PATHS Final programme report: "Togetherness in Health" the Enugu ...

More documents

Recommendations

Info

to access for the Ministry of Health staff due to the computerisation of the payroll. By early 2008, threeLGAs were in the process of piloting a computerised payroll.Training was undertaken for seven district Human Resource Managers, who were later joined bya small number of people from the private sector. Efforts were made to develop potential staffingestablishments for each of the facilities, and proposals for the redeployment of staff, but work did notprogress very far until more accurate data could be accessed. This is an area that needs considerablefurther work to ensure that best use is made of staff through redeployment. Only then will it beclear whether or not additional staff need to be recruited. A further step will be the introduction ofperformance management, which will introduce the incentives and sanctions that will help increaseaccountability within the system.IMPACT/PPRHAAEarly in the PATHS programme the Peer and Participatory Rapid Health Appraisal for Action (PPRHAA)initiative was introduced as a mechanism for local change. This process provided a mechanismthrough which health providers, clients and members of the wider community could be involved in aprocess of facility or local government performance assessment.Standard assessment tools were developed for both primary and secondary care and an initialappraisal of six hospitals, two LGAs and two primary care facilities was undertaken in 2003. Theprocess identified the main areas that needed to be strengthened as well as the strategies for doingso. The process proved an effective means of involving providers and their managers in a detailed butrapid assessment of the institution, and of building local ownership of the subsequent change process.The appraisal component of PPRHAA was supported by a process of bringing together all participantsat an annual summit, which provided a learning opportunity for peers within the health sector.In September 2004 all the PATHS supported states came together to review progress withimplementing PPRHAA and discussed how the process itself could be further refined. As a result of thismeeting, PPRHAA evolved into IMPACT (Improving Management Through Participatory Appraisal andContinuous Transformation), a four-stage change management process. It will take some time beforethe four elements of IMPACT are fully implemented in the state.The IMPACT InitiativeCOMPONENT 1:Appraisal and Planning (PPRHAA)COMPONENT 4:Quality Assessment andRecognitionBETTER HEALTHSERVICES FORCOMMUNITIESCOMPONENT 2:Building Systems andCapacity (HMIS, IMCI, SMI,Financial Management,DRFs, etc.)COMPONENT 3:Integrated SupportiveSupervision (ISS)36 PATHS Final Programme Report
Over time, implementation of PPRHAA evolved. With theadvent of the DHS responsibility for PPRHAA was devolvedfrom a state PPRHAA team to seven district teams,although a small central core PPRHAA team continued toprovide support.In 2006 the Catholic Society for Nigeria rolled out PPRHAAacross all 18 of their facilities in Enugu.Participants trained in PPRHAA:2004: 1472005: 1512006: 432007: 46The spider diagram shows the scores achieved (out of 20 possible points) on completion of aPPRHAA exercise. The method provides a means of visually assessing functioning at the time ofthe appraisal and over time (as the PPRHAA is an annual event, comparisons can be made withprevious spider diagrams).A PPRHAA spidergram from Bishop Shanahan Hospital, EnuguPatient CareManagementServiceOutputInternalManagementClient andCommunity Views5101520Finance,Equipment andInfrastructureImplementation of a Drug Revolving Fund (DRF)The SMOH introduced a Drug Revolving Fund in an effort to prevent the frequent occurrence of “out ofstock syndrome”, a common feature of most public health facilities.Initial preparatory work prior to the establishment of a DRF included a scoping mission, followed by areview of the Enugu Central Medical Stores. In February 2004 consideration was given to the possibledecentralisation of the DRF to six District hospitals. Throughout 2004 and 2005 the wider PATHSprogramme supported the development of a DRF model for both primary and secondary care. Thisculminated in a roundtable event in February 2006 where the models were finalised. In Enugu thespecific issues relating to implementation of a DRF model within the context of a DHS were reviewed“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 37
Page 3 and 4: "Togetherness in Health"the Enugu E
Page 5 and 6: FORWARDI am very pleased on behalf
Page 8 and 9: 6 PATHS Final Programme Report
Page 11 and 12: Section 1:Setting the Enugu Context
Page 13 and 14: KEY FACTSHealth Indices: Comparison
Page 15 and 16: PHC centres and cottage hospitals i
Page 17 and 18: Section 2:Overview of the PATHSProg
Page 19: Stakeholder initiatives supported b
Page 22 and 23: PATHS ApproachEngagement Process wi
Page 24 and 25: Pro-poor FocusPATHS pro-poor focus
Page 26 and 27: “PATHS has indeed impacted very p
Page 28 and 29: the 56 Executive Secretaries of Loc
Page 30 and 31: Health Board and the Districts. The
Page 32 and 33: it was agreed that the original ide
Page 34 and 35: •••Working to an agreed timef
Page 36 and 37: PATHS provided much of the infrastr
Page 40 and 41: and the core DRF models used in oth
Page 42 and 43: Enabling Service DeliveryDeveloping
Page 44 and 45: Procurement of Drugs and EquipmentT
Page 46 and 47: equired in order to ensure that mor
Page 48 and 49: Training in the laboratory of Annun
Page 50 and 51: The services to be delivered were a
Page 52 and 53: Where care is givenEnugu’s health
Page 54 and 55: Enugu State Total Deliveries in Pub
Page 56 and 57: The selection process resulted in t
Page 58 and 59: Reduced maternal andinfant mortalit
Page 60 and 61: By the conclusion of the second ser
Page 62 and 63: With the advent of the DHS it was a
Page 64 and 65: Inter-Personal Communication and Co
Page 68 and 69: Intermediate Outputs1) The DHS stru
Page 70 and 71: 5) A culture of business planning a
Page 74 and 75: 4) The tendency for politicians to
Page 76 and 77: Abbreviations and AcronymsANCBCCBEO
Page 78 and 79: AcknowledgementsThe PATHS programme
Page 80 and 81: Master trainersSMoH/faith based sec
Page 82: 80 PATHS Final Programme Report

PATHS Final programme report: "Togetherness in Health" the Enugu ...

Create successful ePaper yourself

Delete template?

Save as template?