Table 1

Summary of HSS interventions implemented in Ifanadiana district between 2014 and 2017, classified by building block of HSS* affected

Level of careIfanadiana district (idHSS+control catchments)
District hospital
Total Ifanadiana: 1

  1. Network of three ambulances for referrals and emergency care; infrastructure renovations, provision of medical and non-medical equipment, including full laboratory capacity; social support for vulnerable patients

  2. Staffing of health workers and non-clinical staff above MoPH norms; trainings for medical staff

  3. Creation of a hospital-based M&E team to follow-up progress of activities; frequent facility readiness surveys

  4. Supply chain management to reduce stock-outs, management of hospital pharmacy

  5. Cost of outpatient and inpatient care fully covered for referred patients (district hospital and tertiary care outside Ifanadiana)

  6. Creation of a joint MoPH-PIVOT executive committee for hospital management and transparency; subcommittees for specific projects

 idHSS catchmentIfanadiana district (idHSS+control catchments)
Health centres
Total Ifanadiana: 13
idHSS catchment:
4 (2014 to 2016)
5 (2017 to 2018)

  1. Infrastructure renovations, provision of medical and non-medical equipment; implementation of IMCI and malnutrition protocols for every child under 5 years of age

  2. Staffing of CSBs above MoPH norms; frequent trainings for medical staff

  3. Joint MoPH-PIVOT training and supervision to improve HMIS data quality

  4. Supply chain management, training and reduction of stock-outs;

  5. Essential medicines and consumables provided free of charge to all patients

  6. Close collaboration with district health managers for the planning and implementation of activities

  1. Provision of medical and non-medical equipment†

  2. Staffing to bring all health centres up to MoPH norms; trainings for medical staff

  3. Basic package of health services free of charge for children under 5 years of age and pregnant women†

Community health
Total Ifanadiana:
195 fokontany idHSS catchment:
21 (2014 to 2016)
43 (2017 to 2018)

  1. Construction of 43 community health posts by community, with PIVOT support; implementation of IMCI and malnutrition protocols for every child under 5 years of age

  2. Training, coaching and monthly supervision of community health workers by mobile teams of trained nurses (14 nurses for ~86 CHWs)

  3. Joint MoPH-PIVOT training to improve HMIS data quality

  4. Monthly provision of MNCH medicine stocks to CHWs and follow-up of medicine stock use

  5. Cost of MNCH medicine stocks fully covered by PIVOT; financial incentives to CHWs for stock management and attendance to supervisions (~US$4 per month)

  6. Community engagement and participation (eg, building health posts)

  1. Provision of non-medical equipment and supplies

  2. Training every year; monthly performance evaluation at health centres; on-site coaching by technical assistants (one for ~15 to 35 CHWs) every 2 months‡

  3. Provision of a free initial stock of products and medicines (subsequent stocks are purchased by CHWs)‡

  4. CHWs make a profit from a small margin in the sale of medicines (except those in idHSS catchment)

  • *Building blocks of HSS: (1) Service delivery, (2) Health workforce, (3) Health information systems, (4) Medicines and supplies, (5) Financing and (6) Leadership and governance.

  • †Implemented by PAUSENS programme (World Bank)

  • ‡Implemented by Mikolo programme (USAID)

  • CHW, community health workers; HMIS, Health Management and Information Systems; HSS, health system strengthening; idHSS, integrated district-level health system strengthening; IMCI, integrated management of child illness; M&E, Monitoring and Evaluation; MNCH, maternal, newborn and child health; MoPH, Ministry of Public Health.