Most staff of global health projects tend to focus on improving project inputs and outputs such as numbers of healthcare workers trained or equipment provided and not health system outcomes. Most projects do not design and implement strategies to improve the outcomes of the health system they are to support, but focus on improving their own outputs. To be successful and ensure aid is used in the most effective way, it is essential to focus on outcomes.
In my book “Aid Effectiveness in Global Health” I introduced the “Project_Program_System” paradigm, the PPS paradigm for short. (Sorry for introducing another acronym in global health. I know there are too many in development assistance already, but this one is really important!). PPS means that in order to effective, every project must be designed to contribute to improve one or a number of the country’s health programs and improve the outcomes of the health system.
For example, a project designed to improve the care of people living with HIV/AIDS must demonstrate it improves the performance of the country’s HIV/AIDS program and how well the country’s health system delivers the right quantity and quality of prevention, care and treatment and community-based follow up services. The way to know if the PPS is happening is to focus on and measure outcomes. A health system outcome is a result of the health care delivery process. For example, here are a number of outcomes to monitor and improve, I like to put them into question format to help focus on outcomes:
- Is the number of people diagnosed and treated for HIV/AIDS going up or down?
- Is the number of virally-suppressed people going up or down?
- Is the number of patients lost to follow-up going up or down?
- What is the coverage rate for the HIV/AIDS program in the country? in the project’s catchment area?
To get started to focus on outcomes, I suggest you focus on a few “high-level” outcomes and track them consistently. Focus on outcomes that do have an impact on the epidemiological situation of the country first. If high child and maternal mortality rates are the most important problem in the country in terms of numbers of lives lost, focus on child and maternal health outcomes first. Here are two examples:
- Number of women who received at last 4 antenatal visits, had a supervised delivery and healthy postnatal period
- Number of newborns that are breastfed, immunized and followed up monthly
Finally, you can improve your outcomes by turning them into %. Use denominators to report how much of a difference your interventions and projects are making:
What is the % of patients living with HIV/AIDS that are lost, or died in your catchment area? The whole country?
What is the % of women who completed 4 antenatal visits and had a supervised delivery in your catchment area? The whole country?
What is the % of children that are fully immunized in your catchment area? The whole country?
Focus on outcomes and you will have answers to these and other questions. Contact RGH today to find out how you can improve the effectiveness of your project or program. I look forward to helping you get started to focus on health outcomes. If we work together, we can make PPS standard practice in global health.
