Problem Solving Module: Addressing Kaduna State's PHC Overcrowding Dilemma

1. National Primary Health Care Development Agency Leadership Development Academy Course title: Problem Solving Module (Exercise templates) Date: July 2020 CONFIDENTIAL AND PROPRIETARY Any use of this material without specific permission of NPHCDA is strictly prohibited

2. Introduction to problem case: Kaduna Overcrowding’s Dilemma Kaduna State Government has spent N50,000,000 on publicity campaign to achieve its 2020 primary health care (PHC) revitalization goal. The campaign led to a massive influx of the residents to primary health care centres around them. As a result of the influx of clients, primary health indicators like immunization coverage and HIV testing numbers have drastically improved. However this influx also caused the clients at the PHC centers to wait for long period – over 45 minutes, before they can meet the service provider for consultation. From previous assessment, the state understands keeping clients for over 15 minutes before consulting with the service provider, inhibited majority of the population from using the PHC centres. To avoid losing its recent gains, the Kaduna SPHCB ES has requested technical assistance from the NPHCDA, in solving the long patient wait- time in its PHC centres. As a fellow within the NPHCDA, your Director has asked you to help solve the Kaduna SPHCB challenge. Now in your groups, define the problem to help Kaduna SPHCB solve their problem | Source: Team analysis 2

3. DEFINE THE PROBLEM 1 Example of a good problem statement “Type your problem statement here” • Specific • Measurable • Action-oriented • Relevant (to the key problem) • Time-bound “How can the Kaduna SPHCB reduce the patient wait-time, before consultation, at all its primary health care centers to a maximum of 15 minutes by the end of 2020?” | Source: Team analysis 3

4. DEFINE THE PROBLEM 1 Practice exercise: We already defined the problem completely to guide our process How can the Kaduna SPHCB reduce the patient wait-time, before consultation, at all its primary health care centers to a maximum of 15 minutes by the end of 2020? Initial situation  High influx of clients  Extra waiting time Decision makers  HCH  ES Other stakeholders  HCWs  Clients and caregivers Success criteria  Reduced waiting time to less than 15 mins  Maintain the influx of clients Constraints  Inadequate HRH  Inadequate functional PHCs Project scope  Increase the number of Revitalized PHCs in Kaduna state | Source: Team analysis 4

5. BUILD AN ISSUE TREE 2 Practice exercise: Let us develop an issue tree to answer Kaduna’s overcrowding problem NOT EXHAUSTIVE Revitalize more PHCs Create more service delivery points Create more service delivery points ( Outreaches, mobile sessions and medical missions) Deploy more resources to PHC( Human and financial) “How can the Kaduna SPHCB reduce the patient wait-time, before consultation, at all its primary health care centres to a maximum of 15 minutes by the end of 2020?” Engage more HCWs Employ more HCWs to new and existing PHCs Engage Community volunteers Build capacity of HCWs on Health service delivery Provide the necessary equipment to deliver services Strengthen the HCWs to deliver services HCWs should delegate less important task to other HF staff Integrate service delivery approach Design an HCW rooster, add more staff to peak periods HCWs to be efficient in time management HCWs should schedule appointments for clients | Source: Team analysis 5

6. PRIORITIZE POSSIBLE ACTIONS 3 Practice exercise: Let us prioritize the possible actions identified on the issue tree using the feasibility-impact matrix Activities X High 1. Revitalize more PHCs 2. Create more service delivery points ( Outreaches, mobile sessions and medical missions 3. Engage more HCWs 4. Engage Community volunteers 5. Build capacity of HCWs on Health service delivery 6. Provide the necessary equipment to deliver services 7. HCWs should delegate less important task to other HF staff 8. Design an HCW rooster, add more staff to peak periods 9. HCWs should schedule appointments for clients 2 x 5 x 8 7 x 4 Feasibility 1 x 9 6 3 Low Low High Impact | 6 Source: Team analysis

7. PRIORITIZE POSSIBLE ACTIONS 3 Practice exercise: Our issue tree then reduces to the highest priority activities NOT EXHAUSTIVE xxx xxx xxx “How can the Kaduna SPHCB reduce the patient wait-time, before consultation, at all its primary health care centres to a maximum of 15 minutes by the end of 2020?” xxx xxx xxx xxx Build capacity of HCWs on Health service delivery Strengthen the HCWs to deliver services Provide the necessary equipment to deliver services HCWs should delegate less important task to other HF staff Integrate service delivery approach Design an HCW rooster, add more staff to peak periods HCWs to be efficient in time management HCWs should schedule appointments for clients | Source: Team analysis 7

8. GATHER DATA AND ANALYZE 5 Practice exercise: Let us design an analysis and work plan using our Kaduna exercise ▪ Take the plan to optimize health worker to patient ratio during service delivery hours ▪ Determine which analyses you should do to develop a recommendation ▪ Conduct the analyses and compile your results Hypothesis (or end product) Analysis to prove hypothesis Information sources/ needs Issue HCWs should schedule appointme nts for clients Provide the necessary equipment to deliver services • Effect of distributing patient appointment time across the operational hours of the day on service delivery rate Effect of having the requisite working tools Hospital records of patient’s visit to determine the peak client times Inventory list of Health equipment and essential medicines • • Kaduna SPHCB needs to reduce the patient wait- time, before consultation, at all its primary health care centers to a maximum of 15 minutes • • • Source: Team Analysis | 8