (MOPH) at the central and provincial level to build its capacity to perform its primary function of guiding the health system by establishing national health objectives that address national health priorities while ensuring equity and fostering sustainability. Tech-Serve provides ongoing technical assistance in key public health technical areas and engages both central and provincial managers in developing their management and leadership skills to focus on health results and accountability. The Tech-Serve Management Support for Provinces (MSP) initiative works directly with provincial health directors and their teams to effectively articulate their health priorities, strategies to address health needs, to plan, implement the strategies and to monitor their activities. This project was launched in July 2006 by Management Sciences for Health under an Associate Cooperative Agreements.

Support to the Grants and Contract Management Unit

The Grants and Contracts Management Unit (GCMU) of the Ministry of Public Health in Afghanistan oversees the awarding and management of service delivery grants to private-sector service delivery organizations. Nearly all funds for delivery of basic services are managed by this unit (more than 50% of the total government health budget). Tech-Serve has assisted the GCMU in building its capacity in financial and contract management to meet USAID pre-qualifications for directly receiving the funds. A team, including one Tech-Serve consultant and 12 GCMU staff, developed a transparent process for management and improvement of service delivery grants to ensure that planned service outputs and community coverage for services are achieved. In June 2008, the GCMU became the first government agency within Afghanistan certified by the U.S. Government to receive significant direct funding. The certification also involved a review of systems at the Afghan Ministry of Finance, which handles all financing for the Afghan government. By June 2009, the GCMU had successfully awarded 17 new major contracts. Many of these processes will be replicated by teams at GCMU managing grant funding from the World Bank and European Community.

Leadership Development Program

Using the Leadership Development Program (LDP) developed by MSH under the M&L Program with USAID core funds, Tech-Serve has trained more than 1,800 health professionals, including senior-level MOPH and NGO managers. The LDP has been scaled up to include 66 health facilities throughout the 13 provinces Tech-Serve administers. In 2008, Tech-Serve delivered a facilitator’s training program in Kabul to past participants of the LDP so they could further replicate the program with minimal outside assistance. In early 2009, an LDP Networking Workshop was delivered to participants from 16 provinces to provide further support for scaling up the program.

Distribution of Essential Medicines and Contraceptives

Tech-Serve is responsible for distributing essential medicines and contraceptives to NGOs responsible for 387 health facilities and 4,400 health posts. These locations serve a population of more than 7 million in the 13 provinces Tech-Serve covers. As of June 2008, Tech-Serve distributed more than $8.5 million in pharmaceuticals. The project’s improved stock management system has reduced stock variance to less than .15% for 2008 while also minimizing waste due to drug expiration.