The services to be delivered were agreed as:MSP <strong>in</strong> Primary Health CareMSP <strong>in</strong> Secondary Health CareMaternal Health•Ante-Natal Care (from 12 to 40 weeks)•Ante-Natal Care (from 12 to 40 weeks)•Safe Delivery•Safe Delivery•Post Natal Care (for up to 6 weeks)•Post Natal Care (for up to 6 weeks)••Basic Emergency Obstetric Care (BEOC)Rout<strong>in</strong>e Immunization (<strong>in</strong>clud<strong>in</strong>g TetanusToxoid)••Comprehensive Emergency Obstetric Care(CEOC)Rout<strong>in</strong>e Immunization (<strong>in</strong>clud<strong>in</strong>g TT)•Family Plann<strong>in</strong>g•Family Plann<strong>in</strong>gChild Health•Growth monitor<strong>in</strong>g•Growth monitor<strong>in</strong>g•Nutritional supplements•Nutritional supplements•Rout<strong>in</strong>e Immunization•Rout<strong>in</strong>e Immunization•Health Education•Health Education••••Treatment and management of m<strong>in</strong>orailments <strong>in</strong>clud<strong>in</strong>g malaria, diarrhoea,acute respiratory <strong>in</strong>fectionFebrile convulsionsDeworm<strong>in</strong>gMale circumcision••••Treatment and management of m<strong>in</strong>orailments <strong>in</strong>clud<strong>in</strong>g malaria, diarrhoea,acute respiratory <strong>in</strong>fection, febrileconvulsionsDeworm<strong>in</strong>gIntermediate SurgeryManagement of Emergency Tracheotomy•Male circumcisionAdult Health•M<strong>in</strong>or surgery for <strong>in</strong>cision and dra<strong>in</strong>age ofabscesses, abrasions and cuts•Intermediate Surgery – <strong>in</strong>cision anddra<strong>in</strong>age of abscesses, abrasions and cuts•Treatment and management of variousailments e.g. diabetes screen<strong>in</strong>g,hypertension, malaria, arthritis,gastroenteritis and TB.•Treatment and management of variousailments e.g. diabetes screen<strong>in</strong>g,hypertension, malaria, arthritis,gastroenteritis and TB, HIV/AIDS•Acute respiratory <strong>in</strong>fections, cardiacfailure, peptic ulcers, sexually transmitted<strong>in</strong>fections and pelvic <strong>in</strong>flammatorydiseases48 <strong>PATHS</strong> <strong>F<strong>in</strong>al</strong> Programme Report
In order to ensure that <strong>the</strong> MSP could beprovided effectively, extensive tra<strong>in</strong><strong>in</strong>g wasprovided <strong>in</strong> a number of key cl<strong>in</strong>ical areas <strong>in</strong> aneffort to improve <strong>the</strong> services on offer with<strong>in</strong> <strong>the</strong>facilities.The work to <strong>in</strong>troduce <strong>the</strong> MSP took place over<strong>the</strong> period 2005-2008. The expectation is that bymid 2008 35% of <strong>the</strong> health facilities <strong>in</strong> <strong>Enugu</strong>will be <strong>in</strong> a position to deliver <strong>the</strong> MSP.“Before <strong>PATHS</strong>, <strong>the</strong> maximum patient turnoutper day was never more than 12. At times,by <strong>the</strong> end of <strong>the</strong> month we may score up to150 patients. But now with <strong>the</strong> tra<strong>in</strong><strong>in</strong>g andorganisation, coupled with <strong>the</strong> communitymobilization, we record up 30-40 patients aday.”Dr Enih DHB CEODevelopment of Packages of CareIn order to support improved service delivery,and <strong>in</strong>formed by <strong>the</strong> agreed M<strong>in</strong>imum ServicePackage, a decision was made to develop anumber of Packages of Care (POC). The ideawas that <strong>the</strong>se would provide a guide to bestpractice.Work commenced <strong>in</strong> April 2004. The decisionabout what packages of care should bedeveloped emerged through consultation.Between April 2004 and July 2005 twelvemedical and four surgical packages of care weredeveloped.The purpose of <strong>the</strong> packages of care was tohelp all staff provide safe and relevant care forany patient. They identified where care shouldbe given, and who <strong>the</strong> care provider shouldbe. Each POC was based on a holistic model ofcare, detail<strong>in</strong>g preventive, promotive, curativeand rehabilitative care activities at each level.The skills and capacity available at each level ofcare were recognised <strong>in</strong> <strong>the</strong> development of <strong>the</strong>packages.A package of care wasdef<strong>in</strong>ed as:“a protocol to be observed by ALL healthcare providers, which <strong>in</strong>cludes wherehealth care will be provided, by whom, andto what basic and specific standards.”* * *<strong>Enugu</strong> Packages of CareMedical: acute respiratory tract <strong>in</strong>fection,common worm <strong>in</strong>festation, gastro-enteritis,HIV/AIDS, hypertension, malaria, maternalhealth, measles, osteoarthritis, diabetes,IMCI, TBSurgical: Basic surgery, Gynaecology,Obstetrics, Trauma/OrthopaedicsEach package conta<strong>in</strong>ed a limited number of standards of care <strong>in</strong>clud<strong>in</strong>g:• Every patient is treated with dignity, respect and confidentiality• Every patient will have prompt access to appropriately tra<strong>in</strong>ed health care providers <strong>in</strong> anemergency, or with<strong>in</strong> an hour of arrival at <strong>the</strong> facility• Every patient is given enough <strong>in</strong>formation to make an <strong>in</strong>formed choice• Every patient will have a clear and comprehensive medical record• Every patient will have easy and quick access to affordable drugs• Every patient will be cared for by staff us<strong>in</strong>g good <strong>in</strong>fection control practices• The health facility is kept clean, safe and user-friendly.“<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 49
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