| Assessment: |
Equipment shortages and lack of maintenance e.g. Sphygmomanometers that are never recalibrated leading to spurious readings |
New equipment being bought |
No Equipment management, condemning etc. |
Providing resources |
Systems thinking: How does this phase affect the other phases and how does this contribute to the performance of the system as a whole? |
| Little time to focus on patient (12 minutes for one patient with multiple co-morbidities) |
Clinical skills training |
No efficient and effective supply chain management |
Research and evidence and innovation |
Financing; Service delivery-enhancing capacity –clinical skills training; Pharmaceutical products; Leadership; Human resources(HR); Health Information system |
| High patient volumes (cocktail of epidemics) |
Central Chronic Medicine Dispensing and Distribution (CCMD) |
Revision of PHC staffing norms to accommodate the evolving disease profiles and comorbidities-research based |
Streamlining work |
Where is high leverage? What is the feedback saying? |
| Multiple registers |
Ward based teams |
One register |
Streamlining work |
Time saved from duplicate data entry etc. can then be spent on patient care; Accurate data (HIS) leads to improved planning (leadership and governance and responsive health systems; Accurate assessment of patient impacts diagnosis, treatment and consequently patient outcomes |
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Electronic medical records |
Innovation |
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| Diagnosis: |
Results take long to get back to clinic |
|
Onsite basic lab services |
Enhancing capacity |
Systems thinking: How does this phase affect the other phases and how does this contribute to the performance of the system as a whole? |
| Results get lost along the way |
|
Electronic Medical Records |
Strengthening infrastructure |
Financing; Service delivery; Pharmaceutical products; Leadership; Human resources (HR). Health Information system |
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|
Providing resources
Research and evidence and innovation |
Where is high leverage? What is the feedback saying? Accurate diagnosis of patient impacts treatment plan and consequently patient outcomes |
| Treatment and nursing plan: |
Drug stock-outs |
Supply chain management training |
Task shifting: Pharmacy assistants could take over dispensing-freeing up time for nurses to focus on patient |
Streamlining work |
Systems thinking: How does this phase affect the other phases and how does this contribute to the performance of the system as a whole? |
| Prescribing and dispensing at the same time |
|
Time management-Meeting management |
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Financing; Service delivery; Pharmaceutical products-Supply chain mx training; Leadership; HR; Health Information system |
| Too much paper work-use of bar codes |
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Where is high leverage? What is the feedback saying? Informed planning impacts, implementation of treatment and consequently patient outcomes |
| Implementation: |
Staff shortages |
Leadership training |
Human resources for health (HRH) plan |
Enhancing capacity |
|
| Multiple, Impromptu and ad hoc meetings, workshops and trainings |
|
District Health systems (DHS) set up, establishment and management |
Research, evidence and innovation |
Systems thinking: How does this phase affect the other phases and how does this contribute to the performance of the system as a whole? |
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|
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Financing; Service delivery; Pharmaceutical products; Leadership; HR; Health Information system
Where is high leverage? What is the feedback saying? Example: supporting broader capacity building, in light of (nurse) health-worker shortages across the developing world[@13709]; What is working, for whom, where and why? Evaluation feeds back into planning and subsequent nursing processes leading to continuous improvement |
| Evaluation: |
Time pressure and lack of continuity of care (multiple registers that get lost etc.) |
|
Revision of PHC Supervision culture |
Enhancing capacity |
Leadership and Management strengthening |
| Policing culture rather than mentoring approach to supervision |
|
Revision of staffing norms |
Research, evidence and innovation |
Data use locally-Monitoring & Evaluation of own facility performance ad designing plans for improvement
Systems thinking; How does this phase affect the other phases and how does this contribute to the performance of the system as a whole?
Financing; Service delivery; Pharmaceutical products; Leadership; HR; Health Information system;
Where is high leverage? What is the feedback saying? Example: turning vertical funds directly to strengthen health systems or to assure health care for all members of society (for example, through Universal Health Coverage (UHC) tied to health systems strengthening[@13709]; What is working, for whom, where and why? Evaluation feeds back into planning and subsequent nursing processes leading to continuous improvement |