Strengthening service delivery: integrated, family-centered, coordinated, evidence-based, quality services
Social service system strengthening
“The social service system is defined as the [combination] of interventions, programs and benefits that are provided by governmental, civil society and community actors to ensure the welfare and protection of socially or economically disadvantaged individuals and families.” (2) Critical to a strong social service system is a well-planned, well-trained, supported social service workforce that is capable of delivering quality, sustainable, multi-sectoral services.
Strong country ownership and availability of quality services requires addressing capacity of the social service system at all levels. Yet, this system is in an emerging state in most countries, and responsibilities are dispersed among a broad array of actors and organizations. To increase capacity and sustainability, programs must strengthen coordination and strive to include a continuum of care and services. Many service delivery problems are the result of gaps within the social service system, made worse by the lack of communication and coordination within and among government ministries, different levels of government, civil society and communities.(3) These coordination issues hinder the system’s ability to provide strong service delivery. Increasing government and civil society coordination and improving information exchange among service providers ultimately improves service delivery and strengthens the social service system’s ability to support the most vulnerable children and families.
Strengthening service models
To strengthen and scale up quality services for families and children, many African countries either have completed or are engaged in the process of mapping and assessing their child protection systems’ policies, practices, resources and structures.
Based on assessments like these, system strengthening programs can be designed and coordinated to improve service delivery models by tailoring services to local populations’ needs and offering a range of family-centered, context-specific social protection interventions including, education, HIV prevention, health promotion, economic strengthening, and reintegration. (4) The Inter-agency Group on Child Protection Systems in sub-Saharan Africa identifies three specific examples of service delivery models for vulnerable groups in different contexts:
- The Minimum package of services – health, child protection and social protection, used in Southern African Development Community [SADC] and Rwanda; (5)
- The Continuum of care model, providing services from prevention to promotion to protection, used in Zambia, Guinea Bissau, Senegal, Ethiopia, Malawi, Swaziland and Ghana; and
- The Democratic Republic of Congo’s Protected Communities model, often used in emergency and post-conflict settings. (6)
Integrated service delivery systems can serve as good models and suitable entry points for system strengthening. Several promising examples of integrated service delivery have emerged from a review of unpublished program reports. For example, Mozambique’s PMTCT program integrated an At Risk Child Consultation Clinic (ARCC), with services for HIV-exposed infants, into its Maternal and Child Health program, thereby increasing the number of HIV-exposed infants who received follow up care and treatment. Additionally, Lesotho restructured its ANC services and used task-shifting to create a model of care that integrated HIV care and treatment within ANC. The integration of services decreased the average time for ART initiation from four to eight weeks from diagnosis to 10-14 days, more than doubling the number of pregnant women starting ART every month. (7)
Information and Communication Technology (ICT) and service delivery
Where it is available and affordable, Information and Communication Technology (ICT) can help move service delivery towards a more integrated care model. (8) ICT can strengthen collaboration and coordination among service providers, government offices and donors. Advances in technology have the potential to transform data collection and analysis, strengthen monitoring and evaluation, and maximize the effective use of resources. (9) In their study of opportunities and risks of using technology to deliver social protection for pilot projects in Malawi, Devereux & Vincent (2010) found that using ICT to deliver social protection increases project efficiency and cost-effectiveness, particularly at large scale, given the expense of technology-based delivery systems. When combined with accurate targeting, technology can increase effective service delivery by empowering women and girls, expanding national economic benefits, and increasing flexibility and broader banking access. Using effective risk reduction strategies, such as information regulations and data security, ICT opportunities can considerably outweigh risks. (10)
Key approaches to strengthen service delivery models:
- Strengthen the social service system at every level including: ministries of social welfare, district social service offices, civil society organizations (CSOs), community social- and para-social workforce, families and communities served, and finance and information systems. (11)
- Advocate for the establishment, adoption, and implementation of national OVC standards for service delivery, and support governments and CSOs to monitor, evaluate, and conduct quality assessments to strengthen services. (12)
- Promote country and local ownership and capacity to deliver evidence-based, integrated services that deliver high-quality, coordinated interventions for vulnerable children and families.
- Map social service systems – identify gaps and areas for improving coordination and measuring service integration to maximize coverage of the most vulnerable.
- Increase community capacity to collect, analyze and respond to data to ensure that service delivery systems meet the needs of the most vulnerable children and families. (13)
- Support the strength of families and communities; offer family-centered, integrated services including economic strengthening, health and social support. (14)
- Examine the availability, feasibility and opportunities for using technology to improve service delivery.