The Road to Stronger Health Systems

Transcription

End of Project Report
USAID-funded
Health Systems Strengthening II Project
2009 - 2014
Implemented by
Abt Associates Inc.
This report was prepared with support from the United States Agency for International
Development (USAID) through the Health Systems Strengthening II (HSS II) Project,
contract number GHS-I-00-07-00003-00
HSS II End of Project Report
Health Systems Strengthening II (HSS II)
The Health Systems Strengthening II Project (2009-2014) is funded by the United States
Agency for International Development and implemented by Abt Associates Inc. in
partnership with BAHA Consultant Engineering, Initiatives Inc., O’Hanlon Health Consulting,
LLC and TAGI Training.
HSS II  Wadi Saqra, Arar Street, Bldg No. 215, Amman – Jordan
 Tel: +962-6-5655792  Fax: +962-6-5655793 www.hss.jo
Abt Associates Inc.  4550 Montgomery Avenue, Suite 800 North, Bethesda, MD 208143343, USA  Tel: +1-301-913-0500  Fax: +1-301-652-3916
HSS II END OF PROJECT REPORT
Task Order Contract Number:
GHS-I-00-07-00003-00
Submitted to:
Dr. Issam Omar: COR, Population and Family Health Office / USAID Jordan
Dr. Nagham Abu-Shaqra: Activity Manager / USAID Jordan
Submitted on:
October 29th, 2014
Disclaimer
The author’s views expressed in this publication do not necessarily reflect the views of the United
States Agency for International Development or the United States Government.
I
MESSAGE FROM THE CHIEF OF PARTY
After an exciting and rewarding 5 years, HSS II has completed its implementation. At the
beginning, HSS II was designed to support national health priorities and improve public
sector health care with an emphasis on selected systems and services. Looking back, the
strategies we set and the programs we implemented yielded great returns, as they helped to
shape the direction of the strengthened Jordanian health system. The initial phase of
assessments was followed by intensive implementation of program activities in the field and
at the policy level by the Abt-led HSS II team, in full partnership with counterparts and
stakeholders.
Close to 85 Ministry of Health (MOH) health centers were successfully accredited.
Fourteen maternal, newborn and emergency departments at public hospitals were
renovated and equipped with state-of-the-art medical equipment. Across Jordan, hospital
staff was trained on evidence-based clinical guidelines, with best practices for maternal and
newborn care maintained at high levels. Family planning counseling and services improved in
hospitals and health centers. Upgraded health management information systems improved
the use of data. Communities became more involved in the health system through more
than 100 community health committees established in different parts of the Kingdom.
While the project faced a number of challenges during implementation, HSS II continued to
meet its goals and undertake new initiatives addressing the country’s health priorities. I am
optimistic that even more progress will be achieved in the coming years. In this report, we
present some of the major challenges and lessons learned to help decision makers to further
improve health systems and services in Jordan.
None of this work would have been possible without partnerships and strong collaboration
with the true implementers of our joint programs. Without their interest, commitment and
energy, our own hard-working HSS II staff would not have been able to achieve any of the
impressive progress detailed in this report. First and foremost, these implementing partners
are the leaders, managers and health providers of the MOH, the Royal Medical Services
(RMS), the Higher Population Council (HPC) and Jordan University Hospital (JUH). Our vital
partners also included community volunteers who carried out impressive programs in their
own communities to improve health status. In addition, we have benefited from great
collaboration with other USAID projects and other organizations too numerous to mention
here.
To shape these joint efforts, we relied on excellent guidance and support from USAID,
which has been a dedicated partner ensuring that we are able to respond to emerging issues
and meet new challenges as they arise.
Finally, I would like to thank the people of Jordan not only for trusting USAID’s HSS II
project to strengthen the health system that serves them, but also for believing in the
potential for positive improvement of health outcomes.
Dr. Sabry Hamza
HSS II Chief of Party
III
TABLE OF CONTENTS
MESSAGE FROM THE CHIEF OF PARTY ............................................................. III
TABLE OF CONTENTS ............................................................................................. V
LIST OF ABBREVIATIONS ..................................................................................... VII
I. EXECUTIVE SUMMARY .......................................................................................... 1
II. ACHIEVEMENTS ..................................................................................................... 9
OBJECTIVE 1: PROMOTE THE PRINCIPLES AND PRACTICES OF KNOWLEDGE
MANAGEMENT (KM) AT THE MOH.............................................................................. 9
Context ............................................................................................................................................... 9
Approach ........................................................................................................................................... 11
Achievements ................................................................................................................................... 13
Sustainability ..................................................................................................................................... 14
Challenges ......................................................................................................................................... 14
Lessons Learned .............................................................................................................................. 14
OBJECTIVE 2: IMPROVE QUALITY OF CARE AT PRIMARY HEALTH CARE LEVEL ............ 15
Context ............................................................................................................................................. 15
Approach ........................................................................................................................................... 15
Sustainability ..................................................................................................................................... 20
Challenges ......................................................................................................................................... 21
Lessons Learned .............................................................................................................................. 22
OBJECTIVE 3: IMPROVE QUALITY OF SAFE MOTHERHOOD AT HOSPITAL LEVEL ......... 23
Context ............................................................................................................................................. 23
Approach ........................................................................................................................................... 23
Achievements ................................................................................................................................... 25
Sustainability ..................................................................................................................................... 28
Challenges ......................................................................................................................................... 28
Lessons Learned .............................................................................................................................. 28
OBJECTIVE 4: IMPROVE QUALITY OF AND INCREASE ACCESS TO FP/RH SERVICES .... 30
Context ............................................................................................................................................. 30
Approach ........................................................................................................................................... 30
Achievements ................................................................................................................................... 33
Sustainability ..................................................................................................................................... 36
Challenges ......................................................................................................................................... 36
Lessons Learned .............................................................................................................................. 37
V
OBJECTIVE 5: IMPROVE COMMUNITY HEALTH ........................................................... 39
Context ............................................................................................................................................. 39
Approach ........................................................................................................................................... 39
Achievements ................................................................................................................................... 44
Sustainability ..................................................................................................................................... 44
Challenges ......................................................................................................................................... 45
Lessons Learned .............................................................................................................................. 45
OBJECTIVE 6: RENOVATE, EQUIP, FURNISH AND MAINTAIN HEALTH FACILITIES ....... 47
Context ............................................................................................................................................. 47
Approach ........................................................................................................................................... 47
Achievements ................................................................................................................................... 50
Sustainability ..................................................................................................................................... 52
OBJECTIVE 7: DEVELOP HUMAN RESOURCES ............................................................ 53
Context ............................................................................................................................................. 53
Approach ........................................................................................................................................... 53
Achievements ................................................................................................................................... 55
Challenges ......................................................................................................................................... 56
Lessons Learned .............................................................................................................................. 56
III. HAND-OVER OF HSS II PROGRAMS TO GOJ COUNTERPARTS AND
RECIPIENTS ......................................................................................................... 57
IV. HSS II CELEBRATES FRUITFUL PARTNERSHIP AND SUCCESSFUL
CONCLUSION .................................................................................................... 58
V. ANNEXES ............................................................................................................. 59
ANNEX 1:
ANNEX 2:
ANNEX 3:
ANNEX 4:
ANNEX 5:
INDICATOR MONITORING ........................................................................................... 59
LIST OF COUNTERPART ADMINISTRATIONS AND DIRECTORATES........................... 77
LIST OF 120 HEALTH CENTERS PREPARED FOR ACCREDITATION ........................... 78
LIST OF HOSPITALS THAT RECEIVED THE SAFE MOTHERHOOD PROGRAM ............. 81
LIST OF HOSPITALS THAT WERE UPGRADED THROUGH RENOVATION AND
EXPANSION WORKS..................................................................................................... 82
ANNEX 6: LIST OF HOSPITALS THAT RECEIVED MEDICAL EQUIPMENT, FURNITURE AND
IT EQUIPMENT ............................................................................................................... 83
ANNEX 7: LIST OF UPGRADED TRAINING CENTERS INCLUDING EQUIPMENT AND
FURNITURE PROVIDED ................................................................................................ 110
ANNEX 8: LIST OF COMMUNITY HEALTH COMMITTEES ........................................................... 113
ANNEX 9: LIST OF HSS II PUBLICATIONS ................................................................................... 116
ANNEX 10: LIST OF HSS II STUDIES ............................................................................................. 117
ANNEX 11: LIST OF TRAINING PROGRAMS AND NUMBER OF TRAINEES ................................. 118
ANNEX 12: EXPENDITURE FOR CURRENT QUARTER (YEAR 5 – QUARTER 4) ........................ 123
VI
LIST OF ABBREVIATIONS
AIA
AMTSL
AWSO
BCC
CHC
CI
CPAP
CPR
CSB
CYP
DBE
DM
DPPM
FP
FP/RH
FPLMIS
GOJ
GP
GIS
HA
HC
HCAC
HCAD
HD
HMIS
HP
HPC
HR
HRH
HSMC
HSS II
IT
ITD
IUD
IV
JAFPP
JHAS
JU
JUH
KM
American Institute of Architects
Active Management of Third Stage of Labor
Arab Women Speak Out
Behavior Change Communications
Community Health Committee
Confidential Inquiry
Continuous Positive Airway Pressure
Cardiopulmonary Resuscitation
Civil Service Bureau
Couple Years of Protection
Directorate of Biomedical Engineering
Diabetes Mellitus
Directorate of Planning and Project Management
Family Planning
Family Planning/Reproductive Health
Family Planning Logistic Management Information System
Government of Jordan
General Practitioner
Geographical Information System
Hospital Administration
Health Center
Health Care Accreditation Council
Health Communication and Awareness Directorate
Health Directorate
Health Management Information System
Health Promotion
Higher Population Council
Human Resource
Human Resources for Health
Hospital Safe Motherhood Committee
Health Systems Strengthening II
Information Technology
Information Technology Directorate
Intrauterine Device
Intravenous
Jordan Association for Family Planning and Protection
Jordan Health Aid Society
Jordan University
Jordan University Hospital
Knowledge Management
VII
KPI
LAM
LARC
LDP
MCH
MDG
MMR
MOH
NCD
NGO
NICU
NNMR
OB/GYN
OJT
OPMT
PA
PAC
PDF
PHC
PIH
PIS
PPH
PP/PM
PRA
QD
QI
QUHs
RDS
RH
RMS
RO
SDM
SM
SHOPS
TOT
TWG
UNRWA
USAID
WCHD
WHO
WISN
Key Performance Indicator
Lactational Amenorrhea Method
Long-Acting Reversible Contraception
Liquid Display Panel
Maternal and Child Health
Millennium Development Goal
Maternal Mortality Ratio
Ministry of Health
Non-Communicable Diseases
Non-Governmental Organization
Neonatal Intensive Care Unit
Neonatal Mortality Rate
Obstetrics/Gynecology
On-the-Job Training
Operational Planning Monitoring Tool
Performance Assessment
Post-Abortion Care
Portable Document Format
Primary Health Care
Pregnancy Induced Hypertension
Perinatal Information System
Postpartum Hemorrhage
Post-Partum and Post-Miscarriage
Participatory Rapid Assessment
Quality Directorate
Quality Improvement
Quality Unit Heads
Respiratory Distress Syndrome
Reproductive Health
Royal Medical Services
Referral Officer
Standard Days Method
Safe Motherhood
Strengthening Health Outcomes through the Private Sector
Training of Trainers
Technical Working Group
United Nations Relief and Works Agency for Palestine Refugees in the Near
East
United States Agency for International Development
Women and Child Health Directorate
World Health Organization
Workload Indicator for Staffing Needs
VIII
I. EXECUTIVE SUMMARY
The Health Systems Strengthening II Project
The USAID funded Abt led HSS II project improved access to and quality of high priority
health care services in Jordan. Building on the partnership and experience gained under the
prior projects (PHCI, 1999-2005 and HSS, 2005-2010), HSS II continued to strengthen
health systems that directly support key aspects of the Jordanian MOH’s Strategic Plan. In
each program area, HSS II built the capacity of the appropriate government counterparts
and worked hand-in-hand with them through the stages of the project. All of the project’s
programs included capacity-building for counterparts on Needs Assessment, Joint
Planning, Use of Evidence, Best Practices and Use of Data for Improvement.
Strategies
The HSS II project focused on strengthening the Ministry of Health’s capacity by supporting
two of the Ministry’s core functions -Management (Systems and Processes) and
Service Delivery (Services and Programs). HSS II’s approach is organized into seven
strategies based on firm evidence that in order to improve delivery of priority health
services, constraints in the health system must also be addressed.
Improving Quality
of and Increasing
Access to FP/RH
Services
Engaging and
Empowering
Communities
Improving Human
Resources for
Health
Strengthening
Selected Health
Systems
Improving
Quality of Safe
Motherhood
Services
Institutionalizing
Knowledge
Management
Practices
Improving Quality
of and Increasing
Access to PHC
Services
Figure 1: HSS II Strategies
Implementation Approach
To ensure integrated and institutionalized systems supporting priority health services, HSS II
worked at all levels of the Jordanian MOH system. Figure 2 illustrates the HSS II strategies
at each level and their intended purpose.
1
Central
Health
Directorate
Health
Centers
&
Hospitals
Political Commitment at Central and Health Directorate (HD) Levels Enhanced
HD’s Capacity to Expand, Implement and Manage Systems Strengthened
Institutionalizing Knowledge Management
Practices
Health Management
Information Systems
Strengthening Selected Health Systems
Performance
Assessment
Human
Resources
Planning &
Supervision
Referral &
Appointment
Maintenance
System
High Performing Systems Support Quality Health Services
Access to Essential Health Services Expanded
Quality of Essential Health Services Improved
Improving Quality of Safe
Motherhood and Emergency
Services
Quality Improvement
& Information
Systems
Improving Quality of & Increasing
Access to FP/RH Services
Renovation
&
Equipment
Method
Mix
Expansion
Decrease
Missed
Opportunities
Decrease
Unmet
Needs
Improving Quality of &
Increasing Access to PHC
Services
PHC Accreditation
Communities Practice Healthy Lifestyles
Engaging and Empowering Communities
Community
Health Promotion
Community Mobilization
Figure 2: HSS II Implementation Approach in Integrating and Institutionalizing Systems that Support Quality Health Services
2
Core Values Guiding Implementation: The basic principles that guided HSS II’s partnership with the Jordanian public health sector are:
Trust and Confidence
HSS II earned trust and confidence
through a variety of mechanisms including
joint planning, regular meetings and
frequent communications, which
encouraged openness and transparency
between the project and partners
Technical Excellence
and Innovation
Accountability
The HSS II team demonstrated
commitment to working with
Jordanian counterparts and
achieved the project’s milestones
and results
During its 5 years of implementation,
HSS II provided the MOH and other
public health sector entities with
technical assistance of the highest
standard and that reflected
international best practices and
innovating
Core Values
Guiding
Implementation
Results-Driven and
Results-Oriented
Collaboration and
Partnerships
Together with Jordanian counterparts,
HSS II established realistic goals and
expectations that reflected the MOH
strategy, set the direction and guided
the project’s activities
Key to the project’s approach was the
spirit of collaboration and partnership
with Jordanian stakeholders, whereby
entities shared the risks and rewards
of strengthening the health system
Figure 3: Core Values Guiding HSS II Implementation
3
Geographic Coverage
HSS II geographic coverage
extended from the central level to
the grass roots level across the
Kingdom. At the central level, the
project
worked
with
the
Headquarters of the MOH, RMS,
HPC and JUH and other key
governoment entities and stake
holders. At the Governorate level,
the project worked with the
country’s 12 health directorates.
At the service delivery level, HSS II
programs and activities were
implemented in 30 public sector
hospitals, 120 MOH health center
and more than 100 community
health committees in all areas of
the Kingdom.
1
Irbid
2
Ajloun
3
Jerash
4
Mafraq
5
Balqa
6
Amman
7
Zarqa
8
Madaba
9
Karak
10 Tafilah
11 Ma'an
12 Aqaba
Figure 4: Governorates of Jordan
Partnerships
Partnerships were central to the HSS II approach. To implement HSS II programs and
activites, Abt Associates Inc. was proud to partner with key government counterparts. In
addition Abt selected four organizations, “two international and two national”, with proven
track records in Jordan to assist with the implementation of selected programs and
activities.
Ministry of Health
BAHA Consultant
Engineering (Local)
Royal Medical Services
Abu-Ghazaleh & Co.
Consulting "TAG
Consultants" (Local)
Higher Population
Council
Initiatives Inc.
(International)
Jordan University
O’Hanlon Health
Consulting, LLC
(International)
Figure 5: HSS II Partners
Success of the Project
The USAID Midterm evaluation of HSS II was overwhelmingly positive, indicating that HSS II
was meeting its objectives and making an impact. The evaluation report, by independent
consultants, noted:
4
"The HSS II project is highly regarded throughout the MOH for its responsiveness to
health needs and for its integrated approach to health delivery. The project has
strengthened critical health systems through its support to health management
information systems (HMIS), renovations, accreditation, referrals, and capacity-building.
Across all components, from beginning to end, the project has prioritized capacitybuilding and institutionalization.”
The USAID HSS II Midterm Evaluation Report
"These strengthened health systems not only
help USAID and the project achieve their
objectives and better monitor performance,
they help the MOH do the same, which is one
of the reasons the MOH considers USAID a
critically important partner.”
"HSS II is on track to meet all its
objectives by the end of the project. The
project is well managed and has excellent
relations with both the Ministry of Health
and USAID".
5
Key HSS II successes:
Renovated 14 Hospital
Departments
•Renovated 9 obstetrics and neonatal and 5 emergency departments at
public hospitals with state-of-the-art architectural designs, advanced
equipment and best practice guidelines.
Reduction of Maternal
and Neonatal
Mortality
•Contributed to reductions of maternal mortality from 41 to 19 per
100,000 live birth and neonatal mortality from 20 to 14 per 1000 live
births.
Family Planning
Strategic Plan
•Assisted the MOH to develop for the first time its five year family
planning strategic plan, a major milestone in the MOH’s family
planning efforts.
Reduced Missed
Opportunities for
Family Planning
•Reduced missed opportunities for family planning services and
information through the introduction of post-partum/postmiscarriage services in 25 public sector hospitals.
Data Management
•Upgraded MOH’s data management capabilities to facilitate datadriven decision-making at all levels of the public health care delivery
system.
Health Management
Information Systems
Accreditation
Collaboratives
•Strengthened MOH’s information sharing channels through an
overhaul of the MOH website and established different health
management information systems.
•Improved the operational capability of primary health care centers
through the innovative accreditation collaboratives.
Structured Planning
•Institutionalized structured planning processes at all levels of the
MOH to inform performance improvement initiatives.
Referral and
Appointment System
•Established the referral and appointment system at the MOH to
streamline patient flow from the primary care to hospitals and to
facilitate peer-to-peer learning between service providers at both
levels.
Job Descriptions
•Developed the job descriptions for MOH staff to increase
operational efficiency, improve staff satisfaction and enhance quality
of care.
Mobilized
Communitites
•Mobilized communities to adopt healthier life style through the
establishment of more than 100 community health committee in all
regions of the country.
Figure 6: HSS II Success Highlight
More information on specific successes and achievements can be found in the following
pages, which summarize results by the seven HSS II technical areas.
6
Challenges
The extensive experience gained under HSS II and predecessor projects allows USAID, the
MOH, HPC, RMS and other counterparts to consider how best to capitalize on the
momentum achieved in recent years in strengthening health systems and improving
performance of priority programs, and to address remaining challenges that hamper the
performance of national programs including the FP program. Specific program challenges will
be comprehensively addressed within the details of the report.
Barriers to the
Uptake or
Continued Use of
Modern FP
Methods
Highly Vertical,
Centralized Systems
Hamper Progress
Challenges
Inconsistent Use of
Data to Inform
Decision-Making
Human Resources
Allocation and
Management
Figure 7: Highlight of Challenges
Barriers to the Uptake or Continued Use of Modern FP Methods:
High use of traditional FP methods: The persistently high use of traditional FP methods in
Jordan reflects a combination of cultural preferences, misinformation about the safety of
modern methods, and lack of awareness or lack of concern about the high failure rate of
traditional methods among FP users as well as health providers.
Service-related barriers to access: The provision of IUDs by midwives remains uneven. In
2011, the MOH issued an amended job description for its midwives that included IUD
services, if they were supervised by a trained physician. This allowed the WCHD to resume
training and support for midwives to provide IUD services, but did not fully overcome the
concerns of both midwives and physicians regarding their legal protection against any
malpractice claims and about the role of the supervising physician.
Health system issues: During HSS II and its predecessor projects, the MOH received
technical assistance to improve systems and subsystems related to family planning service
delivery. Yet due to the lack of policies and logistics that are needed to enforce these
systems; the quality of services provided at the facility level is inconsistent. The supportive
supervision, planning and information systems need to be enforced at the health directorate
and facility levels.
7
Outside Influences: The rapid influx of Syrian refugees and continued instability in the region
has had a profound effect on the Kingdom. Health facilities are stretching even further to
accommodate patient populations swollen with refugee families. The presence of Syrians and
other refugees in Jordan may lead some Jordanians to feel it is important to continue having
large families, in order to preserve the essential character of the Kingdom.
Inconsistent Use of Data to Inform Decision-Making
While access to data has improved, its use to inform decision-making remains inconsistent.
USAID has supported many health systems strengthening projects including HSS II to work
with the MOH to strengthen multiple data systems. However, additional efforts are needed
to ensure that MOH managers have timely and complete information, to increase the
efficiency of the public health system. Further work is also needed to support a culture of
data-driven planning among stakeholders.
Human Resources Allocation and Management
There is a lack of formal policies at the MOH to guide the allocation of staff based on the
best interests of the system. The current staff in some areas is either overstretched or
lacking the core competency needed to perform a job according to standards. This is also
associated with a lack of an incentive structure that motivates staff performance. There is a
common perception among MOH staff that their performance, good or bad, will not
influence their career development, chances of promotion or advancement, or assignments
in the future. This perception profoundly affects their attitudes and behaviors, particularly
when asked to do additional work to improve quality of care.
Highly Vertical, Centralized Systems Hamper Progress
Because of a high degree of vertical hierarchy in health services, the success or failure of
activities within a particular facility or Health Directorate often rests on a single individual.
At the same time, frequent movement of staff, especially high level staff, makes continuity of
efforts fragile.
8
II. ACHIEVEMENTS
Objective 1: Promote the principles and practices of knowledge
management (KM) at the MOH
Context
In 2009 MOH health management information systems were collecting large amount of
information at both hospital and PHC levels, both for health care and administrative needs.
However, these information systems were suffering from a number of challenges, such as
incomplete computerization, limited access to the computerized systems and the absence of
a well-developed data culture within the MOH. The importance of using information for
better decision-making was neither well understood nor appreciated.
One of USAID’s priorities is to continue supporting the MOH to develop, implement and
systematically utilize modern information systems and tools for improving the efficiency and
quality of health care. A number of HMIS were designed, upgraded and introduced in the
ten years preceding HSS II. HSS II was tasked to update and strengthen these systems to
provide the information needed, as well as to build the culture of using data for decision
making. Status of the HMIS at the outset of HSS II is detailed below:
MCH
QI
Health
Management
Information
Systems
(HMIS)
GIS
FP
Logistics
PIS
Figure 8: Health Management Information Systems
Maternal and Child Health (MCH) Information System
This system was developed with the support of USAID during HSS predecessor project; it
used to provide management indicators and periodic reports readily available for each HC.
HSS II was tasked to link the FP data of the MCH system with the Logistics Information
system to provide a more complete picture of all family planning services provided at a HC,
indicators by HC for measuring the health status of women and children, and the means to
evaluate implementation of mandated norms. This system was partially institutionalized at
the MOH in terms of data collection, data cleaning and entry of HC cumulative data at the
HD level.
9
FP Logistics Information System
This supply side system provided a complete picture of all family planning contraceptives and
supplies provided through the MOH’s Woman and Child Health Directorate. This system is
well institutionalized at the MOH.
Perinatal Information System
This system has been designed to deal with high risk pregnancies to prepare clinicians to
deal with complications before the patient presents to the hospital for delivery. The system
provides access to the patient’s record. Providers can review it prior to or upon receiving
the patient. It also reduces unnecessary or duplicate tests since a patient’s history of tests
and results are available when the patient presents at the hospital. Medical errors can be
reduced with access to the patient’s information at hospital and outpatient clinics.
Data collection for the perinatal system has started in some hospitals during the preceding
project. HSS II was tasked to institutionalize this system.
Geographic Information System (GIS)
This system provided updated information on government and non-government services
that address social, economic, and personal factors which affect health. The system was
developed in the preceding USAID funded HSS project and made available on the MOH
website. At the beginning of HSS II the GIS system was not yet well utilized and the process
of updating data was not well defined at the MOH.
Quality Improvement (QI) Information System
The QI system was intended to provide performance indicators for each HC. These may be
reviewed regularly to monitor the accreditation process. This system also helps in the
development of annual work plans for improving the performance of a HC. The QI system
needed special attention under the HSS II project to improve the QI management
information system and computerization.
Performance Assessment (PA)
USAID originally assisted the MOH to introduce Performance Assessment (PA) to facilitate
the integration of an organizational culture which values and encourages good performance
and leads to the consistent practice of systematic performance assessments of individuals
and organizational units/departments. The PA-generated information was not used for policy
development or decision making which is mainly due to the lack of a monitoring and
evaluation culture at all levels of the MOH.
Knowledge management (KM)
KM appeared as an essential element of the recently developed MOH strategy. At the
beginning of HSS II, introduction and subsequent operationalization of the concept of
knowledge management had not yet started at the MOH.
10
Approach
Over the course of five years, HSS II worked in full collaboration with the MOH in designing
and implementing interventions aimed at gradually developing a knowledge management
culture within the MOH. The project focused on strengthening of existing or development
of new HMIS systems where data/information is systematically used for better decisionmaking.
HSS II focused on the following:
Establishing and promoting knowledge management practices
In order to facilitate the operational function and ongoing implementation of KM technical
initiatives, HSS II successfully formed and built the capacity of a Knowledge Management
Technical Team at the MOH central level. Together with this team, HSS II conducted an
assessment to explore KM practices necessary to respond to knowledge management needs
at the MOH. HSS II used the assessment results as a source for formulating the MOH’s
“Knowledge Management Strategic Plan”. To facilitate the implementation of the KM
strategic plan, a “Knowledge Management Implementation Toolkit” and a “Knowledge
Management Training Manual” were developed in collaboration with the MOH KM
Technical Team. These documents were used by the KM master trainers at the central
MOH level.
Strengthening MOH Information Technology infrastructure and staff capacity to
enable KM practices
Significant improvements were made during HSS II for each of the information systems
supported by the project in close collaboration with the MOH. This was achieved through:

Strengthening the capacity of MOH IT Directorate and HD IT units to maintain the HMIS and
MOH website
The KM Team procured IT equipment for the implementation of the HMIS in relevant
central directorates, health directorates, 120 health centers and 27 hospitals. Local area
networks were installed to enable proper connectivity and data flow.
HSS II worked closely with the MOH to improve the capacity of the ITD and the IT units at
each of the 12 health directorates, enabling them to provide increasing technical support to
health centers and hospitals. While the ITD capacity increased, HSS II gradually decreased
its technical role enabling the MOH become independent while still providing appropriate
support. As shown in the figure below, as the project progressed, more technical support
visits were carried out by the MOH ITD with an appropriate decrease in HSS II visits,
meaning that capacity was being transferred. Capacity building interventions included
provision of technical trainings aimed at strengthening skills in programming and
maintenance of systems. The project also developed processes and tools, such as IT
maintenance checklists and guidelines.
11
140
125
120
100
80
120 120
102
100
95
90
120
80
100
80
75
HSS II
Technical
Support
Visits
65
60
55
50
40
30
20
15
35
30
30
25
20
ITD
Technical
Support
Visits
10
0
Q1
55
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013
Figure 9: Number of Technical Support Visits by HSS II vs ITD
Towards the end of the project the interventions performed by HSS II were limited to
urgent cases only. Even in such cases, HSS II’s role was supportive as ITD staff took the lead
in providing the needed technical support:

Reviewing and updating existing HMIS (QIS, MCH, FPL, PIS, referral and appointment) and
developing new HMIS (NCD & OPMT)
In close collaboration with the MOH, significant improvements were achieved during
HSS II for each of the information systems. HSS II interventions targeted different central
directorates, health directorates and facilities. Interventions included:





Forming technical committees to design the update of the tools and processes of the
HMIS. Processes included data flow, data quality checks and data analysis. Roles and
responsibilities were developed, and MOH policies were communicated to guide
implementation and ensure continuity.
Developing and printing new registries to be used as the data collection tools at the
facility level. Supporting tools, such as user guides and technical documentation of
programs, were developed accordingly.
Building capacity at each point of the data flow to ensure proper updates and quality
of data.
Strengthening the capacity of the central technical directorates to assume their role
in the sustainability of the HMIS. This was done through two main strategies. First,
the project chose a programing language and architecture that would be easier to
support. Second, the majority of the work was performed with full technical
involvement of the MOH ITD, thus ensuring their capacity building and knowledge of
the systems as they are developed.
Promoting the use of information generated by the HMIS by linking their output in
enhanced presentation tools (dash boards). Better and more accessible presentation
provides managers with a comprehensive view of performance and improves the
decision making process. Users from central, health directorates and facilities were
introduced to the system and the types of information generated.
12
Upgrading MOH website to act as a gate to access HMIS information
The MOH website was upgraded to more effectively function as a central point for sharing
information. This included upgrading the MOH hardware by providing two new highcapacity servers, enabling better management of the increased data. Installation included a
Microsoft Share Point server as the main hosting environment at the MOH ITD, thus
reducing the amount of technical support needed in the long-term and increasing stability
and productivity.
HSS II redesigned the structure of the MOH website to function as a central collection point
for HMIS-produced data. The new design took into consideration the different types of
website users, ranging from health professionals to members of the public. Authorized users
can access, filter, and print all information related to MOH key performance indicators in
various presentation formats, including tables, graphs, Excel sheets and PDF documents.
Furthermore, through the upgrade of the MOH website, HSSII added more data analysis
functions to the Geographical Information System (GIS), which is an integral part of the
website. The GIS system is tied to all of the information systems that feed into the website,
including the human resources database, thereby making it easy for stakeholders and
decision-makers to determine the staffing needs of service delivery points.
Strengthen Performance Assessment Unit to promote a culture of performance
excellence
In addition to promoting a culture of KM, HSS II worked with MOH to instill a value of
“performance excellence” throughout the Ministry. In collaboration with the MOH, HSS II
conducted a rapid assessment in Year One to better understand the Performance
Assessment Unit’s staff capacity, processes and procedures and to develop a plan to
strengthen its capacity. Moreover, HSS II updated the PA methodology to reflect
international best practices and the King Abdullah Award for excellence requirements in the
field of PA. All change requires leadership commitment. HSS II worked over the life of the
project to foster, obtain and build MOH commitment for the PA plan, a PA culture and PA
practices. Interventions to build commitment included: raising awareness on best practices
of PA in public sector both in Jordan and elsewhere and establishing PA technical teams at
Central and HD levels to become change agents and early adopters of PA practices.
Achievements
These approaches enabled HSS II to meet its contractual results, and in some cases results
exceeded expectations. Results included, but are not limited to, the following:










120 health centers equipped with IT equipment
Technical departments at the HD and Central level received IT equipment
Technical MOH capacity at different levels strengthened to sustain the HMIS
Upgraded MOH website launched and functioning
Upgraded MCH information system functioning
Upgraded FP logistic information system functioning
NCD information system introduced
An electronic operational planning monitoring tool designed and introduced
Better documented use of HMIS
HD IT units assuming their role in maintaining the HMIS
13
Sustainability
HSS II worked in close collaboration with the MOH at different levels to obtain
commitment for continuity. Several interventions targeting sustainability were implemented
throughout the life of the project:





Empowered ITD with skills and tools related to maintaining and upgrading the systems.
Tactics included switching to more affordable technologies that can be maintained within
the available budget at the MOH. As an example, switching the website architect from
PHP and Oracle to Microsoft SharePoint enables the MOH ITD to better allocate
technical resources needed for scaling up the website.
Enhancing the linkages between central technical directorates (data owners) and the ITD
by defining roles and responsibilities and establishing needed communication channels
among relevant staff to ensure continuity.
Expanded the capacity of ITD programmers to be able to build software technical
documentation, upgrade and maintain the information systems.
With regards to infrastructure, HSS II installed devices at ITD that ensures the safety
and security of data such as firewall and backup devices.
Empowered HD IT units with needed skills and tools related to maintaining and
supporting facilities and improved the communication channels with the central ITD.
Challenges






High turnover of technical staff
Capability of MOH to recruit highly skilled software developers
Procurement mechanisms for IT maintenance support
Budget limitations for IT equipment
Lack of IT regional training labs
Weak culture of data use and IT capacity among MOH staff at all levels.
Lessons Learned




Involving technical data owners from the early stages of the design increases the level of
commitment and ownership
Engaging staff in all levels of data flow improves overall success and provides appropriate
distribution of responsibilities.
Strong leadership at each level of the MOH (central, HD and facility), coupled with
mandates and policies, is needed in order to ensure data generation and use.
Availability of technical staff close to data collection points will enhance and improve the
data collection process. IT units are assuming a very good role in solving field technical
issues.
14
Objective 2: Improve quality of care at primary health care
level
Context
In the late 1990’s, the Ministry of Health recognized the need to improve the quality of
Primary Health Care (PHC) provision to the Jordanian public. Being the most accessible
healthcare outlet, the PHC system of the MOH includes 81 Comprehensive, 367 Primary,
and 252 Village Health Centers across the 12 governorates. Two USAID funded Abt-led
projects, the Primary Health Care Initiatives (1999-2005) and the Health Systems
Strengthening Project (2005-2010), created an enabling environment by establishing a robust
quality improvement structure at the central, health directorate, and health facility levels of
the Ministry of Health.
While the foundation for quality improvement was established, the MOH still in needed to
further develop the capacity of its staff, both technically and organizationally, in order to
apply quality improvement to the provision of PHC. With the support of the HSS II Project,
modern approaches to improving quality have been integrated into the primary health care
system and the QI structures that were established during Abt’s predecessor projects.
Approach
HSS II identified the need to integrate improvements in systems and services, accrued at the
health center level, under the umbrella of Primary Health Care Accreditation. As a result,
HSS II identified the “Collaborative Approach” as a mechanism for enhancing quality
improvement processes at the primary health care level thus advancing the process of
accrediting MOH health centers. Furthermore, and at Health Directorate Level, HSS II
recognized the need to foster the role of the quality councils in supporting accreditation of
health centers by strengthening operational planning and supportive supervision. In addition
HSS II helped the MOH implement a nationwide referral and appointment system. This
system ensures that timely referrals to specialists are organized for patients who need them,
and unnecessary or self-referrals are avoided and assisted to improve operational planning
and supportive supervision systems.
Preparing 120 health centers for accreditation
HSS II systematically introduced, supported and implemented a PHC/FP QI Collaborative
approach that successfully prepared primary health care centers for accreditation.
The Accreditation Collaborative (AC) approach combined a traditional accreditation
preparedness method with a participatory improvement model that promoted rapid scaling
up of best practices through a planned spread strategy. Abt’s HSS II project led and assisted
the MOH to prepare 120 health centers for accreditation using the 18-month collaborative
approach, in which, multidisciplinary PHC teams participated in monthly learning sessions to
share experiences, understand the requirements of the accreditation standards and produce
action plans. In between sessions, PHC teams implemented standards, collected data, and
ran Plan-Do-Study-Act (PDSA) cycles. Together, MOH and HSS II teams provided technical
support to address barriers to standard implementation. At the end of the preparedness
phase, centers were formally surveyed by the Health Care Accreditation Council. Through
continuous capacity building, fully engaging MOH staff at all levels, and supporting systems at
15
the MOH, HSS II prepared the MOH to assume leadership of this process. Ninety five per
cent (95%) of participating health centers achieved accreditation following this approach.
The goal was ensuring that at least 50 of those centers would become accredited during the
lifetime of the project. Of the 120 health centers participating in the collaborative approach,
a total of 100 centers were nominated by the MOH to undergo a final survey by the
independent Health Care Accreditation Council (HCAC) in order to evaluate standards
being met. During the first and second collaboratives, 75 health centers received
accreditation. For the third collaborative, preliminary results indicate that 11 more centers
will achieve accreditation, bringing the total to 86 accredited centers nationwide.
Through its continuous collaboration with the MOH, HSS II ensured that the MOH was
prepared to assume responsibility for the process after the project ends. HSS II has shown
that a systematic design and application of PHC/FP QI Collaboratives to achieve large-scale
accreditation in a middle-income country like Jordan is feasible and effective. Adequate
capacity and leadership of the MOH is vital to its success. The MOH has demonstrated this
capacity by initiating and leading their own PHC QI collaboratives in parallel with the
ongoing 2nd and 3rd collaboratives in the directorates of Mafraq and Ajloun, where each of
the two HDs worked with two of their health centers and with the QD in preparing for
accreditation.
In the 3rd collaborative, new family planning domains and standards were created by HSS II
staff working with WCHD. FP-specific learning session modules were also developed and
focused on improving access to long-term reversible FP methods, reducing missed
opportunities for FP services and improving quality of services. In order to be compliant
with standards, HCs were expected to have a minimum of four FP methods and provide
comprehensive counseling services. At baseline, 11 of the 31 participating HCs provided a
long acting reversible FP method. However, by March 2014, 20 of the 31 centers offered at
least one of these methods.
Two client satisfaction surveys were conducted during the 2nd Collaborative in 25 of the 59
participating health centers, and included 1,749 patients. Satisfaction was a composite of
client perceptions of how services and information were provided during their visit. Mean
scores were 77.5 percent for the 1st survey and 87.9 percent for the 2nd, illustrating a
highly significant (p<0.001) difference in client satisfaction between the two surveys:
Overall
Section
‒ Access and Courtesy
‒ GP Services
‒ Dental Services
‒ Nursing Services
‒ MCH
‒ Pharmacy
‒ Accounting
HC Environment
1st Survey Score
Mean
76%
2nd Survey Score
Mean
84%
84%
82%
72%
80%
75%
69%
73%
88%
88%
84%
87%
85%
82%
85%
4%
7%
12%
7%
10%
13%
12%
74%
89%
15%
Table 1: Client Satisfaction Surveys
16
Mean Difference (%)
8%
Implementing a nationwide referral and appointment system
A high proportion of clients seen at hospital outpatient departments could be appropriately
treated at primary health care centers at lower cost to the client and the health care
system. In the past, referrals were not tracked, and feedback regarding services provided
was not received. Unnecessary referrals flooded the hospital system, overloaded specialists
and staff, and hindered the ability of the government health system to provide optimal health
services. It is for this reason that the Ministry of Health, with the assistance of the USAIDfunded Health Systems Strengthening I and II projects prioritized strengthening the referral
and appointment system from primary health care centers to hospitals.
At all levels within the health care system, serious efforts have been made to implement
referral structures and processes to ensure adequate and timely referral of patients in need.
HSS II worked with the MOH to develop an effective referral system between health
centers and hospitals. To determine the effect of the AC on referrals, HSS II reviewed 30
health centers participating in the 2nd collaborative and a control group of 30 nonparticipating health centers. The control group were selected from the same health
directorates and matched on health center type and average numbers of monthly patient
encounters with the participating AC centers.
Overall, referral system functioning in the 2nd accreditation collaborative health centers was
significantly higher (see table 2). In total, these centers implemented 78 percent (305/390) of
the referral requirements as compared to 72 percent (279/390) in the comparison group; a
statistically significant result (p<0.001). This can be attributed to the combined technical
assistance received by AC centers: mentoring by technical HSS II field coordinators,
strengthening adherence to standards including referral, and participating on HC
committees that monitor results.
Referral Functions
1. Administrative staff trained (Clerk)
2. Technical staff trained (Doctors and Nurses)
3. Phone lines and/or extension for referral
functioning
4. Referral register available
5. Referral forms available
6. HC Clerk enters patient referral data in a register
7. Hospital schedules appointments for referred
patients
8. Appointments noted in register
9. Patient referral forms received from hospital
10. Referral feedback entered in register
11. Monthly referral report produced and forwarded
to HD
12. HD referral analysis received
13. Referral analysis review by HC QI team
Total
2nd Collaborative
(%)
87%
77%
Control Group
(%)
87%
90%
87%
83%
100%
100%
97%
97%
100%
93%
80%
70%
80%
78%
53%
40%
67%
47%
100%
100%
47%
33%
78%
50%
7%
72%
Table 2: Improved Referral Functions at Health Centers
17
Table 3 shows the progressive improvement of the referral system at the collaborative
health center. Multiple functionality review were conducted periodically in participating
health centers which showed that the referral functions improved significantly in all health
centers where the total number of referral functions implemented increased from 61
percent to 78 percent. Maintaining trained staff remains a challenge; Table 3 indicates that
only 68 percent of clerks and 65 percent of doctors and nurses were found to be trained in
the 3rd review. High staff turnover and a lack of real-time monitoring of referral training
needs by referral officers at the HD level contribute to this weakness.
Al-Bashir is the MOH’s largest Hospital and is the Kingdom’s only tertiary referral hospital,
and thus it receives referrals from all directorates. In 2012, Al-Bashir’s emergency room,
operating seven days a week, saw 387,456 patients of which 281,540 were emergency cases.
The outpatient department (OPD), open five days a week, saw 554,434 patients, excluding
dental cases. To treat this high volume, Al-Bashir has 279 specialists who rotate through the
OPD. Comprehensive health centers (CHCs) are intended to take the majority of referrals
from primary health centers (PHCs) and serve as the source of referrals to Al-Bashir. HSS II
worked with the MOH on improving the referral network of 17 satellite CHCs surrounding
Al-Bashir Hospital to streamline patient flow and enhance adequate and timely referral and
appointments. This required developing the referral capacity of the 17 CHCs as well as their
communication and referral links to Al-Bashir Hospital. The project also investigated referral
patterns between PHC centers and Al-Bashir Hospital to both evaluate provider adherence
and in order to better understand the factors prompting referrals.
Implemented Referral
Functions
Health Centers: 13 Functions
1st Review
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Administrative staff trained (clerk)
Technical staff trained (doctors and nurses)
Phone lines and/or extension for referral
functioning
Referral register available
Referral forms available
HC clerk enters patient referral data in register
Hospital schedules appointments for referred
patients
Appointments noted in register
Patient referral forms received (by HC) from
hospital
Referral feedback entered in register
Monthly referral report produced and forwarded
to HD
HD referral analysis received
Referral analysis review by HC QI team
Total
2nd Review
75%
73%
75%
66%
68%
65%
70%
77%
82%
95%
98%
81%
91%
89%
77%
93%
98%
95%
50%
61%
79%
61%
61%
77%
52%
50%
70%
30%
36%
75%
73%
81%
98%
25%
3%
61%
38%
25%
64%
49%
58%
78%
Table 3: 1st, 2nd, and 3rd Reviews of Health Centers
18
3rd Review
Improving MOH strategic, operational, and action planning
For many years, inadequate strategic and operational planning at different levels in the
Jordanian health care system hindered performance improvement. Against this background,
USAID invested time and resources to support the MOH in strengthening and
institutionalizing the planning process at all levels: central, health directorate, hospitals and
health center.
The HSS II project was tasked with aligning the goals and objectives of the central MOH, the
health directorate and the health center to create a unified, but complementary approach to
planning. HSS II’s top-down, bottom-up approach to planning ensures that all ministry levels
create plans that are in line with the strategic priorities of the Ministry, while HD priorities
are shared with the HCs and HC targets are defined based on center capacity. HSS II
strengthened the planning process at all MOH levels: central HD and HCs through the
following accomplishments:
1. Developed and disseminated the MOH Strategic Plan 2013- 2017
2. Incorporated elements of the MOH Strategic Plan into Operational Plans at Health
Directorates and Action Plans in Health Centers;
3. Developed a monitoring and evaluation electronic tool to track progress in these plans,
in all health directorates and 3 central directorates that review their own progress
toward specific KPI and report to the planning directorate
4. Organized regular review meetings to assess progress of the MOH Strategic Plan
5. Supported the Quality Directorate to develop its strategic and operational plans, both of
which included specific objectives, targets and needed actions.
6. Assisted health directorates and the central MOH to conduct a mid-term review of the
annual operational plans
7. Established quality councils in the 12 HDs. These councils work as management bodies
to organize and coordinate the work in each health directorate.
8. Supported HDs to develop operational plans on yearly basis, Updated operational plans
included clear objectives, indicators, and results. Progress was monitored according to a
systematic rigorous progress.
9. Worked with all of the 120 health centers enrolled in the Primary Health Care/Family
Planning (PHC/FP) QI Collaborative to collect and analyze data on hypertension and
diabetes screening and management.
Improving supportive supervision systems
One of the project’s core strategies was to build the capacity of managerial and clinical staff
to sustain improvements. A strong supervision system can improve the effectiveness and
sustainability of the processes and systems that improve the quality of and access to high
priority health services. The rationale for choosing supportive supervision is that the
approach is facilitative and promotes mentorship, joint problem-solving and communication
between supervisors and supervisees. At the central level, the project focused on three
directorates: Quality, Women and Child Health (WCH), and Health Communication and
Awareness. The supportive supervision system was composed of four technical
components: health promotion (HP), MCH, PHC, and quality. Supervisors from the central
directorates played an important role in ensuring the relevant supervisors at the 12 health
directorates supported the provision of service at the health facility level. HSS II assisted
MOH in the following:
19
1. Helped the MOH develop, introduce, and institutionalize a supportive supervision
system that encompasses the three ministry levels
2. in each HD, supervisors responsible for quality improvement (QI), maternal and child
health (MCH), primary health care (PHC), and health promotion (HP) were trained in
the supportive supervision approach and use of tools, consisting of supervision
guidelines and checklists
3. HD WCH unit heads and midwifery supervisors were also trained and supported to
strengthen HD supervisor skills and knowledge of supportive supervision
4. Roles and responsibilities of HD supervisors were defined and included in the newly
developed job description book.
5. Established a process for documentation of supervisory meetings and recommendations.
6. Assisted with the development of MCH central supervision guidelines.
7. Established the Quality Council, which included supervisors to review supervisory and
performance data during their monthly meetings.
8. Conducted assessments, developed supervision guidelines, checklists and training
curricula.
There is a supervisory structure in place at every HD and selected central directorates;
supervisors have been trained and have tools to guide their supervision visits. Some
supervisors are following the guidelines for the supervisory steps, including orienting and
updating of HC manager on the visit, use of checklists, feedback and joint development of a
provider improvement plan, as well as post-visit documentation of the findings. Two
supportive supervision assessments were conducted during HSS II. In 2010, the first
assessment found the supportive supervision system improved provider performance,
service quality and resolution of work problems, adherence to standards, and better
communication and follow-up. Areas for improvement include poor planning of visits, focus
on criticism, lack of regular supervisor visits and follow-up. The 2012 assessment focused on
MCH supervisors and service providers. Satisfaction with the supportive supervision
approach and support was over 70 percent among MCH supervisors, while 37 percent of
providers were always and 43 percent were sometimes satisfied. Preparation for
supervisory visits was high; more than half of the supervisors use checklists and follow
guidance on delivering supervision. Both supervisors and MCH service providers perceive
supportive supervision as effective and agree that supervisors were helpful in resolving
problems at the HD level.
Sustainability
The HSS II strategy for sustainability includes building on previously established work,
instilling sustainable quality improvement processes and procedures, and building the
capacity of the MOH to utilize those systems. The approach also aligns with the existing
MOH QI systems as it activates QI departments and policies in order to implement
accreditation standards in health facilities, thus improving the provision of health services.
The technical and organizational achievements render the MOH systems ready to achieve
further improvements in the provision of care:

The MOH showed its commitment by drawing on multiple central directorates
and departments, such as the Directorates of Planning, Quality Director,
Administrative Affairs, and Supply and Maintenance, to support the quality improvement
collaborative approach.
20

Health directorate and quality directorate staff has improved their fluency with
the standards and effective actions to increase adherence. As agents of change,
the staff is better able to transfer their knowledge to assist implementation of quality
improvement principles.

The MOH was able to initiate, implement and lead the PHC/FP QI Collaborative
Approach in the two governorates of Ma’an and Mafraq, with 3 of the 4 health centers
involved showing positive preliminary results for accreditation.

All 12 QUHs, one from each of the 12 HDs, has earned the consultant status through
the HCAC Accreditation Preparedness Consultant Training which was designed jointly
by HSS II and HCAC. The QUHs have the capacity to manage learning sessions,
and both QUHs and quality coordinators have monitored and aided HCs in interpreting
and achieving standards through using quality improvement methods, and can therefore
duplicate the process with the remaining MOH health centers.

The PHC Accreditation Implementation Toolkit was developed and includes all
MOH policies and procedures plus key steps for supporting the preparation phase and
resources for conducting learning sessions, monitoring progress, conducting
evaluations, developing action plans for meeting the standards. This Toolkit may be
used by the MOH to duplicate the accreditation effort in additional health
centers.

The government has also recognized and endorsed the value of the Collaborative
Approach in improving health systems by including accreditation goals in its
official Strategic Plans along with earmarking a specific budget for its
activities. These are essential pillars needed to sustain the continuous quality
improvement processes following the HSS II Collaborative Approach.
Challenges
Overall, commitment and strong leadership are essential for the success and sustainability of
any improvements at the PHC level. True engagement, with the full assumption of roles and
responsibilities, as well as accountability ensures the continuity of quality improvement in
the technical and organizational processes of the provision of care.
Factors that may continue to challenge further success include:
1.
2.
3.
4.
5.
High turn-over of staff, especially of those staff trained and established in their roles.
Lack of sufficient resources, including logistic support and specific budget for quality
improvement.
Weak engagement and commitment from leadership at any of the three levels: facility,
Health Directorate, or central. In the MOH, the central directorates and departments
may depend completely on one person, and technical and organizational reach to the
directorates and facilities is greatly diminished
Effective communication and feedback between the MOH organizational levels, and best
practices should be documented and shared within and across directorates, further
spreading development.
Leadership at the MOH much set up clear and complete criteria for selecting health
centers to participate in accreditation.
21
6.
7.
8.
9.
The health directorate should ensure adequate staffing, competent and well-resourced
QI teams, and release of QUH and QC for monthly supervision visits to review
adherence and support change to maintain quality services.
Budgets are needed for new and refresher training on accreditation and standards and
annual mock surveys to ensure gaps are identified and addressed early.
At the HC level, the manager’s commitment to maintaining accreditation standards and
supporting quality teams is a key success factor, and should be addressed by the HD
and the central QD. Immediate orientation of new staff on service delivery standards
and engaging all HC staff in monitoring standards is part of sustaining accreditation.
Incentives and recognition of HC achievements should be institutionalized and include
those who support HC staff as well as those who implement the changes.
Lessons Learned
The PHC/FP Quality Improvement Collaborative Approach is a participatory and
transparent improvement model that engages all relevant stakeholders and allows for rapid
scaling up of best practices through a planned spread strategy. While the traditional method
addresses single technical areas, the Collaborative Approach brings the advantage of
allowing a group of centers to cover a comprehensive cluster of health care services at a
time. Involved stakeholders thus gain capacity in applying continuous quality improvement
principles and that capacity is expandable to other areas of their work.
The referral system success was also impacted by the quality improvement collaborative
approach. Health centers participating in the collaboratives scored 78 percent on referral
functions; a similar control group scored only 72 percent; the results were statistically
significant. As important was the difference in implementation of the referral functions that
the HC is responsible for executing; the collaborative sites scored 73 percent, while the
control group scored only 57 percent. This demonstrates that learning in the collaborative
had an effect on the implementation of the referral functions.
22
Objective 3: Improve quality of safe motherhood at hospital
level
Context
According to a survey during 2007, deliveries and miscarriages accounted for 54% of female
admissions to obstetric and gynecological wards in MOH hospitals. But maternity beds are
in short supply in densely populated urban areas. At Al-Bashir Hospital in Amman, the
MOH’s largest referral hospital, more than 20,000 deliveries took place in 2008 with many
women coming as “un-booked” cases. Optimal quality of care for mothers and neonates
cannot be achieved given this situation. Implementation of recently developed clinical
guidelines and accreditation standards presents a challenge to public sector hospitals. While
there is some difference of opinion over the actual maternal mortality ratio (MMR) in Jordan
of 41/100,000 live births from a 1995 study or WHO estimates of in 2005 at 62/100,000,
the policy implications and clinical interventions remain the same.
Infant and under-five child mortality has decreased to levels that are better than many
developing countries. However neonatal mortality represents 70 percent of infant mortality
and will not likely be significantly reduced until focused efforts at improving key aspects of
in-hospital obstetrical and neonatal care are implemented and institutionalized nationwide.
Approach
In partnership with the Ministry of Health (MOH), Royal Medical Services (RMS) and Jordan
University (JU) hospitals, HSS II helped the Government of Jordan (GOJ) strengthen safe
motherhood services in the public sector. The Safe Motherhood (SM) activities are built on
earlier program accomplishments and designed to ensure that international best practices
are integrated into all public SM services. Among other priorities, HSS II works to
strengthen linkages between SM and family planning (FP) services, and foster continuous
quality improvement.
HSS II addressed SM goals using a multipronged approach aimed at improvement and
sustainability of high quality services:



Renovate, expand and equip MOH, RMS and JU hospitals to enhance their SM services.
(Discussed under Objective 6 of this report.)
Build the capacity of MOH, RMS and JU hospital staff to deliver high-quality obstetric,
neonatal and family planning services. Provide training on the mother-newborn package
of care to ensure understanding and use of best practices.
Strengthen the capacity of MOH, RMS and JU hospital managers to supervise the
delivery of high-quality SM services through Hospital Safe Motherhood Committees
(HSMCs).
Renovated, expanded and equipped MOH, RMS and JU hospitals to enhance
their SM services
HSS II worked with the MOH, RMS and JUH to institute improved quality oversight and
technical processes in public hospitals across Jordan to improve overall quality of care and
patient safety (discussed under Objective 6.)
23
Built the capacity of MOH, RMS and JU hospital staff to deliver high-quality
obstetric, neonatal and family planning services; provided training on the
mother-newborn package of care to ensure understanding and use of best
practices
Capacity building activities included:
Best Practices
•Developed maternal and neonatal best-practices guidelines for
implementing the mother-newborn package of services, and
disseminate to all public sector hospitals.
Neonatal Aseptic IV
Fluids Preparation
Protocol
•Developed neonatal aseptic IV fluids preparation protocol and
guidelines, and disseminate to all public sector hospitals.
Perinatal Information
System (PIS)
•Developed Perinatal Information System (PIS) to track high risk
pregnancies.
Clinical Performance
Checklists
•Developed and used clinical performance checklists as a
monitoring and educating tool to verify the quality of care.
Didactic and on-Job
Training
•Conducted didactic and OJT training sessions on clinical
guidelines and best practices to increase the healthcare providers
competency with special focus on high risk cases including
Magnesium Sulfate (MgSO4) use for patients with pregnancy
induced hypertension (PIH), partograph use to prevent prolonged
labor, active management of third stage of labor (AMTSL) to
decrease postpartum hemorrhage (PPH), and provision of family
planning (FP) postpartum PP/post-abortion care (PAC) services.
Focus areas for neonates included: Introducing nasal continuous
positive airway pressure CPAP system as a first line management
for neonates with respiratory problems, neonatal resuscitation
program (NRP), and support for breastfeeding and use of LAM
Transferred Lead
Responsibilities
•Transferred lead responsibilities to the core trainers in MOH, RMS
and JUH hospitals to provide supportive supervision, didactic and
OJT for maternal and neonatal best practices.
Medical Records
•Developed standardized Essential Obstetric Care and Neonatal
Care medical records to enable health providers to provide high
quality services, improve their ability to monitor the
implementation of the clinical practice guidelines, and to increase
the readiness of the hospitals to respond to one of the
accreditation requirements to have standardized medical records.
Monitored Maternal and
Neonatal Indicators
•Institutionalized structured planning processes at all levels of the
MOH to inform performance improvement initiatives.
24
Strengthened the capacity of MOH, RMS and JU hospital managers to supervise
the delivery of high-quality SM services through Hospital Safe Motherhood
Committees (HSMCs)
To achieve sustained quality improvement in maternal and newborn care, the project
established Hospital Safe Motherhood Committee (HSMC) in 30 public hospitals. The
purpose of this committee is quality planning, monitoring and improvement. The HSMCs’
achievements include:
1. Raised awareness of the hospital staff about
main causes of maternal and neonatal
mortalities and morbidities through
confidential inquiry into maternal mortality
and near-misses.
2. Monitored the quality of safe motherhood
services by evaluating certain disease
specific indicators, generated data on
regular basis to inform quarterly safe
motherhood improvement plans.
3. Improved the documentation within the
medical records
4. Regular committees’ monthly meetings
were held in which they discussed
problems, gaps and constraints.
5. Annual hospital operational plan developed
by the HSMC members with certain goals
and objectives to further reduce morbidities
and mortalities.
Figure 11: Neonatal Nurses Practice Assembly of
CPAP
Achievements

Figure 10: HSMC Meeting
Improved Neonatal Survival with Enhanced Technology: HSS II provided 30
hospitals with the CPAP system, and built the capacity of health providers on its use in
managing premature neonates with respiratory distress. This technology is non-invasive
and can substitute for the use of a ventilator in many cases. Its use in Jordan’s public
hospitals has resulted in pronounced improvement in neonates suffering from
respiratory distress with more than 90% survival rate.
Improved Neonatal Survival Rate
27 public hospitals reporting
92%
92%
2013
2014
89%
87%
2011
2012
Figure 12: Neonatal Survival Rate in Public Hospitals during
Years 2011-2014
25
There is consistent improvement in the
survival rate of inborn neonates
admitted into the neonatal intensive
care unit. The target for Y5 is 90%.
HSS II has exceeded its target on this
indicator. Several significant changes
introduced by HSS II have contributed
to this improvement: infrastructure
renovation including state of the art
incubators, better – trained service
providers, and introduction of CPAP and
aseptic preparation protocols.

Reduced the Risk of Neonatal Sepsis: according to the Jordan Perinatal and
Neonatal Mortality Study Final Report, January 17, 2013 (UNICEF), respiratory distress
syndrome (RDS) was the leading cause of death (53.5%). The most common cause of
death following RDS was sepsis (16.2%). HSS II therefore performed a needs assessment
report on IV preparation at the neonatal intensive care units in public hospitals, and
developed recommendations to overcome the practical challenges in infection
prevention that are faced by the staff in public Neonatal Intensive Care Units in Jordan.
HSS II formed and supported an interagency technical working group (TWG) from the
three public institutions to develop “Aseptic I.V. Preparations and Infection Prevention
Guidelines” and to train core trainers from each institution to introduce them to NICU
staff. Data shows the decrease in neonatal sepsis in selected hospitals.
Year
2009
2010
2011
2012
2013
2014
(Jan-June)
Total
Number of
Newborns
Delivered
Total
Number of
NICU
Admissions
Number of
Neonatal
Deaths in
NICU
% of Death
among NICU
Admissions
3467
4165
4061
4127
4204
909
820
730
857
751
68
77
71
47
39
7.5
9.4
9.7
5.5
5.2
529
523
15
2.9
Number
of Death
due to
Sepsis
% of
Sepsis as
a Cause
of Death
12
38.7
8
20.5
0
0
Table 4: Reduced Deaths due to Neonatal Sepsis at JUH, the Largest Referral
Hospital in Jordan

Reduced the Risks of Pregnancy and Child Birth: in an effort to further reduce
maternal mortalities in hospitals, HSS II has helped the public hospitals to institutionalize
best practices embraced by the international health community, including but not limited
to the systematic use of:






Active Management of Third Stage of Labor (AMTSL) to reduce post-partum
hemorrhage deaths
Partograph to monitor women and babies during childbirth and to prevent
prolonged labor and its complications
Perinatal information system (PIS) to track high risk pregnancies
Magnesium sulfate to manage pregnancy-induced hypertension and to prevent
convulsions
Use of confidential inquiries into maternal deaths and near misses to improve the
quality of safe motherhood services
Created a Culture of Quality: HSS II helped form and activate 30 (23 MOH, 6 RMS,
and 1 JU) HSMCs in public hospitals to act as supervisory bodies for safe motherhood
and neonatal care. Main roles and responsibilities of HSMCs are planning, monitoring
and quality improvement of all SM interventions within their hospitals.
26
% of women monitored with
partograph
91%
86%
87%
2012
2013
81%
77%
2010
2011
HSS II introduced an improved
partograph to public hospitals.
The chart shows a consistent
increase in the percentage of
women monitored with this
improved partograph.
2014
Figure 13: % of Women Monitored during Labor Using Partograph
PIH patients managed according to
clinical guidelines
89%
88%
86%
79%
79%
2010
2011
2012
2013
HSS II has contributed to a 10%
(Y1-Y5) increase in cases of
pregnancy-induced hypertensive
patients managed according to
best practice guidelines.
2014
Figure 14: %of Patients with PIH Managed according to Clinical Guidelines
% of Hospitals using Confidential
Inquiries
65%
65%
2013
2014
40%
25%
2011
2012
Figure 15: % of Hospitals Using CI into Maternal Mortality and Near-Misses
27
There is a significant
improvement in this indicator
from Y2 to Y5.
Sustainability





Hospital Safe Motherhood Committees (HSMC) functioning in 30 Hospitals are a key
aspect of institutional sustainability. Their tasks include tracking performance indicators,
developing action plans to address any weaknesses and presenting progress reports to
the Hospital Director on a regular monthly basis.
A Technical Working Group (TWG) led by the Chief of Ob/Gyn Specialty from central
MOH and including all the Heads of Ob/Gyn departments of the six teaching hospitals is
meeting regularly to jointly analyze confidential inquiries into maternal mortalities and
near-misses, implement safe motherhood improvement interventions and submit reports
to the MOH leadership.
Core trainers in MOH, RMS and JUH hospitals are capable to lead provision of
supportive supervision, didactic and OJT for maternal and neonatal best practices and
clinical guidelines
Health Directorates and HSMC use an operational planning system for SM services to
monitor and improve hospital’s performance on annual basis
New standardized Essential Obstetric Care and Neonatal Care medical records will
enable health providers to provide high quality services, improve their ability to monitor
the implementation of the clinical practice guidelines, and to increase the readiness of
the hospitals to respond to one of the accreditation requirements to have standardized
medical records
Challenges






Unmet need for central MOH support to Hospital Safe Motherhood Committees
Inconsistent commitment of HSMCs to work because of lack of recognition, incentives
or sanctions concerning their roles and responsibilities
Reluctance of hospital staff to fully implement confidential inquiries into maternal
mortalities and near-misses, mainly because of fear from punishment and litigation
Lack of consistent PIS data entry, and data utilization for decision making
Lack of sufficient qualified human resources, because of the high turnover of trained staff
to health centers
Lack of sufficient funds for organizing and conducting trainings, incentives for core
trainers, and transportation reimbursement for trainees coming from remote areas
Lessons Learned



The commitment of the hospital’s staff in establishing and activating HSMCs and
sustainable hospital interventions is a crucial point for the success and sustainability of all
interventions. Recognition, incentives, and the presence of an oversight body from the
central Ministry of Health to encourage and support the hospitals is a critical factor for
success.
The CPAP technology proved to be non-invasive with an excellent survival rate
exceeded 90 percent. Therefore, consumables needed for CPAP system should be
included in the annual procurement list of MOH and RMS.
Didactic and on-job training of SM providers is an on-going need that requires extensive
use of human and financial resources. Longer term solutions must be pursued within the
MOH that includes recognition of the extra work done by core trainers and recognition
of decentralized on-job training.
28



Staff performance should be supportively supervised and closely monitored to improve
the effectiveness of various safe motherhood interventions.
Information/data from the perinatal and supervision monitoring systems should serve as
the basis for regular monitoring and feedback in order to ensure that safe motherhood
interventions are meeting their targets and objectives.
The current Safe Motherhood Committees in hospitals have to be translated into a
more institutionalized and supported system. This system must be able to track and act
upon maternal and neonatal deaths in all public hospitals, through maternal mortality
surveillance system.
29
Objective 4: Improve quality of and increase access to FP/RH
services
Context
Improving access to and quality of family planning services is a priority for USAID and the
Government of Jordan because high rates of population growth will impede continued social
and economic progress in Jordan and have a negative impact on maternal and child health.
After impressive progress in earlier decades, the modern contraceptive prevalence rate
plateaued at 42% since 2002 and the total fertility rate has hovered around 3.6 since 2007; it
was 3.8 as of the start of the project in 2009, according to the Jordan Population and Family
Health Survey. In 2009 the use of traditional family planning methods such as withdrawal
was high at 17% among married women and 26% of married women stated their last
pregnancy was unintended.
Health Centers of the MOH, supported by Health Directorates in each of the 12
governorates of Jordan, are the main source of primary health care including family planning
(FP) for many women in Jordan, especially those of middle and lower income. Therefore the
FP services provided at these centers, and the management of these services at the
governorate level, are critical factors in FP program growth. The method mix at the lowest
level of the public health system at the start of the project was limited; especially access to
long acting reversible methods - IUDs and Implanon. Access to female physicians was and is
low in the public sector; women health providers are the preferred source of FP in general
and IUDs in particular. In 2010 an additional issue emerged – trained midwives who had
previously been providing IUD services in MOH health centers (HCs) were advised they had
no legal coverage for this service, so provision of IUD services in MOH HCs declined
sharply over the following year.
Public hospitals also constitute an important source of reproductive health care; 65% of
Jordanian women deliver in public hospitals and post-miscarriage treatment constitutes
around 8% of obstetrics and gynecology (Ob/Gyn) admissions at MOH hospitals. At the
start of the project none of the public hospitals in Jordan were providing FP information,
counseling or services to women in the postpartum/post miscarriage period before they
were discharged from the Ob/Gyn department.
To ensure availability of high quality FP services, related policy and health systems also
needed support. There was no MOH policy specifically related to FP services; health
managers at different levels had insufficient information regarding FP service delivery; and
the supervision system needed improvement. The lack of clarity regarding MOH
authorization of midwives to perform IUD services hampered access to this popular
method. Midwives were not exposed to FP during their pre-service education, and general
physicians were not prepared to supervise them in their FP work.
Approach
Building the managerial and clinical capacity of the MOH, the Royal Medical Services (RMS)
and other key institutions in FP has been a core strategy under HSS II. The HSS II team
collaborated with these stakeholders to enable them to improve access to high-quality
family planning information and services throughout the Kingdom.
30
The Women and Child Health Directorate (WCHD) of the MOH led most of these
activities, since this directorate is in charge of family planning service delivery throughout
the MOH. HSS II supported the WCHD to work with other national stakeholders to
accomplish the above results, organized around three main objectives:
Supportive
Environment
for FP
Improve Quality
and Access to FP
•Develop and implement policies and
strategies that created a supportive
environment for FP in the Kingdom.
Policy
•Improve quality of, and increase access to,
family planning counseling and services in
public health centers and at public hospitals
Services
Improve
Performance of
Systems
Systems
•Expand and improve performance of
systems that support quality FP services
In addition, to support increased use of family planning services, HSS II worked to engage
and empower communities to adopt healthier lifestyles, including birth spacing, as explained
under Objective 5.
A) Strengthening the supportive policy environment for FP
In coordination with the Higher Population Council and through evidence based advocacy
and policy dialogue, HSS II assisted the MOH and RMS to address policy issues that impeded
progress in FP services. HSS II assisted the MOH WCHD and the other stakeholders to
accomplish the following steps:
1. Developed and disseminated the MOH FP Strategic Plan 2013-2017;
2. Incorporated elements of the MOH FP Strategic Plan into Operational Plans at Health
Directorates and Action Plans in Health Centers;
3. Developed a monitoring and evaluation framework to track progress in these plans,
including formation of FP Committees in all Health Directorates that review their own
progress, develop plans to address challenges and report to the Women and Child
Health Directorate;
4. Organized regular regional and national review meetings to assess progress of the MOH
FP Strategic Plan and of RMS FP activities;
5. Participated in the development of the National FP Strategy with the Higher Population
Council;
6. Helped address specific MOH policies and regulations on FP service delivery; advocated
to add IUD services to the job description of midwives and to issue a policy that
addresses deployment of trained providers ;
7. Developed policies regarding postpartum and post-miscarriage FP services and
outpatient FP services in hospitals
8. Assisted in expanding human resources for FP service provision through a task-shifting
approach; this includes introduction of FP counseling by regular MCH nurses, with initial
training of the nurses on FP counseling
9. Integrated family planning information and standards in nursing, medical and
pharmaceutical curricula of Jordan University and Jordan University for Science and
Technology and the midwifery diploma at Princess Muna Nursing College.
31
B) Increased access to and quality of modern FP methods
HSS II used a comprehensive approach to improve public sector FP services, working with
the WCHD and other stakeholders such as the Royal Medical Services and Jordan
University Hospital in public health centers, health directorates and hospitals to expand and
upgrade their FP approaches and services. To strengthen FP service delivery in primary
and comprehensive health centers, HSS II worked closely with the MOH WCHD to
undertake a series of steps:
1. Updated evidence-based clinical guidelines for FP services, and disseminate these to all
Health Directorate and HC staff;
2. Established a core of family planning trainers within the MOH and RMS
3. Developed and implemented didactic and on-the-job training approaches to reinforce
compliance with the updated FP clinical guidelines;
4. Provided in-service clinical training of 125 midwives and 69 physicians on IUD services
and 187 physicians on Implanon services;
5. Supported Health Directorates to increase supportive supervision of FP providers in
health centers using updated supervisory tools;
6. Strengthened midwives’ and nurses’ capacity to provide high-quality FP counseling
services through didactic and on-the-job training programs on FP counseling;
7. Built HC staff capacity to manage FP issues by encouraging them to develop their own
action plans, using FP quality indicators to monitor their progress;
8. Reduced missed opportunities for FP by raising awareness of other health providers at
the center (those providing curative care, for example) to identify and refer women with
unmet needs for family planning services to the MCH unit of the clinic;
9. Fostered a positive attitude among midwives, nurses and physicians from MOH health
centers toward FP, through structured behavior change communication sessions that
provided convincing evidence of the value of FP in protecting health, and corrected
common misconceptions about side effects.
10. Provided clients with FP information within the health facilities through visual aids such
as posters and calendars, particularly in the immunization and general practitioner areas
of health centers;
To expand access to FP services in hospitals, HSS II helped the MOH, RMS and Jordan
University integrate them within postpartum and post-miscarriage (PP/PM) services:
1. Developed the Standards for Postpartum & Post-Miscarriage Family Planning Services
and related training curriculum;
2. Built the capacity of Ob/Gyn wards and out-patient clinics service providers on FP
counseling and services using updated FP clinical guidelines;
3. Developed and introduced the use of FP-related job aids in hospitals;
4. Developed and implemented a regular reporting system in which midwives in each
hospital completed forms that were reviewed within the hospital and then submitted to
the central MOH (WCHD and HA);
5. Assured that the Hospitals’ Safe Motherhood Committees monitor PP/PM FP services
through agreed upon performance indicators using the reports that are discussed within
their monthly meetings and semi-annual meetings with other hospitals;
6. Strengthened midwives’ and nurses’ capacity to provide high-quality FP counseling
services through didactic and on-the-job training programs on FP counseling;
32
7. Supervised the implementation of PP/PM FP policies disseminated at hospitals through
field visits and OJT;
8. Established, equipped and furnished a special FP counseling and services room within the
Ob/Gyn wards of 15 hospitals.
C) Expand and improve performance of systems that support quality FP services
Many of the systems and processes introduced, expanded or improved in collaboration with
the MOH and other counterpart institutions under other HSS II objectives, notably under
the Knowledge Management and Quality Improvement objectives, directly support quality
FP services. These included:
Under Objective 1:
1. Improved the MOH Logistics Management Information System to generate indicators
needed to track progress of the MOH FP strategy
2. Improved the performance of the MOH Maternal and Child Health Information System
by updating the parameters collected from health centers, developing a full set of
indicators sheets, related log books and reporting forms, with HD data entered into the
MOH website.
3. Facilitated MOH FP program management through the creation of a dashboard that
displays regularly updated key indicators such as CYP by health directorate and by
facility and number of HCs providing at least four modern FP methods;
4. Developed a computerized system to enter monthly PP/PA FP reports from hospitals
and generate related indicators and graphs;
Under Objective 2:
1. Used the Operational Planning and Action Planning systems introduced in Health
Directorates, HCs and hospitals to develop specific indicators and targets for FP and to
monitor their progress; and
2. Improved the oversight and quality of FP services through the enhanced MCH
Supportive Supervision System performed by HD MCH staff and WCHD staff in the
central MOH.
Over the course of the project, HSS II also undertook in-depth studies to better
understand the dynamics of FP provision, acceptance, and behaviors in Jordan. These studies
were useful in achieving consensus with key stakeholders concerning specific aspects of FP
service provision and informed subsequent work plans.
As explained under Objective 5 in this report, HSS II also worked extensively to engage
and empower communities to adopt healthier lifestyles, including birth spacing.
Achievements
The combined efforts of the MOH Women and Child Health Directorate, Hospital
Administration, Health Directorates, hospital and health center staff, RMS and JUH with HSS
II project personnel were instrumental in re-energizing FP service delivery and helping
improve access to high-quality family planning information and services throughout the
Kingdom.
33
The MOH FP Strategic Plan 2013–2017, a first for Jordan, sets clear objectives and timelines.
Activities to meet the goals of the plan are systematically included in health directorate and
health center action plans, and their performance is regularly monitored. HSS II also helped
the MOH Women and Child Health Directorate reverse a 2010 MOH decision to ban
midwives from inserting IUDs. Over two thirds (68%) of post-partum patients now receive
FP counseling before discharge at 25 public hospitals that offer postpartum FP services. The
percentage of MOH primary health and comprehensive health centers offering four or more
family planning methods, including at least one long-acting reversible method, rose from a
low of 19% in 2011 to 33% by end March 2014.
This chart shows CYP for all MOH
health facilities (clinics, hospitals) in
Jordan. Increasing CYP has been
challenging, mainly due to
interruptions in service provision as
a result of conflicting regulations
regarding IUD insertion by
midwives. (These challenges have
been discussed at length in previous
reports.) However, as the chart
shows, overall, there is a clear
upward trend in CYP levels
between 2011 and 2013. The
sustained increase health centers
inserting IUDs and four modern
methods, as shown in the following
chart, attests to this upward trend.
Couple Years of Protection
110,258
2011
115,697
113,038
2012
2013
Figure 16: CYP for MOH Health Facilities in Jordan
Number of MOH HCs Providing at least 4 Modern FP
Methods
127
111
106
118
128
131
138
130
137
145
97
92
80
Figure 17: Number of MOH HCs Providing at least 4 Modern FP Methods
Here again we observe a significant upward trend in the number of HCs providing at least four
modern methods. The data are from the Logistics System, an institutionalized health information
system at the MOH. According to the latest figures (January – March, 2014), 33% of MOH HCs are
providing at least four modern methods.
34
Number of HCs Inserting IUD
(for at least 8 months in each year)
160
133
114
88
2011
2012
2013
2014
Figure 18: Number of HCs Inserting IUD Each Year
In order to get a better picture of uptake of modern FP trends, it is useful to disaggregate modern
FP methods. This chart shows the consistent increase in the number of HCs providing IUDs, which
are the most popular modern method in Jordan. Between 2011 and 2014, the number of HCs
providing IUDs increased two fold.
Percentage of Postpartum (PP) & Post-Miscariage (PM) Clients
Received Family Planning (FP) Counseling & Services before
Discharge from Public Hospitals
68%
59%
54%
53%
43%
38%
33%
32%
36%
34%
24%
21%
19%
% of PP Counseled
24%
27%
16%
% of PP Received Modern FP
Method
% of PA Counseled
% of PA Received Modern
FP Method
Jun-Dec 2011 (13 Hosp)
Jan-Dec 2012 (17 Hosp)
Jan-Dec 2013 (22 Hosp)
Jan-Aug 2014 (25 Hosp)
Figure 19: % of PP/PM Clients who Received FP Counseling and Services before Discharge from
Public Hospitals
“I wish that earlier on I had someone talk to me about family planning. I am glad now that I will
have a reliable method that will allow me to take more care of myself and my kids, and will
enable me to continue breastfeeding Ra’fat for two years.”
Sumaia, a 20 year old Jordanian mother who gave birth to her third baby, Ra’fat, at Prince Faisal MOH
Hospital in Zarqa in June 2013
35
Sustainability
Key personnel (FP managers, trainers, supervisors, clinicians and counselors) at every level
of the MOH system currently have the technical capacity to maintain FP services within
health centers and hospitals. They also have established systems and processes to support
them, including standardized operational planning, supervision, monitoring and reporting
systems.

The MOH FP Strategic Plan is used at every level of the MOH to track progress, with
accountability for performance at the HD, Hospital and national levels (e.g., FP
committees, HSMCs)

Core trainers are capable of training staff in FP operational planning, counseling,
contraceptive technology updates, clinical services and logistics

Supportive supervision policy and system for FP services that Health Directorate and
WCHD can use to monitor and improve performance

The WCHD has demonstrated leadership in engaging HDs, other Directorates of the
MOH, and other partners to review their own progress in supporting FP services,
identify weaknesses and make plans to address these weaknesses. The formation of FP
Committees in every HD, and regular regional meetings among FP managers and
supervisors to review their progress, are good examples of this type of program
leadership that bodes well for sustainability of the national FP program.

The WCHD has taken responsibility for aggregating FP data from all MOH, RMS and JU
hospitals providing PP/PM FP services and generating related indicators.

Prior to the project, the MOH took on full responsibility for purchase and distribution
of contraceptive commodities for its own facilities and for other partners participating in
the national FP program, including the RMS, JUH, JFPP and UNRWA, and the NGOs and
private physicians collaborating with the SHOPS project. To date they have fully met
the current demand for contraceptives across all of these organizations.
However, there are several issues that hamper sustainability of the national FP program,
acknowledged by our counterparts. These are discussed in detail in the Challenges section
below.
Challenges
The challenges described below affect not only access to and quality of FP services in the
public sector, but also the long term sustainability of the national program.

A major challenge that affected FP results over the first part of the project was a debate
within the MOH over the legitimacy of midwives providing IUD services that came to a
head in late 2010 and caused most MOH midwives to stop providing IUD services over
the course of 2011, greatly affecting FP program performance. The loss of FP program
momentum and corresponding decreases in CYP from the MOH in 2010 is directly
related to this issue. This challenge was partially resolved in late 2011 after considerable
advocacy and support from HSS II, when the MOH issued an amended job description
36
for its midwives that included IUD services among their responsibilities, if they were
supervised by a trained physician. This allowed the WCHD to resume training and
support for midwives to provide IUD services, the most popular method in Jordan, but
did not fully overcome the concerns of both midwives and physicians concerning
ambiguities about their legal protection against any malpractice claims and about the role
of the supervising physician.

Continued and growing reliance of many couples on traditional FP methods, especially
withdrawal, with a considerable number of midwives using or supporting use of
withdrawal as a contraceptive method. Deep suspicions about the health impact of use
of hormonal contraception persist among the general population and even among some
health professionals.

Lack of sufficient qualified human resources at the central MOH (WCHD), HDs, HCs
and hospitals specifically assigned to support FP services. The current staff is
overstretched and relies on technical support from the project to complete some of the
essential processes for which they are responsible, such as supervision and training in
long term reversible contraception.

Lack of sufficient funds for organizing and conducting training. This includes lack of a
clear process for paying for logistics such as meals and overnight lodging if needed,
reimbursing trainers for their extra efforts, and compensating participants for their outof-pocket costs to attend training. The ability of HSS II to organize trainings and provide
logistics has been a great help to the MOH and other partners in overcoming logistical
issues but not compensation of trainers or participants. Given high turn-over of staff and
attrition of trainers, this inability to conduct regular in-service training without external
support is a major concern for sustainability.

Lack of clarity of linkage between individual performance regarding FP and any
recognition, or conversely, negative consequences. There is no distinction made
between those who make extra efforts and those who do nothing, when it comes to
promotion, assignment of tasks, or any other aspect of recognition. While scrupulously
following Tiahrt and other regulations, the MOH could still make major improvements
in performance assessment that could inspire staff to continue their efforts, or motivate
those who currently under-perform.

Lack of good grounding in family planning and contraception among recently graduated
midwives and physicians, which causes a constant need for in-service training in the
MOH, RMS and other public organizations that provide FP services.
Lessons Learned
A clear lesson from HSS II is that true program ownership at all levels of the MOH and
other partner organizations is vital to success of all FP efforts, in the near term as well as in
the longer term. Structured processes for program planning, monitoring and analyzing
performance enable the actors at all levels to consider how best to meet their own goals
and to identify barriers that must be addressed. The extensive experience gained under HSS
II and predecessor projects, allows the MOH, HPC, RMS, other counterparts and USAID to
consider the optimal ways to capitalize on the program momentum achieved in recent years
and address the remaining challenges that hamper national FP program performance.
37
1. The persistently high use of traditional FP methods in Jordan reflects a combination of
cultural preferences, misinformation about the safety of modern methods, and lack of
awareness or lack of concern about the high failure rate of traditional methods – not
only among FP users or potential users but among health providers themselves. Training
in counseling for health providers is necessary but not sufficient to address these factors.
More creative and effective ways to enable providers to overcome their own resistance
to modern methods and to provide accurate information and support for FP acceptors,
and to reach men and women with counseling and services adapted to their needs, are
necessary. Introduction of a modern natural method, SDM, is one option to be tested,
but it must be done carefully to overcome strong concerns of MOH program staff that
this could undercut their progress in making long acting reversible contraception more
accessible and acceptable in Jordan.
2. In-service training of FP providers is an on-going need that requires extensive use of
human and financial resources. Project assistance in this area is necessary for the near
future, but longer term solutions must be pursued, including pre-service education of
midwives, physicians and nurses concerning family planning counseling and services, an
organized and funded in-service training process within the MOH that includes
recognition of the extra work done by trainers; and recognition of decentralized and onthe-job training as legitimate, certified ways to achieve proficiency in specific aspects of
service delivery.
3. Supportive supervision, which can and should include on-the-job training, is a powerful
tool to maintain and improve competency and adherence to performance standards. The
supportive supervision system has been embraced by the different levels of the MOH,
but adequate technical and logistic support for supervisors to carry out this system must
be available at HDs and at the central MOH level.
4. Increasing the linkages between public hospital services and the different sections in
health clinics is an important way to improve quality and access to FP services. From a
client’s perspective, consistency in information and services is reassuring and supports
adoption and continuation of FP. The introduction of PP/PM FP counseling and services
in 25 hospitals was a major contribution to increasing access to FP, that should be
continued and expanded. Increasing internal referral for FP within health clinics is
another proven way to increase access. Hospital outpatient departments provide
minimal FP services; they would benefit from increased involvement of midwives in
delivery of FP and oversight of their services by MCH supervisors.
5. Because of a high degree of vertical hierarchy in health services, the success or failure of
FP activities within a particular facility or Health Directorate often rests on a single
individual. At the same time, frequent movement of staff, especially high level staff, makes
continuity of efforts fragile. Team-based program leadership and management must be
supported to improve and sustain program performance.
6. The success of the FP QI Initiative introduced in 20 health centers in 2013 shows the
power of collaborative efforts to improve quality of FP care, Quality assurance at all
levels must be an essential part of family planning services, to ensure that clients are
receiving safe, respectful care that meets their expectations. For long term continuity of
these family planning standards, HCAC should be encouraged to integrate them into the
current accreditation standards for health clinics.
38
Objective 5: Improve Community Health
Context
Approximately 50% of the Jordanian population relies on primary health centers or clinics
for outpatient services; the MOH remains the main and sometimes sole source of health
services for populations living in remote areas and for lower income groups. Given the
current social, demographic and economic pressures, the role of the primary health care
system is vital in sustaining and advancing the health gains of the last two decades. Thus, a
major intervention and important focus for USAID is strengthening and expanding the
linkages between the community and the primary health center.
USAID, through multiple health systems strengthening projects (HSS & HSS II), has assisted
the MOH to develop and implement a community mobilization model which is a set of
integrated interventions to increase the demand for, improve the quality of and expand
access to primary healthcare services throughout the country. The model is designed to
foster a partnership characterized by interdependency between health care services and the
community. In selected geographic areas, specifically catchment areas surrounding a PHC,
the model helps empower communities to ensure that they become active participants in
the health system and play a role both in managing their own health and in utilizing the
system effectively and responsibly through appropriate health seeking behavior.
Furthermore, USAID supported the MOH to design and implement a health promotion
(HP) program at primary health care centers. The aim of the HP activities is to empower
individuals with knowledge and skills needed to assume healthier lifestyles and to manage
their own health. An important goal of HSS II is to support the Ministry of Health (MOH) to
institutionalize the community health program, emphasizing the importance of individual
responsibility in managing one’s own health, and understanding one’s rights.
Approach
Building on the above established momentum and in close collaboration with the MOH,
Health Communication &Awareness Directorate (HC&AD), the HSS II project team
worked side by side with health centers and local communities to establish Community
Health Committees (CHCs) throughout Jordan. The aim was to encourage the CHCs to
mobilize and organize the efforts of all community members and groups, and direct them
towards participatory work with all entities that function locally in the health area.
A CHC is a committee of volunteers structured at the community level. It consists of
12-15 representatives from various sectors in the local community, such as religious affairs,
education, and nongovernmental organizations, as well as staff from the health center.
The CHC members help in identifying the local community’s health needs: planning
and implementing interventions that provide people with health information and
create opportunities for people to practice healthy lifestyles.
From the establishment of community organizations to maturity
HSS II worked with the different levels at the MOH to strengthen their capacity to establish
and supervise the work of CHCs across the Kingdom. Interventions were targeted at the
central, health directorates, health centers and community levels.
39
Central MOH level
HSS II provided technical and managerial support to HC&AD staff to better assume their
role in managing the community health program. Capacity building at the central level
included an update to the health promotion strategic and operational plans, and certification
of HP trainers. Furthermore, HSS II supported the HC&AD in supervising the HP staff at the
health directorates to ensure proper implementation of the community health interventions.
HSS II also supported advocacy efforts to increase the visibility of the community health
program. Advocacy efforts focused on recognition of HP trainers and clarifying the job
descriptions of HP staff at different MOH levels.
Health Directorate level
HSS II continued strengthening the capacity of the 12 health directorates to improve
planning, coordination and implementation of behavioral change interventions targeting high
priority audiences at the facility and community level. Health directorate operational plans
and health center action plans included health promotion/behavioral change activities that
respond to defined health priorities and focused on mobilizing communities to increase
access to family planning and PHC services. Capacity building activities included health
promotion approaches related to increasing the use of modern FP methods and the
management of chronic diseases, as well as planning and expanding facilitative supervision.
HSS II developed the tools and guidelines to assist the HDs and HCs to establish and
monitor the work of the CHCs.
Health Center level
With the MOH, HSS II trained staff at 120 health centers on health promotion concepts and
practices, and health promotion action plans were developed. A special focus was
developing stronger connections between the health facility and the community through the
establishment of the CHCs.
Community level
A CHC is expected to play an active role in directing community resources to address
health issues and assisting the health center (HC) staff to reach community members with
health education and screening, as well as promoting the HC services. For a HC to be
accredited as a high quality service delivery point, it needs to have an active CHC that is
engaged in the leadership and management committee of the HC. Interventions targeting
CHCs passed through three phases:
Phase 1: Establishment
HSS II conducted several meetings with HD and HC personnel to introduce the approach
and identify the catchment area for the CHC. In this phase, the primary local players were
identified and officially asked to participate. Furthermore, terms of reference of the CHCs
and agreement on capacity building activities for the members were completed.
Phase 2: Capacity-building and action planning
HSS II and the MOH conducted Participatory Rapid Appraisal (PRA) workshops with CHC
members. PRA is a hands-on methodology that helps CHCs define health needs and develop
their action plans accordingly.
40
CHC members collected information about the HC catchment area population, HC
services, the economic sectors, relevant community-based organizations in the area, and
health needs. Data were analyzed and used by CHC members to identify and prioritize
needs. Using the community action cycle, CHCs developed their action plans to address the
identified issues.
In selected areas in Irbid and Maan, HSS II conducted focus group discussions with women’s
and men’s groups to define barriers to receiving family planning services. Results of these
discussions were used to direct the action plans of the CHCs to design activities that
address local barriers and increase demand for FP services.
The following three graphs show results of a case control study done in Irbid to evaluate the
impact of community-led FP promotion activities. As can be seen, interventions in treatment
communities significantly increased the number of FP visits to the clinic. Furthermore,
interventions that targeted both women and men resulted in a relatively higher number of
FP visits than interventions that targeted women alone.
"Men and Women Interventions"
Total Number of FP Visits
2012 (June-September) vs. 2013 (June-September)
323
230
222
213
127
76
91
16
2012
2013
2012
Huwara
2013
2012
Al-Mazar
2013
2012
Kafar Yuba
2013
Hartha
Figure 20: Number of FP Visits in Selected Irbid Communities for Men and Women Interventions
"Women Only Intervention"
Total Number of Visits
217
116
2012
247
241
193
151
2013
Ramtha
2012
2013
2012
Al-Sareeh
2013
Al-Kareema
226
164
2012
2013
Deir Abi Sa'eed
Figure 21: Number of FP Visits in Selected Irbid Communities for Women Only Interventions
41
"Control Community"
Total Number of Visits
151
137
82
72
69
71
33
29
2012
2013
Haneena
2012
2013
2012
Um-Qais
2013
Waqaas
2012
2013
Deir Yousef
Figure 22: Number of FP Visits in Selected Irbid for Control Community
Furthermore, HSS II assisted three active CHCs to transition into voluntary societies. In
collaboration with the USAID-funded Civic Initiative Program, HSS II offered capacity
improvement activities including finance, grant management, advocacy and communication
trainings.
Phase 3: Monitoring and follow-up
All CHCs were supported by HSS II and MOH staff while implementing their planned
activities, CHCs also advocated for local support, and networked with different entities in
implementing their activities. The role of the MOH Health Directorate was essential in this
phase. It helped to identify gaps and provide ongoing support for the CHCs, ensuring they
stay on track and implement their respective work plans.
Studies measuring effect of CHCs on increasing demand on FP services were conducted in
Irbid and Ma’an. The studies provided qualitative and quantitative information on the impact
of encouraging volunteer community health committees to work with health centers, both
on attitudes towards FP and on increasing demand for FP methods in health centers.
Through the CHCs the project worked on mobilizing communities to adopt healthier
lifestyles and increase demand for FP/ PHC services. Mobilization efforts included:
% of Active Community Health
Committees in HDs
28%
29%
2010
2011
90%
87%
78%
2012
2013
2014
Figure 23: % of Active CHCs in Health Directorates
42
There are currently 106 CHCs.
In the latest round of
evaluations, 86 were eligible for
assessment in the final quarter.
Results showed that 78% are
currently active; slightly below
the target of 80%. A committee
is considered active if it has a
demonstrated SOW; updated
annual work plans addressing
health issues; and 60% of the
activities in the annual work plan
implemented within the
allocated timeframe.
Designing and implementing community mobilization campaigns
“Family Planning and Healthy Lifestyle” campaigns were designed and implemented in three
health directorates in full collaboration among Health Directorates, the WCH Directorate
and the Health Communication and Awareness Directorate. The campaign activities
included health fairs, edutainment and screening activities. Partnership and collaboration
with local organizations such as Greater Amman Municipality, Ministry of Education, Ministry
of Religious Affairs, JAFPP and local voluntary and charitable societies helped to ensure
maximum outreach in each location. The USAID-funded Ta’ziz (SHOPS) Project and the
Jordan Health Communication Project actively participated in the campaign with a number
of FP and health promotion booths during the health fairs. National NGO partners included
the Jordan Breast Cancer Program, the Royal Health Awareness Society and the King
Hussein Cancer Foundation.
Forming women’s, men’s and youth family planning advocacy groups
Women’s family planning advocacy groups
HSS II helped promote family planning as a means of improving quality of life and
empowering women to meet their reproductive goals. Using the JUH - “Arab Women
Speak Out” (AWSO) approach, HSS II formed 39 women’s FP advocacy groups around the
country. Participating women were trained on family planning, healthy lifestyles,
communication between spouses and general communication skills. They also developed
action plans to spread their new knowledge to other women in the community with the
help of the local Health Center and the Health Directorate.
Youth Peer Education
Thirty-six groups of youth peer educators were trained in ten governorates to promote
family planning among their peers as part of life planning. Peer educators were trained on
healthy lifestyles, life planning, and introduced to the concept of small family size.
Reaching men in their workplaces
In an effort to reach men and to inform them about the benefits of birth spacing and family
planning, HSS II identified contact officers at various workplaces who were tasked with
spreading the information and knowledge shared during special training sessions. Ten men’s
groups were formed and assisted to reach men in their workplaces, promoting family
planning and available services at health centers. Workshop participants in turn conducted
additional workshops at schools and mosques to reach their colleagues with messages
relevant to healthy families and family planning.
The CHC Recognition Awards
HSS II and the MOH recognized that the CHC mission requires extraordinary efforts,
outstanding commitment and exceptional dedication to achieve goals through the members’
voluntary contributions. HSS II acknowledged these efforts by introducing “CHC
Recognition Awards” aimed at enhancing and promoting the voluntary spirit among CHC
members and motivating existing CHCs towards sustainability. Twenty-two CHCs
competed, submitting projects on women’s and children’s health, chronic diseases and
healthy lifestyles for youth. The six winning CHCs were announced at the CHC Recognition
Awards Ceremony and received health promotion equipment and limited financial support
for continued activities.
43
Figure 24: The CHC Recognition Awards Ceremony
Achievements
Approximately one third of the committees have reached a level of maturity that allows
them to continue activities without the support of HSS II and achieve their goals. CHCs also
help the HCs in achieving primary health care quality improvement accreditation since
community engagement is part of the core standards. By strengthening community networks
and increasing the interaction between community members and CHC staff, the project’s
community health work contributes to the sustainability of HSS II’s achievements.














106 CHCs established and functioning.
6 CHCs recognized for their outstanding initiative and granted Recognition Awards.
3 CHCs have legally registered as community-based organizations, allowing them to
raise funds.
39 women’s family planning advocacy groups are operational
36 youth peer educators groups have been launched
10 men’s FP advocacy groups formed and engaging men on this sensitive topic
15 HP certified trainers available at the MOH to expand the HP program
HP training curriculum approved by MOH technical committee
HP indicators integrated in the updated MCH and NCD information systems
120 health centers actively designing and implementing health promotion activities
12 Health directorates active in mobilizing communities and promoting health.
The MOH adopted a supervisory role toward the CHCs, helping them focus on health
priorities.
Selected CHC catchment areas showed an increase in demand for FP.
The CHC role in monitoring health services has increased in some areas, creating
community pressure on the Health Directorates to improve services.
Sustainability
At the MOH, the HC&AD and HD HP have the capacity to manage the health promotion
and community mobilization program going forward. Processes and tools were designed in
full collaboration and partnership with the HP staff at different levels and properly tested in
the field to ensure appropriateness.
44
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




The HP training curriculum was reviewed and approved by MOH technical staff.
A group of certified HP trainers are available at the MOH central and health
directorates to address the high turnover of HC staff by providing ongoing trainings.
Over the past two years, the HC&AD has assumed responsibility for overseeing the
CHCs. In year three the HC&AD began supervising 14 CHCs. This allowed sufficient
time to ensure that skills and tools were provided as needed.
The HP staff at the central and HD level received IT equipment needed to sustain their
activities and support the health centers and CHCs as needed.
CHCs are trained on networking and accessing local resources when implementing their
activities. During the life of the project CHCs were able to attract local funds for various
activities, increasing independence and chances of sustainability beyond the project life.
CHCs were used by other programs at the HC&AD as a platform for implementing
activities such as care for the elderly and anti- smoking programs.
Challenges






The limited availability of MOH budgets to strengthen central directorate support and
ownership of CHCs made it much harder for health centers to actively support their
work.
The weak linkages between different technical directorates at the central level dilute the
efforts to ensure that community activities receive highly needed support from different
health programs.
The high turnover of MOH staff slowed the pace of implementation and increased the
need for continuous training. This has resulted in occasional dropping of outreach
activities and lack of support from health center management for CHC activities.
The MOH did not provide any special recognition of the HP trainers and supervisors, to
motivate them and sustain their energy for continued community engagement efforts.
Determinants of health go beyond the health system. HSS II was not designed to address
the social determinants of health but achieved considerable success within its sphere of
influence.
Measuring behavioral change requires specific research which falls outside of the scope
of the project. As a result, the MOH has anecdotal evidence of the impact of the CHCs’
activities but there was no comprehensive evaluation of the effectiveness of this package
of interventions.
Lessons Learned
HSS II has defined the following elements at the community level that enable a successful
community health program:



Commitment of other sectors with the local community is essential to engage with the
CH program and address health issues
Availability and willingness of well-established community-based organizations enhance
the link between program and community
Integrating other development actors help to maximize the benefits of the CH program
For a community mobilization program to succeed, the following steps are vital:
45



Create a sense of ownership by establishing and maintaining an ongoing dialogue with
community members in all phases of the program’s development, implementation and
evaluation.
Identify and create relationships with external resources such as the private
sector/donors and community based organizations to identify additional sources of
support.
Ensure the commitment of the MOH to support all phases of implementation to achieve
results, since community mobilization is a long-term process and cannot be achieved in a
short period of time.
46
Objective 6: Renovate, equip, furnish and maintain health
facilities
Context
Jordan’s health infrastructure is well-developed compared to other emerging economies.
However, many facilitates do not comply with international quality standards of maternal
and neonatal health care practices. Moreover, many facilities have either non-code
compliant design problems or are not appropriately maintained.
The physical condition of a health facility is an important element to ensuring the quality of
health care provided and to meeting infection prevention and the requirements of other
international standards.
At the beginning of HSS II, only three regional primary health training centers were
renovated, equipped, and furnished. However, the geographic location of these centers did
not facilitate the convenient attendance of trainees coming from health directorates that are
distant from the training centers.
Approach
Strengthening national capacity to design and build health facilities
A comprehensive approach was used to design
health facilities involving a multidisciplinary
team comprised of engineers, clinicians, and
health managers from the MOH, RMS and JUH.
A key ingredient to the success of these
projects was establishing an agreement on
roles and responsibilities among stakeholders.
During the design and build process, the
project staff built the institutional capacity of
the facility owners and government oversight
Figure 25: Engineers during the Implementation of
bodies to conduct infrastructure assessments,
Construction work at Jordan University Hospital
review and approve blueprints and designs and oversee the contractor performance during
construction. HSS II strengthened the MOH capacity to assume the responsibility of
planning and conducting hospital upgrades of obstetrics, neonatal and emergency
departments according to the American Institute of Architects standards.
The capacity of local contractors in renovation and expansion work of hospitals was also
built during the process, enabling them to continue renovations and improvements using
standard safety and quality protocols. An Environmental Mitigation Plan was also developed,
outlining processes that must be used to ensure worker and patient safety during the period
of renovation or construction. The HSS II teams worked with the MOH to identify and
select a list of priority equipment that would improve neonatal and maternal services.
Priority was placed on procuring resuscitation and life-saving equipment that was suitable to
Jordan, notably equipment that was serviceable in Jordan and matched international
standards.
47
Using an international competitive bidding process, HSS II procured, delivered and installed
equipment and furniture at selected health facilities
Strengthening capacity of health workers to correctly use new equipment and
technologies
Through hands-on training and field coaching, HSS II teams focused on improving the
technical capacity of physicians and nurses to correctly operate and maintain medical
equipment. These inputs assisted them to provide timely, quality services and to improve
the outcome in emergency cases.
Building national and hospital level capacity to maintain hospital improvements
The project teams helped representatives from
both the MOH and the Ministry of Public Works
to form a central-level Maintenance Task Force.
The Maintenance Task Force developed and
institutionalized a Maintenance System Policies
and Procedures Manual for the Ministry of Health
Facilities in 2012 which includes policies and
procedures for use in all their hospitals to ensure
appropriate maintenance of newly installed
electrical and mechanical systems.
“The maintenance manual that HSS
II developed is important for the
longevity and efficiency of hospital
improvements. We even use the
manual in other facilities around the
hospital.”
Eng. Suad Nayef, Head of Maintenance
Department, MOH
This first-ever Maintenance Manual includes supervisory tools, record keeping, an inventory
system and maintenance policies and procedures.
HSS II also supported the formation of hospital
maintenance committees in each hospital to
implement the maintenance plan using the
maintenance manual. Twenty-two hospital
maintenance committees were trained on the
maintenance system. After the training, HSS II
supported MOH Engineers to conduct Key
Performance Indicator visits, to ensure that the
maintenance contractor applied the policies and
procedures. This helped the MOH ensure that
the maintenance contractor performs preventive
maintenance measures correctly.
Figure 26: Upgraded NICUs Enable Providers
to Work in Comfortable and Safe
Environments
After the period of contractor maintenance warranty (one year for civil works, two years
for electromechanical elements) the project supported a smooth transition of health facility
maintenance to the MOH Directorate of Buildings and Maintenance, as well as the smooth
transition of equipment maintenance from the different vendors to the Directorate of
Biomedical Engineering (DBE) at the MOH. This process included working with each of the
facilities to develop an inventory system and to identify priority equipment maintenance
needs. The DBE was trained to take over the responsibility of long-term maintenance.
Medical equipment that the DBE will maintain includes neonatal incubators, vital signs
monitors, resuscitators, ventilators, surgical tables, anesthesia machines, CPAP units,
delivery beds and inpatient beds.
48
Activity
Actions
Stakeholder Involvement
Assess
 Conduct comprehensive physical,
functional and infrastructure assessment,
including mechanical and electrical works:
- heating, air conditioning, and ventilation
- sanitation and fresh water
- lighting and electrical sockets
- medical gases
Design
 Develop schematic design to meet functional,
infrastructural and infection prevention
requirements in accordance with American
Institute of Architects Academy for Health (AIA)
standards
 Prepare final designs in compliance with AIA
standards, as well as the rules, requirements, and
regulations of the Hashemite Kingdom of Jordan,
USAID and Abt Associates
Bid
Award
Renovate
Construct
Hand
Over
Maintain
 Prepare tender documents and contract
conditions
 Pre-qualify contractors based on technical
and financial capabilities
 Invite qualified contractors to bid
 Review bids with USAID and award to the
successful contractor(s)
 Provide support and supervision during the build
phase including daily management provided by
on-site project managers, and senior
management from HSS II to ensure contractor
meets quality standards
 Conduct commissioning and testing of the
electrical, medical gas, water systems to ensure
functioning and safety
 Convene a handover committee to receive
the completed facility
 Transition of equipment maintenance from
the different vendors to the Directorate of
Biomedical Engineering within the Ministry of
Health
 Provide comprehensive equipment
management training through on-the-job
training and coaching to improve technical
capacity of healthcare service providers
(physicians and nurses) to correctly operate and
maintain the medical equipment
 Establish hospital maintenance committees
to assume responsibility for ongoing
maintenance of renovations and
electromechanical systems using the
maintenance manual
HSS II
Hospital management team
(director, head of departments,
physicians, nurses)
Directorate of Planning / MOH
Directorate of Buildings and
Maintenance / MOH
Biomedical Engineering
Directorate / MOH
Ministry of Public Works and
Housing
USAID/Jordan
HSS II
Hospital management team
(director, head of departments,
physicians, nurses)
Directorate of Planning / MOH
Maintenance / MOH
Biomedical Engineering
Directorate / MOH
Ministry of Public Works and
Housing
1 month
2 months
3-4 months
2 weeks
USAID/Jordan
HSS II
Contractor(s)
1 month
1 month
3 weeks
8-10 months
HSS II
Contractor(s)
2 weeks
HSS II
Hospital Handover Committee
Maintenance / MOH
Directorate of Biomedical
Engineering / MOH
Contractor(s)
Hospital Management Team
Healthcare service providers
(physicians and nurses)
2 months
Hospital Maintenance Committee
MOH Engineers from
Maintenance / MOH
MOH Maintenance Contractor
HSS II
The premise is
under MOH
responsibility
after the HSS II
renovation
warranty period
(1 year civil
works and 2
years electrical/
mechanical
works)
Table 5: Phases of Upgrading Hospital Departments
49
Timeframe
Achievements
During HSS II, ten primary health training centers were
renovated and furnished. Nine obstetrics and neonatal
departments at major public hospitals were renovated
and equipped with state of the art biomedical machines.
Five emergency departments were renovated and
equipped. In total, HSS II renovated 15,848 m2 and
constructed 17,403 m2 of hospital spaces, as the following
table shows.
Figure 27: Plaque at the HSS II
renovated central MOH training center
Figure 28: Chart Indicating % of Expansion Area Compared to Exiting Area for Each Hospital Department
before Renovations
Existing Surface Area (m²) before Renovation Vs. Actual
Surface Area (m²) Renovated & Expanded for
14 Hospital Departments
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
33,248
15,845
Existing Surface Area (m2)
Actual Surface Area
Renovated & Expanded (m2)
Figure 29: Chart Indicating % of Total Expansion Area Compared to Total Exiting Area for All 14 Renovated
Hospital Departments
50
Figure 30: The Newly Constructed Obstetrics and Neonatal Departments Building at JUH,
the Largest Expansion Works Executed by HSS II
Figure 31: Inauguration of the Upgraded Obstetrics and Neonatal Departments at Queen Alia
Military Hospital
51
Sustainability
Building National and Hospital Capacity to Maintain
Hospital Improvements: The project teams helped
representatives from both the MOH and Ministry of Public
Works and Housing to form a central-level Maintenance Task
Force. The Maintenance Task Force developed and
institutionalized a Maintenance System Policies and Procedures
Manual for Ministry of Health Facilities in 2012 which includes
policies and procedures for use in all their hospitals to ensure
appropriate maintenance of newly installed electrical and
mechanical systems. This first-ever Maintenance Manual
includes supervisory tools, record keeping, an inventory
system and maintenance policies and procedures.
HSS II also supported the formation of hospital maintenance
Figure 32: The Maintenance
System
Policies and Procedures
committees in each hospital to implement the maintenance
Manual
plan using the maintenance manual. Twenty-two hospital
maintenance committees were trained on the maintenance system. After the training, HSS II
supported MOH Engineers to conduct Key Performance Indicators visits, to ensure that the
maintenance contractor applies the policies and procedures. This has helped the MOH
ensure that the maintenance contractor performs preventive maintenance measures
correctly.
Figure 33: On-Job-Training for Maintenance Staff and Service Providers on the Installed
Electromechanical Systems
After the period of contractor maintenance warranty (one year for civil works, two years
for electromechanical elements) HSS II supported a smooth transition of health facility
maintenance to the MOH Directorate of Buildings and Maintenance, as well as the smooth
transition of equipment maintenance from the different vendors to the Directorate of
Biomedical Engineering (DBE) at the MOH. This process included working with each of the
facilities to develop an inventory system and to identify priority equipment maintenance
needs.
52
Objective 7: Develop Human Resources
To respond to the health system priorities of the Ministry of Health and support the
sustainability of health system improvements in other program areas, Objective 7 was
amended in the approved Year 5 Work Plan to read:
Support the MOH to identify and begin to address human resource issues that
affect performance and sustainability of key health programs, especially
MCH/FP and PHC.
Context
The Ministry of Health (MOH) included human resources for health (HRH) as an important
area for action in its MOH Strategy 2013-2017. Family planning and reproductive health
(FP/RH) are priorities of both the Ministry of Health in Jordan and the US government, and
are directly affected by human resource constraints. In September 2013, HSS II helped the
MOH analyze the current status of HRH and to consider options to strengthen the health
workforce and increase access to effective health services including family planning. HE the
Secretary General of the MOH designated a group of senior health officials and managers to
participate in this analysis.
HSS II worked intensively with these key MOH officials and other stakeholders such as the
Higher Population Council, Higher Health Council and Jordan Nursing Council to identify
important HRH challenges, the main causes of these challenges, and potential ways to
address them. An HRH Technical Working Group (HRH TWG) was constituted by the
Secretary General to continue work on HRH. Membership in the HRH TWG, under the
leadership of the Planning Administration with strong support from the Directorate of
Personnel Affairs, includes not only central directors but also representation from Health
Directorates.
The HRH TWG members identified human resource priorities that they felt were
important and within the ability of the MOH to address in the context of their current five
year strategy. HSS II worked with the committee to select activities that could benefit from
HSS II support during the final year of the project.
Approach

Assist the MOH to assess staffing patterns and gaps in primary and
comprehensive health centers
HSS II helped the HRH TWG introduce and pilot the Workload Indicators of Staffing
Need (WISN) tool, working with the team of the Balqa HD. The WISN methodology
was developed by the World Health Organization in the 1980s and improved in 1998 &
2010 to support rational allocation of staff. It is based on actual work that health
workers do and can be applied to all personnel categories, both medical staff and nonmedical staff. The Balqa HD team applied the tool in five health centers of different
sizes, assessing all tasks performed by all cadres there and the volume of services they
produced. HSS II also organized a workshop at which technical representatives agreed
on the average time needed for each task. Results of these exercises were used to chart
the allocation and productivity of staff across the five health centers.
53

Support MOH deliberations to improve retention and quality of existing staff
HSS II supported regular meetings of the TWG in which key themes were introduced
and discussed, such as identifying gaps in staffing, developing functional competencies for
at least one cadre of staff that would help the MOH to determine eligibility for
promotion, and ways to improve the staff appraisal process. HSS II helped ensure that
the committee invited relevant central and health directorate staff to each meeting so
that decisions made over the course of their deliberations would receive consensus
from the broader group of stakeholders. HSS II also organized a policy formulation
meeting concerning HR for senior MOH managers during the WISN workshop, which
presented key concepts of effective policy development and implementation.

Develop core competencies and career ladder for MOH midwives
HSS II helped the Jordan Nursing Council and the MOH to form an expert group to
define the core technical requirements of midwives as they progress through their
careers, based not on current pre-service training but on actual responsibilities once
they are MOH service providers. With technical assistance from HSS II, the expert
group agreed on the final wording of the core competencies and the career ladder for
midwives (four levels). These documents define provision of IUD services as a core
competency expected of all midwives as of their licensure, which was well accepted by
the Jordan Nursing Council and by the MOH HRH TWG. The methodology used to
develop these documents was provided to the MOH Director of HR Employee
Relations so that this process can be replicated for other staff categories.

Support strengthening of MOH personnel appraisal process
HSS II supported the MOH Director of HR Employee Relations to provide refresher
training to 150 MOH managers, including all Directors and HR managers of all 12 Health
Directorates, on use of the Civil Service Bureau (CSB) appraisal process to assess
performance of their staff. In three one-day workshops, the participants were shown
how to apply the appraisal to medical professionals in a way that will allow managers not
only to assess staff but also to link those assessments to requests for promotion or
recommendations for sanctions, if appropriate.

Disseminate WISN process and results, core capacity exercise and
performance appraisal tools to key stakeholders
In several meetings, the HRH TWG discussed the results of the WISN exercise in Balqa
and agreed it provides an objective way to determine staffing needs, and decided on the
usefulness of establishing core competencies and career ladders as a way to guide initial
training, hiring and promotion of MOH employees. As part of the series of three
workshops cited above, HSS II then worked with the Director of HR Employee
Relations to disseminate the processes, tools and results of the WISN exercise in Balqa
to the other HD Directors and their HR managers, as well as central ministry staff. The
core competencies of midwives, and the proposed career ladder for them, were also
presented and discussed. HD staff generally agreed that these tools should be formally
adopted as MOH policy to guide deployment, careers and annual appraisals.
54

Prepare policy advocacy tool for the HRH TWG
HSS II developed a report that explained the process used to develop and test these
tools and to gain acceptance of key stakeholders, and assisted the HRH TWG and the
Director of HR Employee Relations to consider next steps in mandating the use of
WISN to make staffing decisions. The TWG stated that their objective is to mandate the
use of WISN for determination of staff deployment in 2016.
Achievements
Within the last year of the project, significant progress has been made in identifying key
aspects of human resource management in the MOH that needed strengthening, and in the
understanding and confidence of key MOH managers that these problems can be addressed
using a variety of tools and processes.
Required


Core competencies and a career
ladder for midwives that includes IUD
services as an essential part of their
work have been prepared and
accepted by the Jordan Nursing
Council and the MOH HRH TWG.
The use of WISN as a tool to make
rational decisions about staff allocation
has been practiced and embraced by
the HRH TWG, and the Balqa team is
ready to coach other HDs in its
application.
Staff
Category
Staff
based on
WISN
Current
Staff at
Facility
Difference
Staffing
GP
5
2
-3
Shortage
Midwife
2
3
1
Surplus
Registered
Nurse
1
3
2
Surplus
Nurse
Associate
1
4
3
Surplus
Dentist
1
1
0
Adequate
Pharmacist
2
1
-1
Shortage
Assistant
Pharmacist
2
2
0
Adequate
Medical
Clerk
2
3
1
Surplus
Figure 34: Example of WISN Output for a Comprehensive
Health Center

The Director of HR Employee Affairs
has improved the understanding HD
staff in the use of the CSB performance
appraisal process to assess staff
performance more accurately and fairly
than has been the case in the past.

The HRH TWG and the Balqa HD
team have the capacity to carry on
strengthening HRH, using a policy
advocacy process and specific tools and Figure 35: MOH Officials Discuss the Value of WISN for
products produced with HSS II
Improving Staffing Efficiency in Health Care Facilities
support.
Our work with HSS II on HRH issues including the development of the WISN tool put
us on the right track towards improving the management of our health staff and the
delivery of health care services, as well as strengthening the health system as a whole.
Mr. Ghaleb Qawasimi, Director of the Employee Affairs Directorate, MOH
55
Challenges
The human resources work that was begun in the final year of the HSS II project was a good
start in addressing longstanding issues in management of health staff, as a core aspect of
health system strengthening. For this work to lead to system-wide improvements in
delivery of health services, much more effort will be needed in the future. Key challenges
that still need to be tackled include:




Perception of MOH staff that their performance, good or bad, will not influence their
career development, chances of promotion or advancement, or assignments in the
future. This perception profoundly affects the attitudes and behaviors of health care
staff, particularly when asked to do additional work to improve quality of care.
Lack of formal policies within the MOH to guide allocation of staff
Weaknesses in pre-service education of physicians, midwives and nurses that result in a
need for the MOH to undertake a large volume of in-service training to meet their
program needs
Continued lack of clarity or agreement across the different health professions
concerning the competency of midwives to perform IUD services, despite this being part
of their job description within the MOH.
Lessons Learned
Engaging with the MOH and other counterparts to help them address human resource
needs created considerable interest and energy among them, and raised interest in and
expectations for future support in this area. Some of the lessons learned from this first year
of HRH work include:

The HRH TWG proved to be a very viable body to tackle HR issues within the Ministry,
and should be offered further support if at all possible. The opportunity for central and
HD staff to discuss HRH together and work on solutions was perceived by all involved
as extremely helpful.

Professional bodies have a strong role to play in determining optimal roles for each type
of staff, as shown by the very positive engagement of the Jordan Nursing Council in the
development of midwifery competencies and career ladder. Their continued
engagement, as well as that of other health profession organizations, will be vital to turn
promising approaches into policy that is broadly applied, within or even beyond the
MOH.

Remaining tasks include formalizing specific approaches developed with HSS II support,
such as the use of WISN for staffing decisions and the development of core
competencies to guide professional development, so that they are applied more broadly
in the future, especially by the MOH. The momentum and energy behind the use of the
WISN to determine staffing needs must be sustained through further application of the
tool, but also through specific policy decisions by senior officials of the MOH that
endorse the use of WISN results in staff allocation.
56
III. HAND-OVER OF HSS II PROGRAMS TO GOJ
COUNTERPARTS AND RECIPIENTS
Building the capacity of managerial and clinical staff of the MOH, RMS and other key
institutions such as JUH to sustain program improvements was a core strategy of the
project. To ensure sustainability of gains achieved to date, HSS II implemented a hand-over
strategy with related counterparts which included three levels: hand-over of materials and
tools, hand-over of approaches and for specific elements, hand-over of full responsibility to
allow recipients to assume responsibility to continue without further support from the
project.
1) Materials: Policy documents, guidelines, curricula, manuals, documentation of events,
studies. Materials and products developed with the support of HSS II (policy documents,
guidelines, curricula, manuals, documentation of events, studies) were handed over to
HSS II counterparts. Well-organized, labeled and branded packets of CDs distributed to
the following:





USAID Population and Family Health Office (all materials)
MOH:
 Director of Project Planning and Management Directorate (all materials)
 Relevant Central Administrations and Directorates (all items specifically relevant
to each of them)
 Each HD (all items specifically relevant to that HD)
HPC (relevant materials)
RMS (relevant materials)
JUH (relevant materials)
2) Approaches: Training, supportive supervision, equipment and infrastructure
maintenance, IT system maintenance, performance monitoring and reporting through
graphics, etc. Hand-over of approaches is more complex, and in addition to the CDs, it
required more active handover of data sets to ensure that trained staff is capable of
updating them. A working event for each HD was conducted, in which all technical
aspects of the program were covered in effective way to recognize and support
continued decentralization of responsibility.
3) Full Responsibility transferred: Hand-over of full responsibility for specific tasks
were done for certain aspects of our program that USAID does not expect to support
in the future. This included, full MOH responsibility for leading HCs through the
accreditation process, sustaining infrastructure, and maintaining the referral system.
“The hand-over event for the Capital Health Directorate is a valuable
road map that will help my team to continue on the different
successful programs and sustain gains achieved with support of HSS II
project”
Dr. Leil Al Fayez, Director of Capital Health Directorate in a hand-over
event conducted on August 11, 2014
57
IV. HSS II CELEBRATES FRUITFUL PARTNERSHIP AND
SUCCESSFUL CONCLUSION
On September 22, 2014, following 5 years of dedicated work, the USAID-funded Abt-led
HSS II project successfully concluded its implementation in Jordan in an event held under the
patronage of HE Minister of Health to celebrate the fruitful partnership with public health
sector entities. It was attended by the USAID Mission Director and senior leaderships from
the MOH, RMS, HPC, JUH, Jordan Nursing Council, Higher Health Council, implementing
partners and key stakeholders, in addition to the entire HSS II team including current and
former staff.
The event opened with guests touring a gallery of posters highlighting the joint achievements
of the Abt-led HSS II in partnership with the public health sector in Jordan represented by
the MOH, RMS, JUH and HPC, followed by
“Ms. Paige, Dr. Sabry, the MOH
speeches from senior officials, viewing the end of
promises to take the lead and continue
project movie and ended with presenting
building on the joint accomplishments”
recognition plaques to project partners.
Dr. Deifallah Al-Louzi, MOH Secretary
During his speech, the MOH Secretary General
General during his speech in the EOP
renewed commitment to sustain HSS II's
event
successful programs and achievements. USAID
Jordan also expressed ultimate satisfaction for the impact of HSS II on improving the quality
of health services in Jordan and the project’s dedicated team. This was evident from the
testimonial given by Mission Director, Ms. Beth Paige to the project.
“HSS II’s leadership is remarkable and the project team is the favorite among all USAID activities”
Ms. Sarah Blanding, Director of the Population and Family Health Office / USAID
Figure 36: HSS II Team with the US Ambassador, USAID Mission Director, Minister of Health and Abt CEO at the
Inauguration of the Emergency, Obststetrics and Neonatal Departments at Karak Hospital
“The success of the project would not have been possible without the incredible passion and
team work of the HSS II project team. Anytime you’re with this group, you can feel the energy
and the passion about what they’re doing, and the results are seen every day”
Ms. Beth Paige, USAID Mission Director
58
V. ANNEXES
Annex 1: Indicator Monitoring
Performance Monitoring Matrix
Status for each indicator is calculated based on the percent deviation from
target.
% Deviation = (Actual value – Target value) / Target value * 100 (NOTE: Indicators below
target will have a negative deviation and vice versa)
Deviation Color Legend:
▌ Red: % deviation > 30%
▌Orange: deviation of 10% - 30%
▌Green: % deviation ≤ 10%
N/A = Not Available
59
Objective 1: Promote the principles and practice of knowledge management at the MOH
Result 1.1 MOH staff at the central, Health Directorate, hospital and health center levels have documented use of information generated by various health
information systems for decision-making and quality improvement of services
Performance
Indicator
1.1 Score for
the level of
maturity of
knowledge
management
practice at the
MOH measured
by the KM
assessment tool
Definition
A knowledge maturity model
defines stages of maturity that
an organization can expect to
pass through in its road to
improve its overall knowledgecentric practices and processes
and ultimately business
performance.
The KM maturity model defines
five maturity levels of
knowledge management, each
of which has special
characteristics and emphases.
Data
Source,
Method &
Frequency
KM Survey
assessment
to measure
the KM
maturity at
MOH
Results
Base
Line
1.74
Biannual
Year
Target
Y1
0
Y2
BL
Y3
2.0
Q1
Q2
Q3
Q4
Total
%
Deviation
from
Target
-1.74
Baseline
(Cancelled)
Y4
Y5
2.3
2.24
-2.6%
Result 1.3 The Performance Assessment system is institutionalized at the MOH
1.2 Number of
Performance
Assessment
Reports
developed by
PA department
This is a binary indicator
whereby the finalization and
dissemination of the PAR
identifies that the indicator has
been met. The PAR is a final
report summarizing the results
of an MOH-wide Performance
Assessment study using preselected indicators.
Project
reports
Biannual
0
Y1
Y2
0
1
Y3
Y4
Y5
1
0
1
End of Project Target / End of Project Achieved
60
Status
0
-100%
1
0%
1
0%
2/2
Objective 2: Improve quality of care at primary health care level
Result 2.1: 120 health centers are fully prepared for formal accreditation and at least 50 of the 120 health centers are formally accredited
Performance
Indicator
2.1: Number of
health centers
accredited by
HCAC
Definition
This indicator measures the
number of health centers
that fulfill the requirements
for HCAC Accreditation and
get awarded the HCAC
Accreditation Status in
recognition for their
achievement.
Data
Source,
Method &
Frequency
Quality
Directorate
– MOH
Results
Base
Line
0
Annual
Year
Target
Y1
Y2
Y3
Y4
Y5
0
0
20
N/A
30
Q1
Q2
Q3
Q4
Total
%
Deviation
from
Target
26
30%
49
63%
End of Project Target / End of Project Achieved
50 / 75
Result 2.2: A functioning referral and appointment system in all 12 HDs
2.2 Number of
HDs with
functioning
referral and
appointment
system
This quantitative indicator
measures functionality of the
referral and appointment
system. This system is
considered functional in an
HD when the following
criteria are met:
1. The existence of at least
one hospital with an
appointment unit in a given
HD.
2. 20% of referral forms are
returned from Specialists
in the Hospital to GPs at
the HCs.
HD Records
Y1
6
2
-66%
Y2
10
1
-90%
Y3
10
6
-40%
Y4
10
8
-20%
Y5
10
7
-30%
0
Annual
3. HD generates monthly
reports on HC referrals.
61
Status
Result 2.3: Operational planning, supervision and monitoring systems are functioning in all Health Directorates
Performance
Indicator
2.3a Percent
of controlled
hypertension
patients
attending
MOH PHC
facilities
Definition
This indicator is an outcome
indicator, intending to
measure the % of patients with
essential hypertension who
have their blood pressure
controlled (less than 140 mm
Hg for systolic and/or 90 mm
Hg for diastolic measurement,
and less than 130 mm Hg for
systolic and/or 80 mmHg for
diastolic measurement in
diabetic patients; according to
WHO guidelines), among
registered hypertensive
patients visiting the health
center.
Numerator: Number of
patients with essential
hypertension who have their
blood pressure controlled
Data
Source,
Method &
Frequency
HDs QI
reporting
system
Base
Line
59.56
2
%
Deviation
from
Target
Year
Target
Y1
BL
Y2
60%
62.8%
60.9%
61.7%
2.8%
Y3
60%
63%
67%
65%
8%
Y4
60%
66.5%1
61.7%
64.1%
6.8%
Y5
60%
62.2%2
61%
61.6%
2.6%
Q1
Q2
Q3
Q4
59.6%
Baseline
Semiannual
Denominator: Total of
hypertension patients who are
registered and regularly
attending the health centers
1
Yearly
Average
(%)
Data do not included Tafilah HD, which was experiencing IT issues at the time of data collection.
62
Status
Performance
Indicator
2.3b Percent
of controlled
diabetic
patients
attending
MOH PHC
facilities
Definition
Data
Source,
Method &
Frequency
Base
Line
This is a quantitative indicator
that measures the percentage
of controlled diabetes patients
attending MOH PHC facilities.
A patient is considered as a
controlled diabetic patient if
his/her fasting plasma glucose
level is < 130 mg/dL
Numerator: Number of
diabetic clients with fasting
plasma glucose level < 130
mg/dL at HSS II intervention
MOH/PHC facilities during 6
months
HDs QI
reporting
system
41.6%
3
This is a quantitative indicator
that is based on a binary
measurement of whether or
not the operational plans
developed by HDs contain
interventions that address
Long Acting FP methods
Target
Q1
Q2
Q3
Q4
41.6%
%
Deviation
from
Target
Y1
BL
Baseline
Y2
40%
44.2%
45.5%
44.9%
12.3%
Y3
42%
44.9%
44.3%
44.6%
6%
Y4
42%
50.8%3
44.9%
47.8%
13.9%
Y5
42%
55%
53%
54%
28.6%
Y1
0
Y2
12
11
-8.3%
Y3
12
12
0%
Y4
12
12
0%
Y5
12
12
0%
Semiannual
Denominator: Total number
of diabetic clients from the
same facilities tested for
fasting glucose level during the
same 6 months
2.3c Number
of HDs
operational
plans that
include
interventions
addressing
Long Acting
FP methods
Year
Yearly
Average
(%)
Operational
plans at 12
HDs
Annually
0
63
Status
Objective 3: Improve quality of safe motherhood at hospital level
Result 3.1 Documented improvements in maternal and neonatal mortality and morbidity at public sector hospitals (MOH/RMS)
Performance
Indicator
3.1a Percent of
women
monitored
during labor
using the
partograph
Definition
This is a quantitative indicator that
measures the percentage of women
in active labor who are monitored by
partograph. A woman in active labor
will be considered as monitored by
partograph, if the partograph four
components have been filled: IAssessment of the fetal condition. IIProgress of labor. III- Assessment of
the maternal condition. IV- Outcome
of labor.
Numerator: Number of women in
active labor who are monitored by
partograph during three-month
period
Denominator: Number of women
in active labor who are admitted to
the hospital during the same period
3.1b Percent of
inborn neonates
admitted to the
Neonatal
Intensive Care
Units at selected
MOH/RMS
measures the percentage of inborn
neonates admitted to the intensive
care units at selected MOH/RMS
hospitals and discharged alive. A
surviving newborn is an inborn
neonate admitted to the neonatal
Data Source,
Method &
Frequency
Results
Base
Line
Hospital Medical
Records
Partograph Sheet
Monthly
Partograph
Reports
Quarterly
Neonatal
Logbook
Year
Target
Y1
80%
Y2
85%
81%
Y3
90%
Y4
Q1
Q2
Q3
Q4
Yearly
Average
(%)
%
Deviation
Status
from
Target
74%
79%
76.5%
-4.4%
80%
82%
82%
81%
-4.7%
84%
84%
88%
89%
86%
-4.4%
95%
91%
82%
85%
89%
86.7%
-8.7%
Y5
95%
90%
91%
92%
_
91%
-4.2%
Y1
0
Y2
86.5%
86.5%
0%
80
86.3
Quarterly
64
BL
86.
3%
86.5
%
Performance
Indicator
hospitals who
are discharged
home alive
Definition
Data Source,
Method &
Frequency
Results
Base
Line
intensive care unit for any medical or
surgical intervention and discharged
home alive after completing the
required hospitalization period.
Selected hospitals are those with
upgraded neonatal intensive care
through renovation, equipment and
capacity-building for the service
providers.
Numerator: inborn neonates
discharged alive after being admitted
to the neonatal intensive care unit
3.1c Percent of
pregnancy
induced
hypertensive
clients managed
according to
clinical
guidelines
Denominator: total inborn
neonates admitted to the neonatal
intensive care unit
This quantitative indicator measures
the percentage of pregnancy induced
hypertension (PIH) patients managed
according to the clinical guidelines
according to the following
management procedures:
1. History: Inquired on headache,
epigastric pain, blurring of vision
or fits upon admission.
2. Examination: Checked blood
pressure, reflexes, FHS according
to guidelines.
Hospital Obstetric
Records
PIH Forms
80
Year
Target
Y3
88%
Y4
Q1
Q4
Yearly
Average
(%)
%
Deviation
Status
from
Target
Q2
Q3
87%
88%
89%
91%
88.7%
0.8%
89%
93%
92.7
%
92%
92%
92%
3%
Y5
90%
92%
92%
93%
_
92%
2.2%
Y1
80%
78%
79%
78.5%
-1.25%
Y2
85%
81%
77%
73%
82%
79%
-7.1%
Y3
90%
85%
88%
88%
89%
88%
-2%
LIH Logbook
65
Performance
Indicator
Definition
3. Investigations: Checked for urine
albumin upon admission.
4. Active Management: Gave
magnesium sulfate according to
guidelines.
Numerator: Number of women
admitted to hospital with pregnancy
induced hypertension who are
managed according to clinical
guidelines in 3 months
Denominator: Number of women
admitted to hospital with pregnancy
induced hypertension in 3 months
3.1d Percent of
hospitals using
confidential
inquiries into
maternal deaths
and near misses
to monitor the
quality of
maternal care
measures the percentage of hospitals
using confidential inquiries into
maternal deaths and near misses
according to guidelines. A hospital
will be considered as implementing
Confidential Inquiry if it fulfills the
following criteria:
1. All cases of maternal deaths are
audited according to the
confidential inquiry surveillance
cycle.
Data Source,
Method &
Frequency
Results
Base
Line
Quarterly
Confidential
Inquiry forms
Delivery Logbook
0
Year
Target
Y4
95%
Y5
95%
Y1
0
Y2
25%
Y3
50%
Q1
Q4
Yearly
Average
(%)
%
Deviation
Status
from
Target
Q2
Q3
92%
80%
82%
88%
85.5%
-10%
87%
90%
91%
-
89.3%
-6%
0%
25%
25%
0%
28%
52%
40%
-20%
HSMC MOM
66
Performance
Indicator
Definition
2. 75% of cases of obstetric:
hemorrhage, severe-preeclampsia
and eclampsia are audited
according to the near misses
review cycle.
3. Data should be collected and
investigation done monthly.
Data Source,
Method &
Frequency
Results
Base
Line
Yearly
Average
(%)
%
Deviation
Status
from
Target
Year
Target
Y4
75%
60%
70%
65%
-13%
Y5
85%
63%
66%
65%
-23.5%
Q1
Q2
Q3
Q4
Semiannual
Numerator: Number of hospitals
using Confidential Inquiry into
maternal deaths and near misses in 6month period
Denominator: Total number of
hospitals trained on using the
Confidential Inquiries into maternal
deaths and near misses during the
same period of time.
67
Objective 4: Improve quality of and increase access to FP/RH services
Result 4.1 increased use of modern family planning methods, a shift from traditional to modern method use, and decreased total fertility and
discontinuation rates
Performance
Indicator
4.1 Percent of
MOH health
centers
providing at
least 4
modern FP
methods
Definition
measures the percentage of health
centers providing a range of modern FP
methods, with a minimum of 4 modern
methods. This indicator assures that
clients have a wider choice of method
selection that meets their needs and
desires. It is expected to contribute to
increasing the access to FP services. A
health center will be considered if at
least four modern FP methods are
provided to FP clients; modern
methods are IUD, OCs, condom,
injectables and implants.
Data
Source,
Method &
Frequency
Logistics
Information
System
Results
Base
Line
%
Yearly Deviation
from
Average
Target
(%)
Year
Target
Y1
BL
Y2
35%
24.8
%
24.6
%
24.5
%
21.3%
23.8%
-32%
Y3
40%
18.5
%
22.2
%
25.4
%
28.7%
23.7%
-41%
Y4
35%*
26.5
%
29%
29.4
%
31.1%
29.0%
-17%
Y5
40%*
29%
31%
33%
-
31%
-22.5%
29.7
Q1
Q2
Q3
Q4
BL
29.7%
Baseline
Quarterly
Numerator: Number of health
centers providing at least 4 modern FP
methods during 3 months
Denominator: Total number of MOH
health centers providing FP services
during the same 3 months
*Target was modified in consultation with USAID in Y4.
68
Status
Objective 4: Improve quality of and increase access to FP/RH services
Result 4.2 A more comprehensive client‐centered ESP that enables service providers to expand their services and provides clients and communities with
better-quality family planning information and services
Performance
Indicator
4.2 Percent of
missed
opportunities
for FP
counseling at
MOH PHC
centers.
4
Definition
measures the percentage of missed
opportunities for FP services at MOH
PHC centers. A client is considered to
be a missed opportunity for FP if she is
a married woman in reproductive age
currently not using an FP method and
does not receive FP counseling when
attending an MOH PHC facility. This
indicator will be measured through a
client exit study at a sample of PHC
centers.
Numerator: Number of non-FP users
married women in reproductive age
(MWRA) attending MOH PHC centers
participating in the study who are not
counseled on FP services
Denominator: Total number of nonFP users MWRA who are eligible for FP
counseling at same MOH facilities
Data Source,
Method &
Frequency
Client Exit
Interview Study
Base
Line
82.5
Results
Year
Target
Y1
0
Y2
75%
Y3
70%
Q1
Q2
Q3
75.9
%
Q4
% Deviation
Status
from
Target
-1.2%
65%
+8%4
Y4
Annual
Y5
Figure is positive because lower discontinuation rates are desired.
69
No data will be collected by HSS II in Year 4 and Year 5 for this
indicator, since it is being collected by another institutionalized survey
(DHS).
4.3 Health care providers are counseling and motivating women to use long‐term contraceptive methods and to minimize discontinuation.
Performance
Indicator
I 4.3 Percent
of IUD and
OCs
discontinuers
during the first
year of use at
MOH PHC
centers
Definition
This is a quantitative indicator that measures
the percentage of IUD and combined oral
contraceptives discontinuers during the first
year of use. A client is considered a
discontinuer if she started the use of IUD or
COCs from an MCH center and
discontinued the method use during the first
year of use. A sentinel Surveillance Study is
conducted to follow up use of IUD and
COCs. Discontinuation is measured using
survival analysis for the collected data.
Data Source,
Method &
Frequency
Sentinel
Surveillance
Study
Biannual (Results
will be available
in Y4)
Base
Line
28
14
IUD
42
COC
Results
Year
Target
Y1
0
Y2
BL
Y3
13 IUD
40
COC
Y4
Y5
Q1
Q2
Q3
Q4
14
IUD
42
CO
C
% Deviation
Status
Total from Target
BL
Baseline
11.8
IUD
40
COC
- 7%
IUD
0%
COC
No data will be collected by HSS II in Year 4 and Year 5 for this
indicator, since it is being collected by another institutionalized
survey.
Result 4.4: Family planning services are offered to post‐partum and post‐miscarriage women at MOH, RMS hospitals and JUH
4.4a Percent
of postmiscarriage
clients
receiving
modern FP
methods
before
discharge at
selected public
hospitals
the percentage of post-miscarriage clients
receiving modern FP methods before
discharge from selected public hospitals.
MOH hospitals selected for this indicator
include those which mount to a total of 8085% of annual deliveries according to 2009
MOH statistical report.
Numerator: Number of post-miscarriage
clients receiving modern FP methods before
discharge at selected public hospitals during
6 months
Denominator: Total number of postmiscarriage clients at selected public
hospitals during 6 months
Hospital
Logbooks
0
Y1
0
Y2
10%
N/A
25.3
%
25.3%
153%
Y3
20%
18%
21.9
%
19%
-0.3%
Y4
30%
23%
23.8
%
23.4%
-22%
Y5
40%
26%
26%
26%
-35%
Semiannual
70
Performanc
e Indicator
4.4b Percent
of postpartum
clients
receiving FP
counseling
before
discharge at
selected public
hospitals
Definition
measures the percentage of postpartum
clients receiving counseling for FP before
discharge from selected public hospitals.
MOH hospitals selected for this indicator
include those which mount to a total of 8085% of annual deliveries according to 2009
MOH statistical report.
Numerator: Number of postpartum
clients receiving FP counseling/information
before discharge at selected public hospitals
during 6 months
Denominator: Total number of
postpartum clients at selected public
hospitals during 6 months
Data Source,
Method
&
Frequency
Hospital
Logbooks
Results
Base
Line
Year
Target
Q1
Q2
Q3
Q4
Total
%
Deviation
from
Target
Y1
0
Y2
10%
n/a
34.9%
34.9%
N/A
+249%
Y3
20%
32.9
%
44.7%
38.8%
+94%
Y4
30%
50%
51.8%
50.9%
69%
Y5
40%
63%
68%
65.5%
63.7%
0
Semiannual
Result 4.6: A functional FP supervision and monitoring system at Central and Health Directorate(health centers and hospitals) levels
4.6 Number
of HDs with a
functioning
FP/MCH
supervision
system
This is a quantitative indicator that identifies
the number of Health Directorates with an
active MCH supervision system. The
supervision system is considered active if it
meets all of the following criteria:
1- Annual supervision schedule is
submitted to WCHD.
2- At least 60% of scheduled visits are
completed in Y3 (65% in Y4 and 70% in
Y5).
3- The supervision visit is documented
using the MCH supervision reports
form.
4- Monthly supervision reports are
submitted to the WCHD by the HD.
WCHD
documentation
including HDs’
supervisory
reports
Y1
4
4
4
0%
Y2
8
3
3
3
-62.5%
Y3
12
5
9
7
-41.7%
Y4
12
8
11
10
-16.7%
12
6
-
6
-50%
0
Y5
Semiannually
71
Status
Objective 5: Improved Community Health
Result 5.1: Community health committees are established and functioning in all 12 HDs with special emphasis on poor and underserved populations both in
rural and urban areas
Performance
Indicator
5.1 Percent of
active Community
Health
Committees in
HDs
Definition
the number of active community health
committees in Health Directorates. An active
community health committee should fulfill the
following criteria:
1. A demonstrated Scope Of Work, roles and
responsibilities and operational instructions
2. Updated annual work plans addressing
health issues
3. 60% of the activities in the annual work
plan implemented within the allocated
timeframe
Results
Data Source,
Method &
Frequency
Base
Line
CHCs’ and
HDs’
Documents
Year
Target
Q1
Q2
Q3
Q4
%
Deviation
from
Target
Y1
30
28
-6.7%
Y2
40
29
-27.5%
Y3
80%*
90
13%
Y4
80%
87%
8.75%
Y5
80%
78%
0
-2.5%
Annual
*Target changed to percent in Year 3.
5.2 Number of
HDs with active
HP program
the number of Health Directorates with an
active health promotion program. A Health
Directorate with an active health promotion
program should fulfill the following criteria:
1. Has a Certified HP trainer
2. At least 60% of health centers trained on
HP concept and practices
3. At least 60% of planned HP activities are
implemented at the health centers
4. At least 60% of HCs receiving training are
reporting on a monthly basis
5. HD supervising the HC/HP activities
HDs’
Documents
HP&P
Directorate
Documents
Y1
2
6
200%
Y2
6
10
67.8%
Y3
10
8
-20%
Y4
12
8
-20%
Y5
12
8
-20%
0
Project Reports
Annual
72
Status
Objective 6: Renovate, equip, furnish and maintain health facilities
Result 6.1 Obstetric, neonatal and emergency departments in selected hospitals renovated and upgraded to comply with international standards R 5.2:
Information on the ESP, family planning, reproductive health, maternal, neonatal and child health are promoted at the community level
Performance
Indicator
6.1 Number
of hospitals
with
renovated and
equipped EOC
and NNC
departments
Definition
the number of MOH & RMS hospitals
renovated and equipped. A hospital is
considered renovated and equipped if any or
all of the departments below have been
renovated/remodeled, equipped and furnished
according to the hospitals assessment done at
the beginning of the project. The departments
are: 1) obstetric wards, 2) delivery rooms, 3)
operating theaters for C/S, 5) Neonatal
Intensive Care Units, 6) Ob/Gyn and
neonatal outpatient clinics
Data
Source,
Method &
Frequency
Project
Reports
Base
Line
0
Annual
Year
Target
(EOC,
NNC/ ER)
Results
Q1
Q2
6
Total
0
Y2
EOC/ NNC
=4
ER = 2
EOC/
NNC = 1
ER = 2
-50%
Y3
EOC/ NNC5
=4
ER =0
EOC/
NNC = 4
0%
Y4
EOC/ NNC
=4
ER =3
EOC/
NNC = 3
ER = 2
-28.5%
Y5
EOC/ NNC6
=1
ER = 1
EOC/NNC
=1
ER = 1
0%
Target was modified to carry over uncompleted renovation works from the previous year
Target was modified to carry over uncompleted renovation works from the previous year
73
Q4
Y1
End of Project Total
5
Q3
%
Deviation
from
Target
EOC/
NNC = 9
ER =5
Status
Performance
Indicator
Definition
Data
Source,
Method &
Frequency
Base
Line
Year
Target
(EOC,
NNC/ ER)
Results
Q1
Q2
Q3
Q4
Total
%
Deviation
from
Target
Result 6.3: Selected primary health training centers renovated, equipped and furnished
6.3 Number
of Training
Centers
renovated,
equipped and
furnished
the number of training centers renovated and
equipped. A training center is considered
renovated and equipped if it has been
renovated/ remodeled, equipped, furnished.
Renovated and fully equipped training centers
along with a MOH training plan will contribute
to strengthening technical skills at the facility
level especially improving FP/RH knowledge
and information and improve technical skills to
provide needed services such as IUDs,
voluntary surgical contraception, breast
feeding, PHC, EOC, NNC, IMCI and others.
Project
Reports
0
Y1
0
Y2
8
8
0%
Y3
2
2
0%
Y4
0
Y5
0
Annual
Result 6.4: IT equipment to strengthen/ expand / develop health information systems is procured installed and utilized
6.4 IT
equipment
procured,
installed and
utilized
This is a binary indicator. The procurement
and installation of IT equipment identifies that
the indicator has been met. The indicator will
be considered to be achieved once the IT
procurement plan is developed and approved
by USAID, and equipment is procured and
installed at MOH facilities.
Y1
Project
Reports
0
Y2
100%
100%
0%
Y3
100%
100%
0%
Y4
Annual
Y5
Result 6.5: A standardized and efficient facility maintenance system at central and hospital levels established, functioning and sustainable
6.5 Facility
maintenance
guidelines and
monitoring
tools
developed and
utilized
This is a binary indicator that measures
whether the guidelines and monitoring tools
have been finalized and disseminate or not.
The indicator will be considered to be
achieved once the guidelines and tools are
developed; providers received classroom and
hands-on training for implementing guidelines.
Y1
Project
Reports
Y2
Y3
0
Annual
Y4
Y5
74
100%
100%
0%
Status
Indicator Summary
The above table presented the last available data for each indicator. Explanations for
deviations from target of more than 10% above are given below.
Objective 1: Knowledge management
Explanations for the cancelled Knowledge Management survey in Y3
HSS II and the MOH agreed to cancel the knowledge management survey in Y3 as HSS II
KM staff and MOH counterparts were engaged in the overhaul of the MOH website and
health information systems.
Objective 2: Quality Improvement
Explanations for percent deviations greater than 10 for Quality Improvement
indicators: 2.1



Indicator 2.1: The target of accredited HCs for Year 5 (end of project) was 50.
However, 75 HCs have been accredited year. This higher than expected success rate
demonstrates the effectiveness of the collaborative approach for improving quality at
primary health care level. More importantly, it highlights the commitment of the MOH
to implement the required quality improvement measures.
Indicator 2.2: Out of the target of 10 HDs, three HDs have not yet achieved satisfactory
referral performance: Tafilah, Madaba and Karak. The Health Director of Madaba has yet
to allocate a room for the referral and appointment unit. The HD plans to have the
referral and appointment unit located at the Outpatient Department. However,
outpatient clinics are located outside Nadeem Hospital in the Health Directorate
compound, where construction work is ongoing. The construction works at Karak (now
completed) led to a similar problem. And in Tafilah, the HD decided to accept walk-in
patients without referral in order to ease transportation costs on patients.
Indicator 2.3b: Diabetic patients are currently being monitored using Fasting Blood Sugar
tests, which are less reflective of long-term control as compared to HbA1c. Indicator
Performance for Objective
Objective 3: Safe Motherhood
Explanation for percent deviations greater than 10 for Safe Motherhood indicators:

Indicator 3.1d: Personnel in some hospitals are still hesitant to complete confidential
inquiry forms because of legal liability fears.
Objective 4: Family Planning
Explanations for percent deviations greater than 10 for Family Planning indicators

Indicator 4.1: HSS II and the MOH have made significant progress in increasing the
number of HCs that provide at least four modern FP methods. Nevertheless, this
indicator is still below target. HSS II has documented the reasons for this in the past.
Below is a summary of the main reasons:
75

Pre-service issues: There is disconnect between pre-service education and
certification requirements for physicians and midwives, and the actual skills needed
by the MOH from these cadres at various centers where FP services need to be
provided.

Deployment and job requirement issues: For family planning, the present
requirement that midwives can only insert IUDs at health centers if they are
supervised by physicians specifically trained to perform this role is limiting access to
this popular and reliable FP method. Because physicians assigned to health centers
typically stay less than a year at any one center, this results in many trained midwives
being unable to offer IUD services because the general practitioners (GPs) who are
supposed to supervise them are newly assigned and not yet trained to do this, or in
some cases refuse to perform this function.

On-the-job performance of staff: Currently midwives who agree to offer IUD
services as part of their work in health centers do so on a voluntary basis – there is
no requirement that every midwife assigned to a health center perform this service,
and no specific recognition of the extra effort this requires.

Indicator 4.4a: The percentage of post-miscarriage patients receiving FP methods is
below target. With the MOH, the HSS II team revealed that a significant proportion of
the cases intend to become pregnant again in the immediate future.

Indicator 4.4b: The percentage of postpartum patients who receive counseling is above
target. HSS II, RMS and MOH are putting forth great effort in monitoring and supervising
the services provided at these hospitals. Several hospitals allocated devoted midwives to
provide counseling to postpartum women before discharge. HSS II is continuously
monitoring and supervising the services provided by these midwives through regular
field visits. Furthermore, the commitment of the Capital HD director, Dr. Lail Al-Fayez,
who assigned two midwives to work at Al-Bashir Hospital, which has average monthly
deliveries of 1200 (the highest in the Jordan), has made significant impact on postpartum
counseling numbers.

Indicator 4.6: The deviation from target is due to the Kingdom-wide vaccination drive in
the first quarter (October – December, 2013). In the first quarter, the system was only
60% functional (as measured by completion of scheduled visits). In the second quarter,
the system was 100% functional (i.e. all visit were completed). However, the indicator is
calculated over the first two quarters, which explains the current deviation.
Objective 5: Community Health
Explanation for percent deviations greater than 10 for Community Health indicators:

Indicator 5.2: The number of HDs with active health promotion programs (8) is below
the target of 12. One necessary criterion for an active HP program is having a certified
HP trainer. Due to high turnovers at HDs, this has proven to be a difficult criterion to
maintain.
76
Annex 2: List of Counterpart Administrations and Directorates
MINISTRY OF HEALTH
MINISTRY OF HEALTH
Administrations
Central Directorates
Health Communication and Awareness
Directorate
Director of Buildings and Maintenance
Directorate
1.
Secretary General
15.
2.
Planning Administration
16.
3.
Primary Health Care Administration
17.
Directorate of Biomedical Engineering
4.
Health Directorates Administration
18.
Employee Affairs Directorate
5.
Hospital Administration
19.
6.
Services Administration
20.
7.
Administrative Affairs Administration
21.
Central Directorates
8.
Directorate of Planning and Project
Management
9.
Project Management Department
10.
Performance Appraisal Department
11.
Information Technology Directorate
12.
Quality Directorate
13.
14.
Non-Communicable Diseases
Directorate
Women and Child Health Care
Directorate
Human Resources Development
Directorate
Outpatient Clinics and Emergency
Directorate
International and Public Relations
Directorate
Chiefs of Specialty
22.
Chief of Obstetrics and Gynecology
(Ob/Gyn) Specialty
23.
Chief of Pediatrics Specialty
24.
Chief of Midwifery and Nursing
Specialty
ROYAL MEDICAL SERVICES
JORDAN UNIVERSITY
1.
Planning & Information Department
2.
Chief of Ob/Gyn Department
3.
Chief of Neonatology
1.
Hospital Director
4.
Nursing Director
2.
Head of Ob/Gyn Department
5.
Training Department
3.
Head of Neonatology
HIGHER POPULATION
COUNCIL
4.
Nursing Director
Secretary General
5.
Head of Maintenance Department
1.
1.
University President
JORDAN UNIVERSITY HOSPITAL
77
Annex 3: List of 120 Health Centers Prepared for Accreditation
#
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
Health Centers (HCs)
Balila HC
Qadisiyyah HC
Marsaa’ HC
Souf HC
Sakeb HC
Barma HC
Qafqafa HC
Kufur Khal HC
Al-Kfeir HC
Al-Mastabeh HC
Deir Al-Liyat HC
Ain Jana HC
Rajeb HC
Ajloun Comprehensive HC
Al-Wahadneh HC
Arjan HC
Prince Hasan HC
Buweida HC
Ibn Sina HC
Dahiyat Al-Hussein HC
Eidoon HC
Nuaymeh HC
Al-Razi HC
Ramtha Comprehensive HC
Al-Mazar HC
Al-Taybeh HC
Kufr Yuba HC
Huwwara HC
Al-Sareeh HC
Al-Kraymeh HC
Qumeim HC
Hartha HC
Deir Abi Sa’eed HC
Al-Farouq HC
Al-Husn HC
Manshiyat Bani-Hasan HC
Eidoon Bani-Hasan HC
Mansoora HC
Um Al-Sarb HC
Zaatari HC
Hosha HC
Al-Kom Al-Ahmar HC
Rehab HC
Health Directorate (HD)
Jarash HD
Ajloun HD
Irbid HD
Mafraq HD
78
#
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
Lib CHC
Faisaliyyah Al-Oula HC
East Madaba HC
Al-Areesh HC
Al-Areed HC
Dleilet Al-Hamaydeh HC
Al-Hilalieh HC
Al-Falah HC
Zarqa Jadida HC
Prince Abdullah HC
Shabeeb HC
Hay Al-Rasheed HC
Musherfa Comprehensive HC
Jabal Amir Hamza Comprehensive HC
Tatweer Hadari (Yajooz) HC
Jabal Tareq HC
Al-Bassa HC
Abu-Nseir Comprehensive HC
Al-Thira'a (Hai Nazzal) HC
Al-Awdah (Um-Tineh) HC
Wadi El-Seer HC
Al-Nasser HC
Sweileh Al-Shamel HC
Al-Hashimi Al-Shamali HC
Pr. Basma (Ras Al-Ain) HC
Marka Comprehensive HC
Sahab Comprehensive HC
Al Jwaideh HC
Khreibat Al-Souq HC
Um-Nuwara HC
Al-Jofeh HC
Um Al-Amad HC
Um Al-Basateen
Na’our HC
Tla’ Al-Ali HC (Um Al-Hussein)
Shafa Badran HC
Maghareeb HC
Mahes HC
Al-Salalem HC
Al Nahda HC
Mubess Primary HC
Allan Primary HC
Sbeihi Comprehensive HC
Al-Ma’addi Primary HC
Yarqa Primary HC
79
Madaba HD
Zarqa HD
Capital HD
Balqa HD
#
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
Baqee’ Comprehensive HC
Abu-Nseir Primary HC
Ain Al-Basha HC
Wadil Hoor HC
South Shouneh HC
Nayef Bin-Asem HC (Swema)
Rama HC
Ader HC
Taybeh HC
Majra HC
Ayy Comprehensive HC
Mu’ab Primary HC
Mo’tah Primary HC
Al-Qasr Primary HC
Faqqou’ Comprehensive HC
Manshiat Abu-Hamour HC
Ghor Al-Mazra’a HC
Tafileh CHC - A July 2012
Ees HC
Bseira Comprehensive HC
Al-Ain Al-Baida HC
Eima HC
Al-Qadesiyyah HC
Taybeh HC
Ail HC
Ma’an Gharbi HC
Shobak HC
Petra Comprehensive HC
Aqaba Comprehensive HC
Pr. Basma HC
Al-Khazzan HC
Baldeh Qadima HC
Karak HD
Tafileh HD
Ma’an HD
Aqaba HD
80
Annex 4: List of Hospitals that Received the Safe Motherhood
Program
#
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Hospital
Health Directorate
Health Sector Entity
Ajloun
Balqa
Balqa
Balqa
Balqa
Capital
Capital
Capital
Capital
Capital
Irbid
Irbid
Irbid
Irbid
Irbid
Irbid
Jarash
Karak
Karak
Karak
Ma’an
Ma’an
Madaba
Madaba
Mafraq
Mafraq
Ramtha
Tafila
Zarqa
Zarqa
Zarqa
MOH
MOH
MOH
MOH
MOH
MOH
MOH
RMS
RMS
JU
MOH
MOH
MOH
MOH
MOH
RMS
MOH
MOH
MOH
RMS
MOH
MOH
MOH
MOH
MOH
MOH
MOH
RMS
MOH
MOH
RMS
Al-Iman Ajloun
Al-Hussein Salt
Princess Iman (Ma’addi)
Prince Hussein (Baqa’a)
South Shouneh
Bashir
Dr. Jamil Tutanji
King Hussein Medical Center
Queen Alia
Jordan University Hospital
Abu Obaida
Muath Bin Jabal
Princess Badia / Rahma
Princess Raya
Yarmouk
Prince Rashed
Jarash
Ghor Safi
Karak
Prince Ali
Ma’an
Queen Rania
Nadeem
Princess Salma
Mafraq OBGYN
Ruwaised
Ramtha
Prince Zeid
Prince Faisal
Zarqa
Prince Hashem
81
Annex 5: List of Hospitals that Were Upgraded through
Renovation and Expansion Works
Upgraded
Departments
Area
Area
before
after
Health
Upgrading Upgrading Directorate
in m2
in m2
Health
Sector
Entity
#
Hospital
1.
Al-Hussein
Salt
1)
Obstetrics and
Neonatal
820
2,670
Balqa
MOH
2.
Princess Iman
(Ma’addi)
2)
Obstetrics
and Neonatal
270
1,060
Balqa
MOH
3)
3.
South
Shouneh
Obstetrics
and Neonatal
100
1,970
Balqa
MOH
4)
Emergency
256
991
5)
Obstetrics
and Neonatal
5,900
6,100
Capital
MOH
6)
Emergency
1,150
1,250
Capital
MOH
7)
Obstetrics
and Neonatal
1,720
2,480
Capital
RMS
8)
Obstetrics
and Neonatal
0
6,250
Capital
JU
Emergency
440
1,140
Jarash
MOH
Karak
MOH
4.
Bashir
5.
Dr. Jamil
Tutanji
6.
Queen Alia
7.
Jordan
University
Hospital
8.
Jarash
9)
Karak
10) Obstetrics
and Neonatal
755
1,910
11) Emergency
810
1,275
9.
10.
Mafraq
OBGYN
12) Obstetrics
and Neonatal
1,554
2,950
Mafraq
MOH
11.
Prince Zeid
13) Obstetrics
and Neonatal
1,360
2,060
Tafila
RMS
12.
Prince Faisal
14) Emergency
710
1,142
Zarqa
MOH
Total
15,845
33,248
82
Annex 6: List of Hospitals that Received Medical Equipment,
Furniture and IT Equipment
#
Equipment Item
Quantity
Medical Equipment for Dr. Jamil Tutanji (Sahab) Hospital - Emergency Department
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
Blood gas analyzer
Vital Sign Monitor- Dash 4000
Defibrillator/Cardioverter (AED)
Defibrillator; Manual
ECG machine
End tidal CO2 monitor RespSence
Examination Light, mobile SE51FL
Hand Held Doppler (Vascular) Versalab SE BW
Laryngoscope (curved and Straight)
Magill forceps
Operating Surgical Light
Otoscope/opthalmoscope
Oxygen delivery set, wall unit, French
Plaster, cutter American Orthopedics cast cutter
Portable Ventilator
Pulse Oximeter- 9700 Avant
Resuscitation bag ( Ambubag), adult
Resuscitation bag ( Ambubag), Pediatric
Sphygmomanometer, mobile on a stand (adult, pediatric and thigh cuffs)
Sphygmomanometer, wall mounted (adult, pediatric and thigh cuffs)
Stethoscope
Stool, step
Suction unit (Mobile)
Syringe pump (Standard syringe set)
Ultrasonic Nebulizer
Ultrasound machine Logic P5 Pro
X-Ray viewing box
Fetal Heart Rate Detector (Sonicaid), Medsonics T334
Mnaual Resuscitation bag, neonatal
Operating table, General surgery Amsco 3085
Crash Trolley 239966MRD
Examination bed/ Couch with IV Pole
In patient bed/ Adult with IV Pole
83
1
5
1
1
3
1
6
1
3
3
1
2
15
1
1
5
3
3
5
20
20
7
2
4
2
1
4
1
1
2
1
4
16
14
#
Equipment Item
Quantity
Medical Equipment for Dr. Jamil Tutanji (Sahab) Hospital - Emergency Department
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
Instrument Cabinet
IV Stand
Medication trolley 6450
Spinal Immobilization board, Adult
Spinal Immobilization board, Pediatric
Trolley patient ambulating transport 0747
Trolley patient, radio translucent Trauma
Trolley, Plaster 6030
Wheel chair
Instrument Cabinet
IV Stand
Trolley patient, radiotranslucent Trauma
Wheel chair
4
12
3
2
1
6
3
1
8
1
4
16
14
4
12
3
2
1
6
3
1
8
Medical Equipment for Dr. Jamil Tutanji (Sahab) Hospital – NICU
57.
Nasal Bubble CPAP, Manufacturer: Fisher & Paykel
1
Furniture for Dr. Jamil Tutanji (Sahab) Hospital - Emergency Department
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
4 drawer metal cabinet
chair (guest, bedside)
Chair desk, adjustable height
Changing room lockers (4 doors, 2upper + 2 lower)
Coffee Table medium size
Doctor on call room (bed + cabinet + small side cabinet)
Filing cabinet/ half closed (wood)
Manager Desk Chair
Multi-purpose carts (instrument trolleys)
Office Desk: Approximate size 1200 x 600x720 mm
Trash basket
Waiting area chairs 2-Seats (perforated chrome or stainless steel)
Waiting area chairs 3-Seats (perforated chrome or stainless steel)
84
1
25
10
8
2
1
4
9
3
7
10
3
6
#
Equipment Item
Quantity
Medical Equipment for Prince Faisal Hospital - Emergency Department
1.
Blood gas analyzer
1
2.
1
3.
1
4.
ECG machine
3
5.
1
6.
6
7.
IV Stand
12
8.
3
9.
Magill forceps
3
10.
Operating Surgical Light
1
11.
2
12.
Oxygen delivery set, wall unit, French
12
13.
1
14.
Portable Ventilator
1
15.
Pulse Oximeter- 9700 Avant
5
16.
3
17.
3
18.
Sphygmomanometer, mobile on a stand (adult, pediatric and thigh cuffs)
5
19.
14
20.
Stethoscope
20
21.
Stool, step
7
22.
2
23.
4
24.
2
25.
1
26.
5
27.
X-Ray viewing box
4
28.
Examination Lamp, Burtan-Phillips, Model: SN22FL
1
29.
Swivel Stool, Manufacturer: Winco
1
30.
Wheel Chair, Manufacturer: Invacare
2
Medical Equipment for Prince Faisal Hospital - NICU
31.
2
32.
Manual Resuscitation Bag, Neonatal, Ambu
2
85
#
Equipment Item
Quantity
Medical Furniture for Prince Faisal Hospital - Emergency Department
33.
34.
35.
36.
37.
38.
Instrument Cabinet
39.
40.
41.
42.
43.
44.
45.
46.
Wheel chair
86
1
4
14
1
9
4
3
3
2
1
6
2
1
8
#
Equipment Item
Quantity
Medical Equipment for Al-Bashir Hospital - Ob/Gyn Department and NICU
1.
Anesthesia Cart Lakeside model 2915CBL
13
2.
Anesthesia Unit, Avance care station
1
3.
CTG Machine, FGL, Analogic
11
4.
2
5.
2
6.
Blood gas analyzer
1
7.
ECG machine
6
8.
1
9.
Examination Lamp Burtan model SE51FL
12
10.
12
11.
Fetal Heart Rate Detector Nicoet/carefusion
10
12.
Manikin, AED-CPR Training
1
13.
Manual Resuscitation Bag, Adult
3
14.
Manual Resuscitation Bag, Neonatal Ambu
10
15.
Gas blender
7
16.
Phototherapy unit
19
17.
1
18.
Portable Ventilator
2
19.
Pulse oximeter- 9700 Avant
8
20.
Pulse oximeter, infant/neonatal Nonin 7500
20
21.
6
22.
6
23.
Sphygmomanometer Adult / Mobile on stand
35
Sphygmomanometer, mobile on a stand (adult, pediatric and thigh
24.
10
cuffs)
25.
27
26.
1
27.
Incubator , NICU, Drager model C2000 Isolette
21
CTG Unit GE central station : Trium CTG machine, and screen : with
28.
1
8 monitors model Coro 259 CX
29.
4
30.
Oxygen Delivery Set British Type Connection
20
31.
Pediatric ALS trainer
4
32.
Infant Radiant Warmer/ resuscitator GE Panda
13
33.
Stethoscope
30
34.
Stethoscope Adult
35
35.
Stool, step
10
87
#
Equipment Item
Quantity
Medical Equipment for Al-Bashir Hospital - Ob/Gyn Department and NICU
36.
Stool, Swivel Winco
15
37.
Suction Machine, gardner denver, Aspiration Thomas
7
38.
4
39.
IV Stand
24
40.
Suture Cart 2364M
2
41.
Transport Incubator, NICU
2
42.
6
43.
3
44.
2
45.
Jaundice Meter, Drager JM-103
1
46.
6
47.
Monitor GE 259 CX-A
8
48.
Nasal Bubble CPAP/ Fisher&Pykel
10
49.
TV Sharp LCD 40" Full HD 1920 X 1080 Pixels
1
50.
4
51.
1
52.
Ventilator (NICU): Newport E360S
6
53.
Vital Sign Monitor Pediatric Dash 4000
2
54.
8
55.
Vital sign monitor, GE Dash 4000 Operating room
1
56.
X-Ray viewing box
9
57.
Vital Signs Monitor GE Dash 4000 (NICU)
15
58.
Magill forceps
6
59.
2
60.
1
61.
6
62.
Pulse Oximeter, Infant/Neonatal, Manufacturer: Nonin, Model: 9700
1
#
Equipment Item
Quantity
Medical Furniture for Al-Bashir Hospital - Ob/Gyn Department and NICU
63.
6
64.
Danger Drug Cabinet
6
65.
Delivery bed
4
66.
Digital Scale, Neonatal
13
67.
Examination Bed (Coach)
9
68.
12
69.
Gynecological Examination table with stirrups
5
88
#
Equipment Item
Quantity
Medical Furniture for Al-Bashir Hospital - Ob/Gyn Department and NICU
70.
In Patient bed pediatric
6
71.
12
72.
Infant examination table
3
73.
Inpatient bed Adult Graham Field Alpha AX7114
120
74.
Instrument Cabinet
26
75.
Instrument Table , Lakeside model 8354
8
76.
Medication Trolley
1
77.
6
78.
6
79.
Operating table
2
80.
1
81.
Pediatric Examination/ treatment bed
4
82.
Stainless steel table, small Lakeside model 8357
8
83.
Stainless Steel table, Large Lakeside model 8350
4
84.
Trash basket
15
85.
12
86.
5
87.
1
88.
Delivery Bed, Manufacturer: Hill-Rom, Model: Affinity 4
1
Inpatient Bed, Manufacturer: Hill-Rom, Model: 305 Manual Bed With
89.
25
Foan mattress and IV Pole
90.
Wheel chair
22
#
Equipment Item
Furniture for Al-Bashir Hospital - Ob/Gyn Department and NICU
91.
Chair (guest, bedside)
92.
Chair desk, adjustable height
93.
Chair desk, HON 2091PC
94.
Changing room lockers
95.
Manager Chair
96.
Classroom Chair
97.
Counter Chair
Doctor on call room furniture
98.
(3 beds and mattresses and 3 comidone each)
99.
Executive Desk with Side
100.
Filing cabinet (wood local purchase)
101.
Filing Cabinet, Vertical
102.
Office Desk HON model P3251R
89
Quantity
30
4
25
80
4
100
10
6
1
5
5
25
#
Equipment Item
Furniture for Al-Bashir Hospital - Ob/Gyn Department and NICU
103.
Guest Chair
104.
Guest Chair / Black Leather
105.
Guest Chair / High Back Black Leather
106.
Training Room Table
107.
DVD Sharp with Shelve
108.
Waiting Area Chairs 2-Seats
109.
Waiting Area Chairs 3-Seats
110.
Waiting Area Chairs Stainless Steel
111.
Counter Chair / Black Leather
112.
Bed side cabinet
90
Quantity
30
65
11
25
1
6
24
6
36
120
#
Equipment Item
Quantity
Medical Equipment for Al-Hussein (Salt) Hospital - Ob/Gyn Department and NICU
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Anesthesia Cart, Manufacturer: Waterloo, UTGKU-41212
Anesthesia Unit, Manufacturer: GE, Model: Avance S5
CTG Machine, Manufacturer: Analogic
Digital Scale, Neonatal, Manufacturer: Detecto, Model: 8435KG
Gynecological Examination Table with Stirrups, NK Medical
Incubator, NICU, Manufacturer: GE, Model: Giraffe
Infant Radiant Warmer/Resuscitator, Manufacturer: GE, Model: Panda
Warmer
Operating Surgical Light (LED Technology), Manufacturer: Steris,
Model: Harmony V LED LK-05
Phototherapy Unit, Manufacturer: GE, Model: Lullaby PT
Vital Sign Monitor for Operating Room, Manufacturer: GE, Model:
DASH 4000
Vital Signs Monitor for NICU, Manufacturer: GE, Model: DASH 5000
with Neonatal Accessories
2
1
2
1
4
2
10
2
4
2
1
1
4
1
4
Medical Furniture for Al-Hussein (Salt) Hospital - Ob/Gyn Department and NICU
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Danger Drug (DDA) Cabinet
Examination Bed (Couch), Winco, Color: Blue
Instrument Cabinet, Manufacturer: UMF, Model: SS7834
Movable Anesthesia Chair, Manufacturer: Winco, Model: 4380
Operating Table, Manufacturer: Steris, Model: 3085 SP System
Stainless Steel Mayo Table, Movalble, Manufacturer: Lakeside
Stainless Steel Table, Large, Manufacturer: Lakeside
Stainless steel Table, Small, Manufacturer: Winco
Stool, Swivel, Manufacturer: Winco, Model: 4350
Wheel Chair, Manufacturer: Invacare, Model: EX2
91
1
3
3
27
3
1
1
2
1
3
2
2
#
Equipment Item
Quantity
Furniture for Al-Hussein (Salt) Hospital - Ob/Gyn Department and NICU
28.
Bed Side Cabinet, NK Medical, Model: IC711-MET
2
29.
Changing Room Lockers
25
30.
Counter Chairs
28
31.
Doctor on call room (2 beds+cabinet+small side cabinet)
3
32.
Filing Cabinet / Open (4 shelves wood)
6
33.
Filing Cabinet/Half Closed
8
34.
Guest Chairs for Offices
32
35.
Lecture Room Chairs
25
36.
Manager Desk Chair
16
37.
Office Desk (120x70x72cm)
16
38.
Staff Rest Chairs
24
39.
Waiting Area Chair (3-Seats)
19
92
#
Equipment Item
Quantity
Medical Equipment for South Shouneh Hospital – Emergency, Ob/Gyn Dept. and NICU
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Defibrillator Automated (AED), Manufacturer: Phillips, Model:
Heartstart XL, Accessories include external paddles (Adult and
Pediatric), 10 packs of printing paper, one extra set of ECG cables for
adult and pediatric, 50 AED pads
ECG Machine, Manufacturer: Space Labs, Model: Cardio Express SL12
Warmer
Manual Resuscitation Bag, Adult Ambubag
Otoscope / Ophthalmoscope, Manufacturer: Wech Allyn, Model: 71142
Oxygen Flowmeter (British system with autoclavable humidifier)
Pulse Oximeter Adult/Pediatric, Manufacturer: Nonin, Model: 7500
1
2
1
1
2
8
4
6
2
3
2
1
1
20
1
2
1
18.
Sphygmomanometer Mobile on Stand (adult, pediatric and thigh cuffs),
Manufacturer: Baum, Model: 250
2
19.
Stethoscope Adult, Manufacturer: Viridian, Model: 32
10
20.
2
21.
1
22.
8
23.
Ultrasonic Nebulizer, Manufacturer: Drager, Model: Tropical Plus
MP01205
Vacuum Regulator (British system with safety jar for 500cc)
Vital Sign Monitor Adult (Emergency), Manufacturer: Space Labs,
Model: S12400
DASH 4000
7
24.
25.
26.
27.
28.
93
1
15
2
1
2
#
Equipment Item
Quantity
Medical Furniture for South Shouneh Hospital – Emergency, Ob/Gyn Dept. and NICU
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
Crash Trolley (Red), Manufacturer: Waterloo, Model: UTRLA-333369RED Accessories included IV Pole Oxygen cylinder with flowmeter and
regulator
Danger Drug (DDA) Cabinet
Examination Bed (Couch), Manufacturer: Clinton Industries, Model:
3010 27 Accessories included IV Pole
Infant Examination Table, Manufacturer: Winco, Model: 8400-xx-IV
Unit includes IV Pole
Medication Trolley, Manufacturer: Harlof, Model: VL42BIN3
Operating Table, Manufacturer: Steris
Patient Trolley, Ambulating, Manufacturer: NK/Novum, Model: NK
8000
Patient Trolley, Radiotranslucent, Manufacturer: Stryker, Model: 1037
Wheel Chair, Manufacturer: Invacare,
7
4
1
2
17
1
1
31
8
3
1
1
1
2
2
5
2
#
Equipment Item
Quantity
Furniture for South Shouneh Hospital – Emergency, Ob/Gyn Dept. and NICU
46.
Bed Side Cabinet, Manufacturer: NK Model: IC-711
11
47.
22
48.
18
49.
Counter Chairs
33
50.
4 Drawer Metal Cabinet
1
51.
Cupboard (Wardrobe) for Doctor-on-Call Room
1
52.
Dixon Cabinets/Shelves
6
53.
1
54.
Filing Cabinet (Half Closed) wood 180 X 80
12
55.
6
56.
20
57.
Manager Desk Chair
10
94
#
Equipment Item
Quantity
Furniture for South Shouneh Hospital – Emergency, Ob/Gyn Dept. and NICU
Manager Desk Chair, mesh/base fabric wih foam mash back/chrome
58.
base adjustable height with full arms support, 5 casters base best quality
12
heavy duty, approximate dimension 82cm H X 50cm W
Meeting Room Table, wooden top with melamine or metal screen,
59.
metal legs powder coated no rust, heavy duty design and finishing, size=
6
120 cm X 70cm
Metal Changing Room Lockers (4 doors: 2 upper + 2 lower)
60.
14
approximate dimensions 180 X 60 X 50cm
61.
10
Office Desk, wood, top cover consists of minimum 1.8cm plywood
faced with laminated sheet from both sides heavy duty design,
62.
w/screen/melamine or wood with metal legs powder coated no rust,
12
two drawers with lock, approximate size= 1200 X 700 X 720mm,
heavy duty frame design and finishing
63.
Single Wood Bed with Mattress for Doctor-on-Call Room
1
64.
Staff Rest Chairs
16
Visitor Chair, chrome/base fabric upholstery/chrome legs and handles,
65.
50
5 casters base best quality haevy duty design
66.
12
Waiting Area Chairs (3-Seats): metal frame base and chair, made of
67.
14
perforated chrome or stainless steel best quality
IT Equipment for South Shouneh Hospital
68.
Dell E170SC 17"LCD Monitor; Monitor Stand; power cable 10a/125v
1
Dell Optilex 780 DT Base, 15a/250v Computer; power cable 10a/125v;
69.
Optical Mouse USB, Keyboard, USB; Dell Drivers and Documentation
1
CD;
HP 3015dn 220v Printer; power cord 125v; power cord 220v; Print
70.
1
CartridgeSN: 3027B001AA; Installation Software CD
95
#
Equipment Item
Quantity
Medical Equipment for Mafraq Ob/Gyn Hospital - Ob/Gyn Department and NICU
1.
2.
3.
4.
5.
6.
1
1
1
6
4
8
7.
Warmer
2
8.
9.
10.
11.
12.
13.
Mnaual Resuscitation bag
2
2
2
1
1
2
14.
DASH 4000
1
15.
4
Medical Furniture for Mafraq Ob/Gyn Hospital - Ob/Gyn Department and NICU
16.
2
17.
2
18.
1
19.
1
20.
42
21.
22.
3
3
23.
1
24.
25.
1
2
26.
1
27.
3
28.
2
96
#
Equipment Item
Quantity
Furniture for Mafraq Ob/Gyn Hospital - Ob/Gyn Department and NICU
29.
36
30.
34
31.
Counter Chairs
30
32.
Doctor on call room (2 beds + cabinet + small side cabinet)
3
33.
Filing Cabinet / Open (4 shelves wood)
8
34.
8
35.
42
36.
Lecture Room Chairs
25
37.
Manager Desk Chair
18
38.
18
39.
Staff Rest Chairs
24
40.
23
41.
1
97
#
Equipment Item
Quantity
Medical Equipment for Queen Alia (RMS) Hospital - Ob/Gyn Department and NICU
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Warmer
Oxygen Flowmeter with humidifier
Scale for Incubator, Manufacturer: GE, Model: Giraffe
Vacuum Regulator with safety Jar
DASH 4000
1
4
2
5
4
10
4
2
3
1
30
2
3
1
10
1
6
Medical Furniture for Queen Alia (RMS) Hospital - Ob/Gyn Department and NICU
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
98
4
3
2
2
40
1
45
4
1
3
2
1
5
4
#
Equipment Item
Quantity
Furniture for Queen Alia (RMS) Hospital - Ob/Gyn Department and NICU
33.
26
34.
Coffee Table
4
35.
Counter Chairs
20
36.
4
37.
10
38.
20
39.
Lecture Room Chairs
25
40.
Manager Desk Chair
15
41.
15
42.
Staff Rest Chairs
20
43.
12
99
#
Equipment Item
Quantity
Medical Equipment for Jordan University Hospital - Ob/Gyn Department and NICU
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
#
CTG Machine, Manufacturer: Analogic, Model: Fetal Guard Lite FGL
Accessories included with each unit
Digital Scale, Neonatal, Manufacturer: Detecto
Fetal Heart Rate Detector (Sonicaid), MedaSonics Model: T345D
Incubator, NICU, Manufacturer: Drager, Model: Isolette 8000
Incubator, NICU, Manufacturer: Drager, Model: Isolette 8000 (with scale)
Infant Radiant Warmer/Resuscitator, Manufacturer: Drager, Model:
Resuscitaire
Manual Resuscitation Bag, Neonatal
Oxygen Regulator with Humidifier for Neonatal Department
Oxygen Regulator with Humidifier for Obstetric Department
Phototherapy Unit, Manufacturer: GE, Model: Lullaby LED
Vacuum Regulator with Bottle for Neonatal Department
Vacuum Regulator with Bottle for Obstetric Department
Ventilator, NICU, Manufacturer: Viasys, Model: Avea
DASH 4000
Equipment Item
3
9
10
12
1
6
13
2
11
3
2
35
3
3
3
45
5
14
25
25
2
3
7
Quantity
Medical Furniture for Jordan University Hospital - Ob/Gyn Department and NICU
24.
25.
26.
27.
28.
29.
30.
Anesthesia Cart, Manufacturer: Waterloo, Model: UTGKU-43699
Birthing Bed for Labor, Delivery and Recovery, Manufacturer: Hill-Rom,
Model: Affinity 4 (P3700)
3010-27 accessories included IV Pole IV40
Gynecological Examination Table with Stirrups, Manufacturer: Clinton
Industries, Model: 8870
100
5
4
10
8
2
2
1
#
Equipment Item
Quantity
Medical Furniture for Jordan University Hospital - Ob/Gyn Department and NICU
31.
Infant Examination Table, Manufacturer: Winco, Model: 8400-IV
3
32.
78
33.
11
34.
Movable Anesthesia Chair, Manufacturer: NK/Novum, Model: NV2610B
2
35.
Patient Trolley Ambulating, Manufacturer: NK/Novum, Model: NK8000
2
36.
Stainless steel table Mayo
2
37.
Stainless Steel Table, Large, Manufacturer: UMF, Model: SS8008
13
38.
6
39.
Stool, Swivel Winco
7
40.
1
41.
4
Furniture for Jordan University Hospital - Ob/Gyn Department and NICU
42.
76
43.
Chairs for Meeting Room at Neonatal Department
20
44.
70
45.
Counter Chairs
35
46.
Filing Cabinet, Wood with Lock
30
47.
Guest Chairs for Meeting Room
50
48.
60
49.
Manager Desk Chair HON 2091 High Back with Leather Fabric
15
50.
Manager Desk Chair with Back Rest and Wire Mesh Fabric
12
51.
Meeting Room Table
26
52.
27
53.
Single Wood Bed with Mattress for Doctor-on-Call Room
18
54.
Waiting Area Chair
50
55.
Wooden Cabinet (2 Doors) for Doctor-on-Call Room
2
56.
Wooden Cabinet (3 Doors) for Doctor-on-Call Room
4
IT Equipment for Jordan University Hospital - Ob/Gyn Department and NICU
Desktop Computer: Intel® Core i3,/Compatible with Win 7, XP/4 GB
57.
58.
59.
1333 MHz DDR3 SDRAM/2 DIMM/Minimum 500GB 7200 rpm SATA 3.0
Gb/s min/ Integrated Intel HD/DVD/RW/ Sound line in, microphone / ALL
keyboards Arabic letters / 17 'inch/ 1366 x 768 / VGA and DVI-D connectivity
HP 19" LCD Monitor 1366x768 Resolution Monitor Stand and Power Cable
Network Printer: HP laserJet Pro P1606dn
101
7
7
2
#
Equipment Item
Quantity
Medical Equipment for Prince Zaid (RMS) Hospital - Ob/Gyn Department and NICU
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Warmer
Manual Resuscitation Bag, Ambubag
Oxygen Regulator with Humidifier
Phototherapy Unit, Manufacturer: GE, Model: Lullaby LED
Vacuum Regulator with safety Jar
DASH 4000
1
3
1
5
4
7
4
2
6
2
1
40
1
1
5
15
1
5
Medical Furniture for Prince Zaid (RMS) Hospital - Ob/Gyn Department and NICU
19.
20.
7
3
21.
2
22.
23.
3
2
24.
2
25.
26.
27.
28.
29.
30.
31.
32.
33.
Stainless Steel Table, Small, Manufacturer: Winco
102
38
6
1
1
3
1
8
6
3
#
Equipment Item
Quantity
Furniture for Prince Zaid (RMS) Hospital - Ob/Gyn Department and NICU
34.
35
35.
Bedside Comidone
3
36.
40
37.
Counter Chairs
25
38.
Doctor-on-Call Cabinet
4
39.
Doctor-on-Call Single Bed (2m x 0.9m) with mattress
4
40.
25
41.
Manager Desk Chair
20
42.
Meeting Room Table
16
43.
20
44.
Visitor Chairs
75
45.
35
103
#
Equipment Item
Medical Equipment for Jarash Hospital – Emergency Department
Quantity
1.
1
2.
3.
4.
5.
6.
7.
8.
9.
10.
Oxygen Flowmeter (British system with autoclavable humidifier)
2
6
1
3
2
1
1
20
2
11.
Sphygmomanometer Mobile on Stand (adult, pediatric and thigh cuffs),
Manufacturer: Baum, Model: 250
2
12.
Ultrasonic Nebulizer, Manufacturer: Drager, Model: Tropical Plus
13.
MP01205
14.
Vacuum Regulator (British system with safety jar for 500cc)
15.
Model: S12400
Medical Furniture for Jarash Hospital – Emergency Department
Crash Trolley (Red), Manufacturer: Waterloo, Model: UTRLA-33336916.
RED Accessories included IV Pole Oxygen cylinder with flowmeter and
regulator
17.
18.
10
19.
2
20.
11
21.
22.
23.
24.
25.
26.
27.
Patient Trolley Ambulating, Manufacturer: NK/Novum, Model: NK8000
6
3
2
2
5
4
5
104
1
15
2
4
11
15
#
Equipment Item
Furniture for Jarash Hospital – Emergency Department
28.
29.
Counter Chairs
30.
Manager Desk Chair, mesh/base fabric with foam mash back/chrome
31.
base adjustable height with full arms support, 5 casters base best quality
32.
Office Desk, wood, top cover consists of minimum 1.8cm plywood
faced with laminated sheet from both sides heavy duty design,
33.
w/screen/melamine or wood with metal legs powder coated no rust,
two drawers with lock, approximate size= 1200 X 700 X 720mm,
heavy duty frame design and finishing
34.
5 casters base best quality heavy duty design
35.
105
Quantity
12
15
12
12
14
12
40
14
#
Equipment Item
Quantity
Medical Furniture for Karak Hospital – Emergency, Ob/Gyn Dept. and NICU
1.
1
2.
4
3.
1
4.
5.
6.
7.
8.
3
2
8
4
7
9.
Warmer
5
10.
11.
12.
13.
14.
15.
16.
17.
Operating Surgical Light, Model: Trilight 5300
Oxygen Flowmeter (French system with autoclavable humidifier)
3
2
2
1
1
40
3
2
18.
includes two sets of reusable leads, probes and accessories
2
19.
Scale for Incubator, Manufacturer: GE, Model: Giraffe
20.
10
21.
Suction Jar, 2 Litre
2
22.
Ultrasound Nebulizer, Manufacturer: Drager
1
23.
Vacuum Regulator (French system with safety jar for vacuum regulator
500cc)
30
24.
Model: S12400
2
25.
DASH 4000
2
26.
4
106
#
Equipment Item
Quantity
Medical Furniture for Karak Hospital – Emergency, Ob/Gyn Dept. and NICU
27.
12
Crash Trolley (Red), Manufacturer: Waterloo, Model: UTRLA-33336928.
RED Accessories included IV Pole Oxygen cylinder with flowmeter and 4
regulator
29.
2
30.
18
31.
4
32.
3
33.
45
34.
3
35.
3
36.
Operating Table, Model: Saturn select 3.01
1
37.
Patient Trolley Ambulating, Manufacturer: NK/Novum, Model: NK8000 2
38.
2
39.
Stainless Steel Cabinet, Manufacturer: UMF, Model: SS7834
8
40.
4
41.
2
42.
6
43.
Swivel Stool, Manufacturer: Winco
7
44.
Wheel Chair, Manufacturer: Invacare
8
Furniture for Karak Hospital – Emergency, Ob/Gyn Dept. and NICU
45.
69
46.
Counter Chairs
30
47.
Doctor on call room bed
8
48.
Doctor on call room cabinet
4
49.
20
Manager Desk Chair, mesh/base fabric wih foam mash back/chrome
50.
base adjustable height with full arms support, 5 casters base best quality 26
Meeting Room Table, wooden top with melamine or metal screen,
51.
metal legs powder coated no rust, heavy duty design and finishing, size= 12
120 cm X 70cm
52.
35
53.
26/26
Training Room Chair, chrome/base fabric upholstery/chrome legs and
54.
25
handles, heavy duty design
55.
50
5 casters base best quality haevy duty design
56.
22
107
#
Equipment Item
Quantity
Medical Equipment for Pr. Iman (Ma’addi) Hospital - Ob/Gyn Department and NICU
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Warmer
Inpatient Bed, Manufacturer: Hill-Rom, Model: 305 Manual Bed with
Foam Mattress
Oxygen Flowmeter (French system with autoclavable humidifier)
Vacuum Regulator (French system with safety jar for 500cc)
Vital Sign Monitor for Operating Room, Manufacturer: GE, Model: DASH
4000
1
2
2
4
2
3
3
21
5
2
1
1
1
30
2
2
1
20
1
2
Medical Furniture for Pr. Iman (Ma’addi) Hospital - Ob/Gyn Department and NICU
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
Doctor-on-Call Single Bed with mattress and side comidone
Movable Anesthesia Chair, Manufacturer: Winco
108
5
2
2
1
1
2
1
1
3
2
6
4
3
#
Equipment Item
Quantity
Furniture for Pr. Iman (Ma’addi) Hospital - Ob/Gyn Department and NICU
34.
21
35.
20
36.
Counter Chairs
15
37.
12
38.
50
39.
Manager Desk Chair
12
40.
12
41.
14
#
Hospital NICUs that Received CPAP Units
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Dr. Jamil Tutanji (Sahab) Hospital / MOH
Al-Bashir Hospital / MOH
Al-Hussein (Salt) Hospital / MOH
South Shouneh Hospital / MOH
Mafraq Ob/Gyn Hospital / MOH
Queen Alia Hospital / RMS
Jordan University Hospital (JUH)
Prince Zaid Hospital / RMS
Jarash Hospital / MOH
Karak Hospital
Princess Iman (Ma’addi) Hospital / MOH
Abi Obaidah Hospital / MOH
King Hussein Medical Center / RMS
Ramtha Hospital / MOH
Yarmouk Hospital / MOH
Zarqa Hospital /MOH
Al-Nadim Hospital / MOH
Muath Bin-Jabal Hospital / MOH
Prince Ali Hospital (RMS)
Prince Hashem Hospital / RMS
Prince Hussein (Baqa’a) Hospital / MOH
Prince Rashed Hospital / RMS
Princess Raya Hospital / MOH
Princess Salma Hospital / MOH
Ghor Al-Safi Hospital / MOH
Ma’an Hospital / MOH
Princess Badia Hospital / MOH
Queen Rania Hospital / MOH
109
Quantity
1
10
2
1
2
3
3
2
1
2
1
1
2
1
1
2
2
1
1
2
1
1
1
1
1
2
3
1
Annex 7: List of Upgraded Training Centers including
Equipment and Furniture Provided
#
Location of Training Center (TC)
Governorate
1.
Central Training Center in MOH Building
Capital
2.
Al-Qadesiyyeh Primary Health Center
Jarash
3.
Eshtafena Comprehensive Health Center
Ajloun
4.
Al-Sareeh Comprehensive Health Center
Irbid
5.
Jabal Amir Hamza Comprehensive Health Center
Zarka
6.
Mafraq Comprehensive Health Center
Mafraq
7.
Sahab Comprehensive Health Center
Amman
8.
Ein Al-Basha Comprehensive Health Center
Balqa
9.
Public Health and School Health Building
Tafileh
10.
Ma’an Health Directorate
Ma’an
110
1. Equipment and Furniture Provided to the Upgraded Training Centers
Quantity per Training Center (TC)
#
Equipment & Furniture
Sahab
TC
Ain AlBasha
TC
Mafraq
TC
AlQadesiyya
TC
AlSareeh
TC
Eshtafena
TC
Jabal
Amir
Hamza
TC
Tafilah
TC
Ma’an
TC
1.
Training Room Table
14
12
14
14
14
14
12
12
12
2.
Training Room Chair
60
60
64
64
70
60
50
55
55
3.
4
4
4
5
4
4
4
4
4
4.
Manager Desk Chair with Arm
0
0
0
0
2
2
2
3
3
5.
1
2
1
0
1
2
2
3
3
6.
Office Desk (140cm)
1
0
1
2
0
0
0
0
0
7.
Round Table
4
4
5
4
5
4
4
4
4
8.
White Screen
1
1
1
1
2
0
0
1
1
9.
White Board
1
1
1
1
2
0
0
0
0
10. Flip Chart Stand
2
2
3
3
3
0
0
0
0
11. Desktop Computer
2
1
2
2
2
1
2
2
2
12. Printer
1
1
1
1
1
1
1
1
1
13. Digital Light Projector (DLP)
0
1
0
0
1
0
1
1
1
14. Air Conditioning (2-Ton)
2
2
5
2
0
2
2
5
4
15. Air Conditioning (3-Ton)
1
1
0
0
0
1
1
0
0
16. Photocopy Machine
1
1
1
1
1
1
1
0
0
17. Water Boiler (Kettle)
1
0
1
0
1
0
1
1
1
18. Water Cooler
1
0
1
0
1
0
1
1
1
111
2. Equipment and Furniture Provided to the Upgraded Training Center
at the Central MOH
#
Equipment & Furniture
Quantity
1.
Training Room Table
18
2.
Training Room Chair
60
3.
Manager Desk Chair with Arm
5
4.
2
5.
Round Table
6
6.
White Screen
3
7.
White Board
2
8.
Flip Chart Stand
4
9.
Desktop Computer
2
10.
Printer
1
11.
Podium
1
12.
Digital Light Projector (DLP)
1
13.
Movable Trolley for Datashow
1
14.
Column Speaker 15W @ 100V line with wall
bracket ASC-20T
8
15.
Column Speaker 30W @ 100V line with wall
bracket ASC-40T
2
16.
Power P.A. mixing amplifier 240W rms r max
GZ-240 UNIPEX
1
17.
Wireless Microphone VHF band 2 channel one
set 1 receiver with 2 hand held mics
1
18.
Wireless Microphone VHF band 2 channel one
set 1 receiver with 2 Tai clip mics
1
19.
Table Microphone Stand
2
20.
Wired Microphone 600 ohm AUD-98XLR
2
21.
Water Boiler (Kettle)
2
22.
Water Cooler
2
112
Annex 8: List of Community Health Committees
#
CHCs
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
Sahab
Jizeh
Naour
Bassah
Abu Nuseir
Al-Thiraa’ (Hai Nazzal)
Al-Nasser
Al-Hashimi Al-Shamali
Al-Jofeh + Al-Awdah (Um-Tineh)
Wadi El-Seer
Um-Nuwwara + Al-Qweismeh
Khreibat Al-Souq
Sweileh
Princess Basma
Jwaideh
Marka Al-Shamel
Amman
Um Al Basateen
Shafa Badran
Um Al Amad
Tlaa' Al Ali
Zarqa Jadida + Prince Abdallah
Dleil
Prince Hamza + Zawahreh
Tareq
Hai Al-Rasheed
Al-Musheirfeh Al-Shamel
Al-Tatweer Al-Hadari (Yajooz) + Al Falah7
Shbeib
Salalem
Fuheis
Zai
Mahes
Al Maghareeb
7
Developed into a Community Based Organization (CBO)
113
Amman
Zarqa
Balqa
#
CHCs
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
Al-Baqee’
Abu-Nuseir + Mubes
Yarqa
Ma'addi
Al-Sbeihi
Al Nahda
Allan
Madaba El-Gharbi
Zaatari
Khaldieh
Mansheyet Bani Hasan
Eidoun
Mansoura
Sakhra
Ein Janna
Rajeb
Anjara
Prince Hasan (Ajloun)
Al Wahadneh
Balila
Souf
Jarash + Al-Qadisiyya + Deir Al-Layat
Al Razi
Burma
Al-Kfeir
Sakeb
Kufur Khal
Qafqafa
Al-Mastabeh
Marsaa’
Beit Ras
Huwwara
North Shouna
Kraymeh
Rayyan
Buweida
Deir Abi Saeed (Koura)
Madaba
Mafraq
Ajloun
Jarash
Irbid
114
#
CHCs
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
Barqash
Hartha
Dahiyat Al-Hussein + Al Razi + Ibn Sina
Aydoun
Al-Sareeh
Huson
Al-Mazar
Kufur Youba
Al-Nuaymeh
Qumeim
Ramtha
Taybeh
Al Farooq
Ader
Taybeh
Majra
Al-Qaser + Al Rubbeh
Faqqou’
Manshiat Abu Hammour
Mutah + Al-Mazar
Ay
Mouab
Al Eis
Tafil
Bsaira
Eima
Petra
Ail
Ma'an
Manshieh
Husseinieh
Princess Basma
Al-Khazzan
Old City
Aqaba
115
Karak
Tafila
Ma’an
Aqaba
Annex 9: List of HSS II Publications
#
Publications
1.
Best Practices for Implementing the Mother-Newborn Package of Services at
Hospitals 2011 - Maternal
Best Practices for Implementing the Mother-Newborn Package of Services at
Hospitals 2011 - Neonatal
The Evidence-Based Clinical Guidelines for Contraceptive Use 2013 - Arabic
The Evidence-Based Clinical Guidelines for Contraceptive Use 2013 - English
The Evidence-Based Clinical Guidelines for Contraceptive Use 2013 – References
Emergency Health Care Clinical Guidelines 2010
Emergency Nursing Procedures 2011
Emergency Department Service Standards For General Hospitals
Evidence Based Medicine Manual 2011
Family Planning Strategic Plan 2013-2017 – Arabic
Family Planning Strategic Plan 2013-2017 – English
Knowledge Management Strategy 2011
Long Acting Hormonal Contraceptives; Contraceptive Implants
Clinical Guidelines 2011
Long Acting Hormonal Contraceptives; Contraceptive Implants
Training Module 2011
Maintenance System Policies and Procedures Manual 2012
MOH Job Descriptions 2011
MOH Strategy 2013-2017 – Arabic
MOH Strategy 2013-2017 – English
Standards for Providing Postpartum and Post-abortion Family Planning Services 2011
Diabetes Mellitus Guidelines for PHC 2012
Hypertension Guidelines for Primary Health Care 2012
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
116
Annex 10: List of HSS II Studies
#
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Studies
Family Planning Sentinel Surveillance 2010
Missed Opportunities for Family Planning, Client Exit Interview Study Report 2010
Situation Analysis Report for Readiness to Provide Intrauterine Device Insertion
Services in MOH Health Centers Where Midwives are Not Currently Providing this
Service 2012
Maternal and Child Health Supervision System Assessment 2012
A Decade of Task Sharing in Jordan: Lessons for Policy and Service Delivery 2013
Family Planning Services Provided at Selected MOH Hospital Outpatient Clinics –
Situation Analysis Report 2013
Decision Makers’ Attitudes towards Family Planning Services –
Qualitative Research Report 2013
Users of Traditional Family Planning Methods Needs Assessment –
Qualitative Research Report 2014
Effect of Family Planning Counseling Provided to Postpartum Women before
Discharge from Al-Bashir Hospital on the Adoption and Continuation of Modern
Contraceptive Methods – Study Report 2014
Uses and Attitudes regarding Family Planning in Ma’an - Qualitative Research Report
2014
Missed Opportunities for Family Planning, Client Exit Interview Report, 2011
Pre-Intervention Report: Assessment of Community FP Uses and Attitudes - Irbid
Initiative, 2013
Post Intervention Report: Assessment of Community FP Uses and Attitudes - Irbid
Initiative, 2014
National Midwifery Core Competencies & Career Structure Framework, 2014
Family Planning Sentinel Surveillance Newsletter, 2013
Health Care Providers Practices and Beliefs towards FP Methods, July 2013
Users of Traditional FP Methods – Needs Assessment Report, 2014
117
Annex 11: List of Training Programs and Number of Trainees
#
Component
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
Knowledge
Management
Training Title
ArcGIS I – Introduction to GIS
ArcGIS II – Essential Workflows
ArcGIS III – Performing Analysis
Building Web Application Using
the ArcGIS API for Silverlight
CISCO CCDA (Cabling &
Networking)
Computer Basic Skills
Creating & Publishing Maps with
ArcGIS Desktop
Editing Data with ArcGIS for
Desktop
Migrating to ArcGIS 10.1 for Server
QIS Maintenance Troubleshooting
A+ (Micro 2000 A+ Course)
Advance Microsoft Access
Advanced MS Excel & Access
Basic Advance Excel
Basic Microsoft Access
CCNA
Cisco CCNP Switching
Cvoice
Designing, Deploying, and
Managing a Network Solution
Java Programming Language (J2EE)
Microsoft C#
Microsoft C# Development
Language Basic and Intermediate
Microsoft SharePoint 2010
Installation and Configuration
MS PMP
Network+
Oracle DBA
Oracle DBA 1 & 2
PHP
SPSS
TOT for KM
Sub-Total
118
Total
Total
Total
Male
Female
Trainees
Trainees Trainees
0
5
5
0
4
4
0
4
4
0
4
4
6
4
10
35
169
204
0
4
4
0
4
4
0
5
30
3
17
1
3
14
6
6
4
5
93
7
33
7
7
2
3
4
4
10
123
10
50
8
10
16
9
10
10
38
48
4
3
5
7
9
10
3
7
10
8
14
22
7
30
5
7
1
3
11
218
17
111
4
5
6
19
20
616
24
141
9
12
7
22
31
834
#
Component
Total
Total
Total
Male
Female
Trainees
Trainees Trainees
Training Title
37.
PHC QI Collaborative Learning
Session
Accreditation
Accreditation Collaborative
Initiative
Advanced TOT for QUHs and
QD
Chronic Diseases Guidelines
Training (Hypertension &
Diabetes)
Coordinators’ Training
Workshop
Employee Engagement Model
38.
Essential Services Packages
31.
32.
33.
34.
35.
36.
39.
40.
41.
42.
43.
44.
45.
Infection Prevention
Management and Leadership
Skills
Monitoring & Evaluation
Primary
Operational Planning
Health Care
(HC Annual Action Plans)
& Quality
Improvement PHC Clinical Guidelines
PHC QI Cluster Specific Training
for HD Staff
PHC QI Collaborative
1035
2543
3578
607
2163
2770
118
266
384
17
16
33
105
309
414
9
8
17
29
86
115
86
311
397
14
72
86
147
173
320
29
23
52
150
266
416
20
11
31
44
100
144
459
1445
1904
46.
Referral
686
866
1552
47.
Refresher Supervision Training
12
30
42
48.
Strategic Planning
135
117
252
49.
Supervision System
144
821
965
50.
TOT for PHC
16
11
27
51.
TOT for Quality
Training on Indicators including
MCH Indicators
TOT for Referral System
Training on the Implementation
of HCAC PHC Medical Records
Standards
Updated Accreditation Standard
23
37
60
331
1196
1527
7
3
10
1
22
23
17
31
48
Sub-Total
4253
10932
15185
52.
53.
54.
55.
119
#
Component
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
Safe
Motherhood
Total
Total
Total
Male
Female
Trainees
Trainees Trainees
Training Title
Best Practices for Implementing
the Maternal Mother-Newborn
Package of Services (MNPS) Clinical TOT
Best Practices for Implementing
Neonatal (MNPS) Clinical TOT
Aseptic Preparation and
Administration for IV Medication
And Fluids Guidelines
Breastfeeding & LAM Education
for Maternal & Neonatal Service
Providers
CPAP System Training
Clinical Guidelines and Best
Practices for Mechanical
Ventilation
Essential Maternal Care & its Best
Practices Training Workshop for
Midwives
Essential Maternal Care & its Best
Practices Training Workshop for
Physicians
Essential Neonatal Care & its
Best Practices Training
Workshop for Nurses
Essential Neonatal Care & its
Best Practices Training
Workshop for Physicians
Midwifery Clinical Guidelines
NNC Clinical Guidelines for
Nurses
Orienting HSMCs on
Postpartum/Post-abortion FP
services
HSMC Confidential Inquiries
HSMC Operational Planning
Supportive Supervision for
HSMCs
TOT for EOC and NNC trainers
OJT for Maternal Best Practices
for Implementing the MNPS
OJT for Neonatal Best Practices
for Implementing the MNPS
Sub-Total
120
15
67
82
12
54
66
5
15
20
2
175
177
77
300
377
41
28
69
1
247
248
46
14
60
1
239
240
25
27
52
0
54
54
1
40
41
33
72
105
43
66
81
106
124
172
17
32
49
12
58
70
78
334
412
26
253
279
501
2196
2697
#
Component
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
Family
Planning
Total
Total
Total
Male
Female
Trainees
Trainees Trainees
Training Title
Breastfeeding & LAM Education
for the Maternal & Neonatal
Service Providers
FP Counseling and Standards for
PP/PM for Head Nurses of
Obstetric Wards and Clinics
FP Services QI Initiative
Fostering Good FP Practices
FP Counseling for Health
Providers at PHC and Hospital
Levels
FP Orientation for Non-MCH
Health Providers at PHC level
IUD Insertion for Physicians
IUD Insertion for Midwives
Logistics for Midwives
MCH Supervision
Orientation of Universities on
the Integrated FP Information
within Curricula
Orientation on FP PP/PM
Standards for Hospital Service
Providers
Orienting HSMCs on PP/PM FP
Services
Refresher TOT for RH/FP at
PHC and Hospital Levels
Refresher Training for RH
Trainers on the Updated
Evidence Based Clinical Practice
Guidelines for Contraceptive Use
Refresher Training on
Contraceptive Technology
Update, Including IUD Insertion
Refresher Training on FP for
Couples about to Marry
2
175
177
0
58
58
184
37
587
390
771
427
7
1195
1202
131
669
800
8
0
3
3
61
125
266
26
69
125
269
29
0
16
16
78
490
568
33
72
105
2
27
29
17
61
78
167
119
286
0
21
21
92.
Refresher Training on IUD
Insertion for Midwives
0
44
44
93.
Specific Counseling on Implanon
17
62
79
94.
TOT for RH/FP at PHC and
Hospital Levels
6
56
62
95.
TOT on LAHC; CI
5
6
11
121
#
Component
96.
97.
98.
Family
Planning
(continued)
99.
100.
101.
102.
103.
104.
Community
105. Health
106.
107.
108.
109.
110. Renovations
111.
112.
113.
114.
Human
115. Resources
for Health
116.
117.
118.
119.
Training Title
LAHC; CI
TOT on the Updated FP
Counseling Curricula
Training for RH Service Providers
on the Updated Evidence Based
Clinical Practice Guidelines for
Contraceptive Use
Training on the MCH Logbooks
Use of FP Educational Materials
for Midwives
Sub-Total
HP Role in Case Management
Supervision Skills in HP
TOT for HP
Community Activation Cycle
Participatory Rapid Assessment
Arab Women Speak Out
Men Advocacy Groups
Youth Peer Education
Advanced BCC
Sub-Total
OJT for Hospital Maintenance
Committees
Sub-Total
CPR TOT
CPR for PHC Service Providers
Updated CPR Guidelines for
Emergency Care Providers
TOT on Evidence Based
Medicine
Evidence Based Medicine
TOT on Emergency Health Care
Emergency Health Care Clinical
Guidelines for Physicians
Emergency Nursing Procedures
Human Resources for Health
Sub-Total
Total Number of Trainees
122
Total
Total
Total
Male
Female
Trainees
Trainees Trainees
86
101
187
0
17
17
69
410
479
4
98
102
1
393
394
860
5545
6405
209
8
7
712
517
0
161
177
19
1810
637
7
9
794
576
715
27
482
30
3277
846
15
16
1506
1093
715
188
659
49
5087
211
173
384
211
19
730
173
2877
2877
384
32
3607
280
240
520
5
1
6
83
29
38
6
121
35
182
55
237
112
29
1469
9322
215
54
3499
26238
327
83
4968
35560
Annex 12: Expenditure for Current Quarter (Year 5 – Quarter 4)
Budget Line Item
Jul-14
Aug-14
Sep-14
Total
SALARIES
$104,677.68
$70,300.20
$103,851.20
$278,829.08
FRINGE BENEFITS
$43,964.63
$29,526.09
$43,617.51
$117,108.23
OVERHEAD
CONSULTANT
Consultant fees
Travel and Per Diem Consultant
Consultant ODC's
$26,391.93
$17,151.80
$26,884.28
$70,428.01
$2,224.46
$0.00
$0.00
$906.44
$0.00
$0.00
$0.00
$0.00
$0.00
$3,130.90
$0.00
$0.00
TRAVEL AND PER DIEM (Excluding Consultant)
$7,398.26
$1,809.38
$3,165.50
$12,373.14
ALLOWANCES
$18,595.01
$9,679.63
$10,310.57
$38,585.21
OTHER DIRECT COSTS
EQUIPMENT/ GOVERNMENT PROPERTY
Equipment Procurement
Office equipment
SUBCONTRACTS
Subcontracts Renovation
Subcontracts (Excluding Renovation)
$179,479.75
$37,244.09
$88,051.30
$304,775.14
$452.88
$0.00
$890.00
$0.00
$0.00
$0.00
$1,342.88
$0.00
$56,563.44
$101,694.91
$45,092.65
$0.00
$1,514.83
$12,711.86
$103,170.92
$114,406.77
HANDLING CHARGE
$3,540.59
$1,031.56
$312.99
$4,885.14
GENERAL AND ADMINISTRATIVE
$72,969.08
$31,681.12
$52,476.71
$157,126.91
TOTAL ESTIMATED COSTS (Exclusive of Fee)
$617,952.62
$245,312.96
$342,896.75
$1,206,162.33
FEE
$38,622.03
$15,332.07
$21,431.04
$75,385.14
-$790.52
-$701.09
-$1,210.62
-$2,702.23
$655,784.13
$259,943.94
$363,117.17
$1,278,845.24
Burdened Salary Cap Adjustment
ESTIMATED COSTS PLUS FEE
123

The Road to Stronger Health Systems

Transcription

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