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Development Intervention Update Ruangwa District (Hospital). September 2009 J.J. Beekhuis. Maternity ward. Area’s of intervention. Reproductive Health Care Operating Theater Health Service Management. Theater. Duty board. Development in general. Development in so-called: “ Hardware ”

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Development intervention update ruangwa district hospital

Development Intervention UpdateRuangwa District (Hospital)

September 2009

J.J. Beekhuis

Area s of intervention

Maternity ward

Area’s of intervention

  • Reproductive Health Care

  • Operating Theater

  • Health Service Management


Duty board

Development in general
Development in general

  • Development in so-called:

    • “Hardware”

      • Buildings

      • Room organization (effective use of space)

      • Equipment

    • “Software”

      • Quality of patient-care

      • Staff behavior

      • Management


Former store


Minor theater

Teaching room

Dark minor theater

Maternity ward


Overbed table




Behavioral change



Bad behavior: needles in bin

Partograph use

Hospital assessment july 2010
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
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

Reproductive health care

SOP = Standard of Procedure

Reproductive Health Care

Intensified care room

Emergency medicine box

Challenges repr health
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

Outcomes operating theater
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

Challenges o t
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

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

Patient flow chart1
Patient Flow Chart


doctor sees patient before it is to late!

H s management challenges
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
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 attention


KARIBU Ruangwa