PATHS Final programme report: "Togetherness in Health" the Enugu ...
PATHS Final programme report: "Togetherness in Health" the Enugu ... 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
In order to carry out the necessary buildingworks a clear strategy was preparedincluding:••••••Contracting a local architectProduction of architectural drawingsPre-qualifying contractorsEstablishing a tender procedureOpening of bids by a tender committeeAwarding of contracts• Final agreement on the contract priceand documentation• Monitoring of the building work• Signing off on the completed building• Payment of contractors• Final checks• Completion of payment• Documentation of the whole processRenovated corridor with patients at AgbanihospitalThe final decision about how the work was to beprioritised was made by the Commissioner forHealth.Because of a change in priorities, only four outof the six district hospitals initially earmarked forrehabilitation benefited from the infrastructureprogramme. However, the programme alsosupported the rehabilitation of the Awgu Schoolof Midwifery.“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 41
- 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 38 and 39: to access for the Ministry of Healt
- Page 40 and 41: and the core DRF models used in oth
- 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
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- Page 68 and 69: Intermediate Outputs1) The DHS stru
- Page 70 and 71: 5) A culture of business planning a
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- 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
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In order to carry out <strong>the</strong> necessary build<strong>in</strong>gworks a clear strategy was prepared<strong>in</strong>clud<strong>in</strong>g:••••••Contract<strong>in</strong>g a local architectProduction of architectural draw<strong>in</strong>gsPre-qualify<strong>in</strong>g contractorsEstablish<strong>in</strong>g a tender procedureOpen<strong>in</strong>g of bids by a tender committeeAward<strong>in</strong>g of contracts• <strong>F<strong>in</strong>al</strong> agreement on <strong>the</strong> contract priceand documentation• Monitor<strong>in</strong>g of <strong>the</strong> build<strong>in</strong>g work• Sign<strong>in</strong>g off on <strong>the</strong> completed build<strong>in</strong>g• Payment of contractors• <strong>F<strong>in</strong>al</strong> checks• Completion of payment• Documentation of <strong>the</strong> whole processRenovated corridor with patients at AgbanihospitalThe f<strong>in</strong>al decision about how <strong>the</strong> work was to beprioritised was made by <strong>the</strong> Commissioner forHealth.Because of a change <strong>in</strong> priorities, only four outof <strong>the</strong> six district hospitals <strong>in</strong>itially earmarked forrehabilitation benefited from <strong>the</strong> <strong>in</strong>frastructure<strong>programme</strong>. However, <strong>the</strong> <strong>programme</strong> alsosupported <strong>the</strong> rehabilitation of <strong>the</strong> Awgu Schoolof Midwifery.“<strong>Toge<strong>the</strong>rness</strong> <strong>in</strong> Health” <strong>the</strong> <strong>Enugu</strong> Experience <strong>in</strong> Health Sector Reform, 2002-2008 41
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