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

Enabling Service DeliveryDeveloping theDistrict HealthDeveloping the DistrictThe following key issues were tackled so as to enable serviceSystemHealth Systemdelivery across the DHS to progress smoothly:•Infrastructure development• Planned preventive maintenanceStrengtheningStrengthening• underpinning Procurement of drugs and equipment underpinningsystemssystems• Production of a drug directory• Enabling Development of laboratory servicesservice deliveryEnablingservice deliveryDeveloping the DistrictHealth SystemStrengtheningunderpinningsystemsEnablingservice deliveryPromoting improvedservice Infrastructure delivery in Development Promoting improvedthe facilitiesPromoting improvedservice delivery inservice delivery inFollowing many years of neglect and the absence the facilities of anythe facilitiesmaintenance plan, all aspects of health facility infrastructure inIncreasing demandfrom Enugu communities required attention. An initial report commissioned byIncreasing demandPATHS in 2003/2004 focused on the need to tackle the neglectedIncreasing demandfrom communitiesfrom communitiesinfrastructure and proposed that the six District Hospitals (Agbani,Increased patientNsukka, Ikem, Awgu, Enugu Ezike, Udi) should be prioritised forpatronageIncreased patientrehabilitation. Enugu Metropolitan District’s hospital was initiallyIncreased patientpatronagepatronagePark Lane Hospital, but during the period of the programme thisReduced maternal andfacility was undergoing renovation and refurbishment so that itinfant mortality andReduced maternal andincreased could operate consumer as a tertiary facility thus leaving the District without aReduced maternal andinfant mortality anddemand District in both hospital. publicinfant mortality andincreased consumerand private managedincreased consumerdemand in both publicprimary and secondarydemand in both publicA detailed needs assessment of the hospitals and private was managed carried outcare facilitiesand private managedprimary and secondaryin mid-2004 by a small team from the SMOH and the Ministryprimary and secondarycare facilitiesof Works (MOW). However, this resulted in the production ofcare facilitiesoverly ambitious and poorly costed plans. External support wasprovided by PATHS to support the process of designing a workableinfrastructure programme.Developing the DistrictDeveloping the DistrictHealth SystemDeveloping the DistrictHealth SystemHealth SystemIn most locations there was no need to expand the number of health facilities. Instead a rationalisationprogramme was required which focused onStrengtheninga comprehensive overhaul of key buildings.StrengtheningStrengtheningunderpinningTwenty-six underpinningunderpinningbuilding companies pre-qualified and systems contracts were awarded to four contractors.systemssystemsHowever, the quality of their work was extremely variable; only one contractor met the requiredstandards and deadlines without very considerable supervision. This put a heavy burden on all thoseEnablinginvolved in the management of the initiative and Enabling resulted in considerably more international inputEnablingservice deliverythan was originally anticipated.service deliveryservice deliveryA limited budget and the problems with supervision meant that the programme of work Promoting at each improvedPromoting improvedsiteservice delivery inPromoting was restricted improved to essential remodelling of the service main delivery buildings. in Wherever possible, water supplies werethe facilitiesservice improved delivery and electrical in connections reinstated the to facilities the national grid. The work was kept as simple aspossible the facilities to reduce the burden of future repairs and maintenance.Increasing demandEach hospital required a different approach,Increasingand everydemandfrom communitieseffort was made to ensure that the ideas andIncreasing demandfrom communitiesrequests of the State Health Board, which was responsible for the hospitals, were taken on board.from communities40 Increased PATHS patient Final Programme ReportpatronageIncreased patientpatronageIncreased patientpatronage