Ministry of Health and Social Welfare Republic of Liberia BASIC PACKAGE IMPLEMENTATION Dr' Bernice D

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Ministry of Health and Social WelfareRepublic of
LiberiaBASIC PACKAGE IMPLEMENTATION Dr.
Bernice Dahn, BSc, MD, MPH Chief Medical Officer
/ Deputy Minister of Health Services MOHSW
Republic of Liberia July 14, 2008
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PRESENTATION OUTLINE

• PLANNED ACTIVITIES vs. ACHIEVED
• ACHIEVEMENTS IN IMPLEMENTATION OF THE BPHS
• CHALLENGES
• LESSONS LEARNED

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ACTIVITIES PLANNED vs. ACHIEVED

• PLANNED
• Technical content of BPHS finalized by system
  level
• Update curriculum on BPHS and train trainers
• Training modules for BPHS developed

• ACHIEVED
• 100 Achieved.
• 75 achieved. TTM / BPHS Curriculum developed and
  available. CHWS pending
• 50 achieved. 3 BPHS Modules completed out of 6
  planned. IMCI, RH and Disease preparedness

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ACTIVITIES PLANNED vs. ACHIEVED

• ACHIEVED
• 40 achieved. IMCI, Malaria, HIV/AIDS and LSS
  training for TTM / TMs and health personnel
• 44.3 of existing health facilities are
  providing BPHS

• PLANNED
• Training of health facility personnel in BPHS
• 70 of existing health facilities are providing
  BPHS

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ACHIEVEMENTS BPHS IMPLEMENTATION 2

• Development of County Health Plans as priority
  for BPHS implementation
• Redeploy and recruit staff
• - Central level Program Managers
  (Donor Support to get skilled Staff)
• - County level CHT members Service
  delivery staff (Standardized
• Incentive
  Scheme)
• Implementation of BPHS in the first 40 of
  functional health facilities
• Development of technical documents to support
  implementation of County Health Plans
• - Training curriculum
• - Training modules
• - Essential Drug list
• - Clinical protocols and guideline
• - Clinical tools

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ACHIEVEMENTS BPHS IMPLEMENTATION 3

• - Integrated supervision checklist
• - Accreditation standards and tools
• - Revision of Data Collection forms for HIS
• - Contraceptive commodity security
• Training
• - Health systems management based on
  NHP
• NHP with emphasis on the BPHS
• - BPHS technical content
• - Skills training in BPHS service
  delivery
• - Awareness for the general public
  

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ACHIEVEMENTS BPHS IMPLEMENTATION 4
Introduction of the Quarterly Supervisory Visits
Quarterly Review of BPHS
Implementation Meetings - Check in
with CHTs on status of County Plan
implementation - Find workable
solutions to challenges in
implementing the BPHS
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ACHIEMENT 5 BPHS Pre-Accreditation Assessment

• OBJECTIVE
• Conduct a detailed assessment of each facility
  prioritized by CHTs for FULL implementation of
  BPHS within the first year
• Health Care Management Systems
• Health Services Delivery
• Findings will guide CHT, partners and central
  MOHSW priorities to achieve the first year target
  for accreditation in December 2008.
• Emphasize that by the time partners are ready to
  turn over health facilities to CHTs, the
  facilities are expected to be at least 85
  accreditation level.

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11 Assessment Categories, 4 Accreditation Levels
Accreditation levels lt75 weighted average -
not yet accredited (no stars) 75-84.9 - Pending
Provisional Accreditation (1/2 Star) 85-99.9 -
Provisional Accreditation (1 Star) 100 - Full
BPHS Accreditation (2 Stars)

• Assessment Categories
• Human Resources
• Facility Operations and Financial Management
• Pharmacy, Dispensary Store Room
• Drugs and Supplies
• Laboratory
• Infrastructure and Equipment
• Communicable Disease Control Infection
  Prevention
• Guidelines, Protocols, and Quality of Care
• Medical Records Management
• Referrals and Community Health Outreach
• Health Services
• Maternal and Newborn Health
• Reproductive and Adolescent Health
• Child Health
• Communicable Disease Control
• Mental Health
• Emergency Care

Scored using a weighted average with Health
Services as most important category (25)
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Preliminary data is now available

• A comprehensive finalized report will be
  available in August.
• Data is complete for all regions

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2
3
3
1
4
5
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Average scores by County
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Majority of priority facilities have a qualified
OIC
Is the OIC a full-time employee and a licensed
PA, RN, CM or LPN (physician for hospitals)?
Clinics
All facilities

• Large majority of facilities are run by qualified
  medical professionals

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Scores vary by facility type supporting agency

• Hospitals are providing higher quality care than
  health centers and clinics (on average)
• Only 14 of clinics and 15 of health centers
  scored above 75
• 42 of hospitals scored above 75
• MOHSW hospitals are out-performing NGO-supported
  hospitals.
• Data can compare individual partners within a
  county, region, or nationally comparisons can be
  by total score or in a single category, i.e.
  Maternal and Newborn Care

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Facilities with Sufficient Electricity

• Need for both generators and more fuel
• Patients bringing fuel especially for emergency
  services
• Opportunity to explore alternative options for
  lighting, particularly in clinics

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National distribution shows most facilities below
75
1/2 star
1 star
Not yet accredited
90 of data entered
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Very few facilities received 1/2 or 1 Star
90 of data entered
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Summary of Preliminary Findings ( national
averages)

• Strengths Across Counties
• Health Services
• Maternal and Newborn Health (87)
• Child Health (89)
• Medical Records Management (78)
• Complete records
• Standardized, organized systems

• Priority Areas for Further Improvement
• Facility Operations (57)
• Electricity
• Water
• Payment for services
• Drugs Supplies (52)
• Guidelines, Protocols Quality of Care (52)
• Referrals Community Health Outreach (49)
• Mental Health Services (25)

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Challenges for BPHS Implementation

• Establishing in service training facilities and
  Cost for training
• Increasing workforce (especially midwives)
• Improved incentives/salaries for health workers
  (Comprehensive Strategy Required and the
  resources to support it)

Human Resources

• Provision of additional equipment for facility
  operation
• Generators
• Solar Panels
• Medical equipment
• From BP cuffs and stethoscopes to x-ray machines
  and surgical supplies
• Cleaning and maintenance equipment
• Clean water for many of the health facilities
• Standardized financial records

Facility Operations

• Provision of a comprehensive supply chain for
  drugs, medical supplies and laboratory supplies
• Improved drug storage infrastructure in many
  facilities

Pharmacy, Dispensary Store room
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Challenges for BPHS Implementation

• Printing , training and distribution of
  MOHSW-approved National Patient Records

Medical Records

• Improved supply chain for laboratory reagents and
  supplies
• Provision of essential laboratory equipment at
  most health centers and several key hospitals
• Trained staff

Laboratories

• Provision of communication equipment and
  transport for referrals
• Provision of guidelines and/or criteria for
  patient referral
• Bad roads/no roads in most counties

Referrals Community Health Outreach
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Lessons Learned

• Freeze on healthcare fees, increased access and
  utilization of services through strong partner
  support
• Establishment of an incentive/salary scheme that
  does not take professional, educational
  qualification and tenure into consideration
  creates serious dissatisfaction
• Salaries competitive to professional market
  salaries are crucial for sustaining gains made in
  the health sector
• Strong partnership is key to success

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WHEN DECEMBER COMES

• will the story be different?

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Together we can make a difference..
Thank you