Presentation at the National Capitalization conference of the Swiss-Ukrainian Mother and Child Health Programme (Kyiv, Ukraine, April 23, 2015) http://motherandchild.org.ua/eng/event/768

1. Efficient Management:
Success Stories of Partner
Facilities
Associate Professor, Chair of Social
Medicine, Health Care Organization and
Medical Law, Ivano-Frankivsk NMU
Zoya Tsikhon
23 April, 2015
Kyiv

2. Training for Managers and Implementation of
Management Instruments
Efficient management practices and approaches are
key to good functioning of a facility and the system.
 If a manager has a strategic vision and experience
using management instruments, he will be able to
identify weaknesses and strategies to overcome
them much more easily.
The Program has offered Head Doctors short
trainings on relevant management issues.
Topics for the trainings were chosen based on
managers’ practical needs. Also, international
experience was actively involved, and it was
adapted to Ukrainian circumstances.

3. Topics for Trainings for Health Care Managers
Health Care
Quality
Management
Elements of Strategic
Management Situational Analysis
Stakeholder Analysis Decision Making

4. Topics for Trainings for Health Care Managers
Health Care
Quality
Management
Technological
Management
Implementing
Principles of Energy
Efficiency
Monitoring Concept
and Instruments
Regionalization of
Perinatal Care
Perinatal Audit and
BABIES Matrix
Fundraising
(involvement of
additional resources)

5. Head doctors who were trained under Program say it allowed them
to change their management vision and approaches, that facilitated
their work, they were able to get a more in-depth view of the
processes, they better understood efficient management
mechanisms.

6. Many Management Instruments Have Been
Implemented in Partner Facilities
 Understanding monitoring principles
allows Head Doctors to constructively
perceive monitoring results and
recommendations provided.
 With the help of ВАВІЕS matrix HCF
review perinatal indicators that lets
them identify problem issues.
 SWOТ analysis and stakeholder
analysis are used by managers in their
routine work for situation assessment
and decision-making

7. Many Management Instruments Have Been
Implemented in Partner Facilities
 Knowledge about fundraising has
helped some Head Doctors to
involve additional resources to
renovate their facilities and
purchase medical equipment
 OpenMEDIS software (see
Section on Implementing ICT-
based Instruments) was installed
in 55 partner facilities to analyze
information about medical
equipment and decision-making
regarding its maintenance and
use

8. Implementing Principles of Energy
Efficiency at Pilot Health Care
Facilities

9. That’s How Decisions Were Made…
After training on energy
efficiency the majority of
hospitals took measures on
facilities insulation. After
implementing energy saving
technologies more
comfortable conditions were
created both for patients
and staff

10. Principles of Energy Efficiency Were
Implemented in All Pilot Regions
In total, in partner regions principles of energy efficiency
were implemented in 64 partner facilities.
For example:
In Ivano-Frankivsk Oblast, 65% of partner HCFs were transferred to
alternative types of heating.
Estimated annual savings will be 12,97 MIO UAH or 2,128 MIO m3 of
natural gas.
Investors input 6,7 MIO UAH

11. Energy Efficiency in Kolomyia
In January 2015 the Kolomyia CRH has changes the gas heating to
alternative heating by wood chips that gives the opportunity to save
approximately 25% of the budget for energy

12. Examples of Implementing Principles of
Energy Efficiency in Volyn Oblast
HCFs in Volyn
Oblast
What has been done for
energy efficiency
Expenditures
(UAH)
Outcome
Manevytska
Central District
Hospital
Reconstruction of a
boiler room and
installation of a
heating boiler Кальвіс
950-М (fuel type –
wood chips)
547 500
Fuel consumption to
produce 1 Gcal has
decreased by 1.8 %
Over the heating season
cost of saved energy
resources will be 69,2 K
UAH
Rozhischenska
Central District
Hospital
Reconstruction of a
gas boiler room and
transfer to solid fuel
(wood chips)
1 200 000.00
UAH
Comfortable heating rate
was provided, economic
benefit due to this
introduction is about 600
K UAH per year

13. Examples of Implementing Principles of Energy
Efficiency in Volodymyr-Volynskiy Terrritorial Medical
Unit
HCFs in Volyn
Oblast
What has been done for
energy efficiency
Expenditures (UAH) Outcome
Laundry Installing automatic
laundry machines
70 000 Savings
8 000 UAH/month
CDH Installing boilers to get
hot water
65 000 Estimated savings
12 000 UAH/month

14. Reconstruction and Renovation of
Facilities Providing Perinatal Care

15. The Program Helped Partner Facilities
Managers to:
 correctly determine priorities for
renovation/reconstruction of health care facilities and for
purchasing of medical equipment
 get funds for the HCF from various sources
(communication with administration, using principles and
practices of fundraising)
 assess and apply a principle of rational zoning prior to
reconstruction or renovation

16. Application of fundraising knowledge helped
some Head Doctors use additional resources
to renovate facilities and purchase medical
equipment

17. Mohyliv-Podilsk Hospital
Head Doctor: “…Our desire to participate in the program inspired
large-scale changes in infrastructure and equipment!”
 480 thousand UAH were allocated from the Oblast
budget
 Local budget money were involved
 Money of sponsors were involved
 We applied recommendations of Program experts
regarding correct zoning

18. Mohyliv-Podilsk Hospital
Vinnitsa Oblast

19. Rozhischenska CDH
Volyn Oblast
Activities:
Participation in fundraising training in Kyiv
Development of design estimates for project fundraising
Looking for potential investors interested in project
implementation
Negotiations with investor (Charitable Foundation of an
MP of Ukraine Serhiy Martyniak European Vector)

20. Rozhischenska CDH
Volyn Oblast

21. Tlumatska CDH
Ivano-Frankivsk Oblast
 Visit of Mother and Child Health Program experts to the
facility
 Facility’s staff decision and management commitment
regarding necessary reconstruction
 Developing technical documentation with help of
Program experts
 Submitting proposals to the Oblast level (OSA and Oblast
Council) – 350 thousand UAH allocated
 Support by stakeholders (San Gaben company 200
thousand UAH, businesses, entrepreneurs)
 Using money of local government – 250 thousand UAH

22. Ivano-Frankivsk Oblast
Tlumatska
CDH
Verkhovinska CDH
Dolinska CDH
Kosivska CDH
Kaluska CDH

23. Ivano-Frankivsk Oblast Perinatal Center
Reconstruction of the old admission department
area was driven by objective reasons:
Construction of a new building was stopped;
Patients and visitors complained;
New Head of OSA Health Department visited the OPC;
Looking for potential investors;
Involving OPC staff to renovations.

24. Ivano-Frankivsk Oblast Perinatal Center

25. To reconstruct admission department of the Oblast
Perinatal Center it took:
12 thousand UAH from
Oblast budget;
Money from investors
and charity (dairy
production facility of
Ivano-Frankivsk, gas
station, Caritas,
charitable
contributions).

26. All Maternity Departments at Partner Oblasts Have
Implemented New Technologies in Perinatology
Kolimiyskiy MH
Gorodenkivska CDH
Rozhischenska CDH
Ivano-Frankivsk OPC Mohyliv-Podilska OHIC

27. New Perinatal Technologies
Gorokhivska CDH
Khmilnytska CDH
Kalynivska CDH
IFOPCH

28. Medical Equipment
The Program together with Head Doctors,
Oblast HD/MOH, AR Crimea, regional
teams has defined key needs of facilities
regarding medical equipment to provide
perinatal care. Medical equipment have
been purchased for 56 partner facilities
through bidding performed per
international requirements.

29. Steps performed by Facilities Managers
Regarding Purchasing New Medical Equipment
 Actual medical equipment needs assessment.
 Analysis of associated costs (consumables, spare parts,
maintenance and repair).
 Training of personnel who will be working with the new
equipment for its efficient use.
 Creating technical conditions for the equipment to work
properly.
 Issue of maintenance for future.

32. During one of the previous phases of the Program it was suggested to
establish Medical Equipment Maintenance Centers as part of health care
system
In Ivano-Frankivsk Oblast Pediatric Clinical
Hospital, Medical Equipment Maintenance
Office was established under the Program, it
continues to work today too

33. Regionalization of Perinatal Care and Health
Care Reform in Ukraine
Another success story.
Under the Program, it was the first time in Ukraine that efforts were
made to involve family physicians to provision of perinatal services.
A Perinatal Services Package was developed and approved by the
Order of MOH Ukraine of 12.07.2010 N 560
 “About the Pilot Project to Implement Perinatal Services Package”
 It was proposed to implement perinatal care system in accordance
with levels І-ІІ-ІІІ of care provision.
These steps were the first attempt to regionalize perinatal care in pilot
Oblasts of Ukraine.

34. Implementation of management instruments by partner
facilities managers yielded the following changes in terms of
quality of perinatal care provided:
Key performance indicators were improved:
 Normal delivery rate has increased up to 80-86%.
 Partner deliveries rate has increased 7-fold and on average
it is 85-93%.
 Death rate in maternity hospitals of the 1st level decreased
5-7 times (down to 0 - 1%0).
 Neonatal morbidity rate has decreased 2-3 times.
 Implementing in utero transportation system and delivery
before 32 weeks gestation at level ІІІ – 85-90%.

35. A lot has been changed
Sometimes it is hard to believe we used to do it
differently …
Switzerland Ukraine, Ivano-Frankivsk

36. We learned how to save babies with severe
abnormalities
Switzerland Ukraine, Ivano-Frankivsk
Victoria S.

37. We learned how to care about babies with
extremely low birth weight
Sashko К. , birth weight 940g

38. Effect of Project Activities on Infant Mortality
(of the 1st year) in Ivano-Frankivsk Oblast
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Проект
«неонатологія"
Реєстрація ДС з
масою 500гр
Прект
«Перинатальне
здоров'я»
Програма «Здоров’я матері і дитини»

39. Effect of Project Activities on Infant Mortality (of
the 1st year) in Ivano-Frankivsk Oblast

40. Over the years of implementation of the Swiss-
Ukrainian Program in Ivano-Frankivsk Oblast
(1997-2015), the infant mortality rate has
decreased from 15.8% in 1997 to 6.4% in 2014
– 2.5-fold.
Over the same period the same rate for the
whole of Ukraine has decreased 1.8-fold.

41. Thank you for your attention !

42. THANK YOU ALL!!!