Development Intervention Update Ruangwa District (Hospital)

1. Development Intervention UpdateRuangwa District (Hospital) September 2009 J.J. Beekhuis

2. Maternity ward Area’s of intervention • Reproductive Health Care • Operating Theater • Health Service Management Theater Duty board

3. Development in general • Development in so-called: • “Hardware” • Buildings • Room organization (effective use of space) • Equipment • “Software” • Quality of patient-care • Staff behavior • Management

4. Former store Hardware Minor theater Teaching room Dark minor theater Maternity ward Pulse-oximeter Overbed table

5. Information distribution Behavioral change Software Education... Bad behavior: needles in bin Partograph use

6. 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

7. 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 Team OPD = Out Patient Department

8. SOP = Standard of Procedure Reproductive Health Care Intensified care room Emergency medicine box

9. 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 maternity

10. 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? On the side of the operating table Above the patient

11. 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

12. Walki-talki system Health Service Management • New communication system installed • Training for Clinical Officers planned • Plan for installment Vital Sign Post • Patient Flowchart in discussion phase

13. Patient Flow Chart

14. Patient Flow Chart Result: doctor sees patient before it is to late!

15. 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)

16. 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

17. Thanks for your attention & KARIBU Ruangwa