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Development Intervention UpdateDevelopment Intervention UpdateRuangwa District (Hospital)Ruangwa District (Hospital)
September 2009September 2009
J.J. BeekhuisJ.J. Beekhuis
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Area’s of intervention
• Reproductive Health Care
• Operating Theater
• Health Service Management
Maternity wardMaternity ward
TheaterTheater
Duty boardDuty board
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Development in general
• Development in so-called:– “Hardware”
• Buildings• Room organization (effective use of space)• Equipment
– “Software”• Quality of patient-care • Staff behavior• Management
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Hardware
Teaching roomTeaching roomMinor theaterMinor theater
Maternity wardMaternity ward
Pulse-oximeterPulse-oximeter
Overbed tableOverbed table
Former storeFormer store
Dark minor theaterDark minor theater
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SoftwareInformation Information distributiondistribution
Partograph usePartograph useBad behavior: needles in binBad behavior: needles in bin
Behavioral changeBehavioral change
Education...Education...
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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
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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
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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
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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
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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
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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
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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
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Patient Flow Chart
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Patient Flow Chart
Result:
doctor sees patient before it is to late!
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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)
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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
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Thanks for your attentionThanks for your attention&
KARIBU Ruangwa