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

In order to ensure that the MSP could beprovided effectively, extensive training wasprovided in a number of key clinical areas in aneffort to improve the services on offer within thefacilities.The work to introduce the MSP took place overthe period 2005-2008. The expectation is that bymid 2008 35% of the health facilities in Enuguwill be in a position to deliver the MSP.“Before PATHS, the maximum patient turnoutper day was never more than 12. At times,by the end of the month we may score up to150 patients. But now with the training andorganisation, coupled with the communitymobilization, we record up 30-40 patients aday.”Dr Enih DHB CEODevelopment of Packages of CareIn order to support improved service delivery,and informed by the agreed Minimum ServicePackage, a decision was made to develop anumber of Packages of Care (POC). The ideawas that these would provide a guide to bestpractice.Work commenced in 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 the packages of care was tohelp all staff provide safe and relevant care forany patient. They identified where care shouldbe given, and who the care provider shouldbe. Each POC was based on a holistic model ofcare, detailing preventive, promotive, curativeand rehabilitative care activities at each level.The skills and capacity available at each level ofcare were recognised in the development of thepackages.A package of care wasdefined as:“a protocol to be observed by ALL healthcare providers, which includes wherehealth care will be provided, by whom, andto what basic and specific standards.”* * *Enugu Packages of CareMedical: acute respiratory tract infection,common worm infestation, gastro-enteritis,HIV/AIDS, hypertension, malaria, maternalhealth, measles, osteoarthritis, diabetes,IMCI, TBSurgical: Basic surgery, Gynaecology,Obstetrics, Trauma/OrthopaedicsEach package contained a limited number of standards of care including:• Every patient is treated with dignity, respect and confidentiality• Every patient will have prompt access to appropriately trained health care providers in anemergency, or within an hour of arrival at the facility• Every patient is given enough information to make an informed 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 using good infection control practices• The health facility is kept clean, safe and user-friendly.“Togetherness in Health” the Enugu Experience in Health Sector Reform, 2002-2008 49