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Development Intervention UpdateDevelopment Intervention UpdateRuangwa District (Hospital)Ruangwa District (Hospital)

September 2009September 2009

J.J. BeekhuisJ.J. Beekhuis

Area’s of intervention

• Reproductive Health Care

• Operating Theater

• Health Service Management

Maternity wardMaternity ward

TheaterTheater

Duty boardDuty board

Development in general

• Development in so-called:– “Hardware”

• Buildings• Room organization (effective use of space)• Equipment

– “Software”• Quality of patient-care • Staff behavior• Management

Hardware

Teaching roomTeaching roomMinor theaterMinor theater

Maternity wardMaternity ward

Pulse-oximeterPulse-oximeter

Overbed tableOverbed table

Former storeFormer store

Dark minor theaterDark minor theater

SoftwareInformation Information distributiondistribution

Partograph usePartograph useBad behavior: needles in binBad behavior: needles in bin

Behavioral changeBehavioral change

Education...Education...

Hospital AssessmentJuly 2010

• Total score: 55% (68% 2009)• Main challenges:

– No Radiology (got 0%)– Operating Theater in poor condition– OPD-services far below standard

In my opinion total-score ‘09 &’10 are not comparable

but 55% (‘10) and division over different areas does give good impression

of poor present situation

Result QMT meeting

• DW for first time involved in management issue’s !

• SMART action plan 2010• Start made in increasing power of QMT• 2 fruitful meetings in which focus on:

– Radiology (purchasing ultrasound)– Operating Theater– OPD-services

QMT = Quality Management TeamOPD = Out Patient Department

Reproductive Health CareOutputs achieved:

Hardware

-General organisation of equipment of the ward (purchasing and organising instruments)

-Separate room for premature and ‘intensified care’ of mother next to nursing post

-Maternal Emergency Medicine Box with medication in place (maintenance-system installed)

-Essential SOP’s updated and organised, in process of being placed on wall

Software

-On the job training continuously performed, mainly nurses and midwifes.

-Neonatal resuscitation trainings continuing, difficult for nurses to perform acc to standard!

-Partograph training conducted, difficulties in improving correct fill-in and use.

Intensified care roomIntensified care room

Emergency medicine boxEmergency medicine box

SOP = Standard of Procedure

Challenges Repr. Health

• Hardware– No Filing system – No Ultrasound

• Software– Neonatal resuscitation not up to standard– General patient care not up to standard– Preventive support of labor not up to standard– No correct use of partograph

Filing system maternityFiling system maternity

Outcomes Operating Theater• Start theater renovation plan (ingineer)• Pulse-oximeter• Overbed (Mayo) table• Minor theater relocation

• On job training• Creating awareness

about hygiene

Where to place instruments?Where to place instruments?

On the side of the operating tableOn the side of the operating table Above the patientAbove the patient

Challenges O.T.

• Poor Anaestetic skills and behavior

• Fear for spinal anesthesia (mat death)

• Poor hygiene & sterility by staff (all levels)

• Sometimes long Incision-Decision time

• No proper data-collection Wound infect

Health Service

Management

• New communication system installed

• Training for Clinical Officers planned

• Plan for installment Vital Sign Post

• Patient Flowchart in discussion phase

Walki-talki systemWalki-talki system

Patient Flow Chart

Patient Flow Chart

Result:

doctor sees patient before it is to late!

H-S-Management challenges

• Quality Management, CHMT, CMT & CCHP are not working together

• No proper prioritizing of problems

• OPD services below standard

• Daily ward rounds often not done

• Poor communication between staff and management (absenteeism)

Main challenges project

• Absenteeism of leaders !

• No accountability for responsibility

• Lack of finances (priorities)• MoiC needed for, but not interested in,

doctors meeting or QMT meeting (so it seems)

MoiC = Medical officer in Charge

Thanks for your attentionThanks for your attention&

KARIBU Ruangwa