Strengthening health systems with a focus on mother-and-child health and family planning

Programme description

Title: Programme on Strengthening Health Systems, Yemen
Commissioning party: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Yemen
Lead executing agency: Ministry of Public Health and Population
Overall term: 2014 to 2016

Context

The majority of Yemen’s rural population has only limited or no access to health services. Many health facilities offer low-quality services, since their staff generally have neither the expertise nor the management skills they need. The lack of health education, especially for women, and the limited confidence in health institutions restrict demand.

Although with 71 US dollars per capita (2012), total health expenditure in Yemen is among the lowest in the region, it is considered sufficient to provide an essential services package to the population. Only four per cent of the general government expenditures are used for health (2012); half of what is recommended by WHO as a minimum share (2103). The government health system’s chronic under-financing and inequitable distribution of funds compromise the quality of materials and staffing and the availability of essential drugs. The ongoing political crisis in recent years has further exacerbated the health care situation.

Objective

Access to quality-assured and needs-oriented basic health care services focusing on mother-and-child health and family planning is improved.

Approach

The programme assists the Yemeni Ministry of Public Health and Population in strengthening its capacity and competencies, especially in the area of health financing, quality assurance and health promotion. To this end, the programme uses advisory services offered by long-term and short-term experts, training measures, materials and equipment and financial subsidies.

The concepts developed as part of the programme, such as the quality improvement programme for basic health services, community-based education on sexual and reproductive health and peer education at schools, were successfully implemented and validated at the regional level in the context of previous cooperation. The programme continues to support decentralised implementation while stepping up its efforts to integrate those approaches in the health system. For this reason, it increasingly focuses on national policy advisory services. In line with this, the programme promotes application of previously validated gender-sensitive and human rights-based approaches by different actors. The programme also advises the newly created General Directorate for Quality and Patient Safety at the Yemeni Ministry of Public Health and Population on its functions. It promotes measures for human resources and organisational development and networking with relevant actors, for example, on the establishment of an intersectoral working group for health financing.

There is close cooperation with the social marketing programme funded by KfW Development Bank and the voucher system for reproductive health services.

Results

The programme builds on the results of previous cooperation (Reproductive Health in Yemen). By late 2013, 142 health facilities had been quality-certified and 332 were undergoing the evaluation and qualification process. In addition 40 facilities run by private midwives are involved in the process. Together, they constitute over 50 per cent of the basic health services for reproductive health in the programme provinces and 25 per cent at the national level. Other donors, such as the European Union and various international non-governmental organisations, have adopted the programme’s concept and have introduced it in four additional provinces. The rate of use of services in the area of reproductive health (pre-natal and post-natal examinations for pregnant women, professionally attended births) has increased by an average of over 50 percentage points in the catchment area of the certified health centres. In the area of health education, volunteers in 122 communities ensure low-threshold access to information and modern contraceptives. At over 70 schools, non-governmental organisations trained peer educators. The rate of use of modern contraceptives in the programme communities is around 25 per cent higher than the use rate in comparable communities.