health for all

1. 1

2. HEALTH
POLCY
MANAGMENT
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3. TIME MANAGEMENT
• Time is a precious commodity that can not be replaced .
• Once gone it is unrecoverable
• Time management is;- The process of planning
and exercising conscious control over the amount of time
spent on specific activities especially to increase
effectiveness ,efficiency or productivity.
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4. Time management method
1. Preparing a health unit schedule
• A schedule is required when a different activity , or the
same activity in different place , occurs at intervals or over
time.
• To make a schedule, each different activity or each
different place is listed and assigned dates in turn.
• It requires a map showing routs , distance and travel time .
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5. Con….
2 Preparing a program chart
• A program is a plan that out line a series of events
or activities that will take place in the future.
• It include what will be done, where it will take
place, who will do it and when it will occur .
• There are several ways to make program chart.
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6. Contu ..
• A convenient way is list the activities ;-
 In the order
 In which they must occur
 Down the left side of the page
 Then fill in weeks or months across the tope of the
page and show with a line opposite each planned
which activity it is take place.
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7. Cont…
3 Preparing a year calendar
• In the course of a year many things happen that are
outside the normal routine.
• These may be matters of administration such as annual
stocktaking, estimates, annual reports, and statistical
returns, or they may be external events such as festivals,
elections, courses and seminars, or visits by dignitaries.
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8. Contu ..
• To see the whole year at once, it is very visits by
dignitaries.
• To see the whole year at once, it is very convenient to
have a one page annual calendar or year-planner
pinned on the wall, with important events marked.
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9. Contu..
• This has two functions.
• It acts as a reminder of definite events, usually
outside one's control.
• It shows where it is possible to fit in new events such
as special meetings or periods of travel.
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10. Physical infrastructure management
• One important responsibility in managing a health facility
is maintaining logistics.
• The kinds of issues that need to be addressed in relation
to these activities are:
Medical equipment may not be maintained properly
The budget for maintenance activities is low
There is a lack of skilled persons to maintain the
medical equipment.
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11. con
These problems are commonly seen in public hospitals.
As a consequence of the problems, medical and non-
medical equipment cannot be operated in an optimal
way, and the equipment have shorter life spans in
technical usage.
 This situation will increase costs and reduce the
effectiveness of the operational unit, leading to loss
of competitive advantage for the hospital/HC.
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12. MENTENANCE IN HOSPITAL
• Usually maintaining logistics especially in hospitals
is performed by a unit such as the Maintenance
Department
• The workshop equipment – machinery, hand tools
and a basic stock of consumables should make it
possible to perform:
• Electrical work
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13. Count ..
• Mechanical work (including plumbing)
• Welding
• Tasks involving electronics and medical equipment
• Carpentry
• Minor painting and masonry work.
• Automobile repair and maintenance may also be included
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14. Maintenance in the Health
Centers
• Work shops at the primary hospitals and their
technicians have to organize the technical operations
for all health facilities throughout the entire woreda .
Wherever possible one staff member per facility
should be appointed ‘maintenance officer’ and
trained to carry out relevant maintenance work
(support personnel are often suitable for such tasks).
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15. CONT….
• Major maintenance activities for the health
centre and dispensary staff comprise
 Preventive maintenance, including: regular inspection, proper
use, proper storage and regular cleaning/servicing;
 Simple repairs
 Reporting and referral to the next maintenance level.
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16. Count …
Items to be maintained or repaired at these levels include:
* Buildings (roofs, doors, windows, etc.)
* Lighting and electricity
*Water supply
* Refrigeration
* Laboratory equipment
* Sterilization
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17. HEALTH FACILITY
RESOURCES MANAGEMENT
Management Systems at the Point of Care
• In attempting to improve national, regional, and district
level health systems and their management systems, it is
easy to lose sight of the individual, day-to-day encounters
between clients and health service providers.
• These encounters take place at points of care, wherever
the client and provider meet. They include the full range
of care, such as what’s provided by:
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18. Count ..
• They include the full range of care, such as what’s
provided by:
• A village health volunteer providing health information to her
neighbors in their homes;
• A nurse treating a child’s high fever in a community health center;
• A surgeon or other medical specialist caring for patients in a
tertiary hospital.
• Point of care is where strong management systems and
subsystems come together to support high-quality preventive and
curative health services.
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19. Cont…
• The PDSA cycle is as follows:
Plan:
• The objective is to establish admission criteria to reduce the
number of low-risk patients in labor and delivery who are in false
or latent labor.
Do:
• After a test (implementation) of one week, 10 patients were
identified as being at low risk. On the midnight shift, the nursing
staff did not realize that the criteria should be applied then as
well and did not use them for the first three nights. 19

20. Contu
Study:
• Of the patients admitted before the test, 5 of 7 (71%) had
dilation less than 4 cm.
• After the test, only 3 of 9 (33%) were admitted prior to
4cm dilation. Nursing staff were fairly comfortable, but
had trouble convincing two of the patients that it was safe
to go home. The three physicians were very comfortable
with the admission policy. There was still come confusion
about who was at low risk. The test is working, but needs
to adjust several areas before proceeding.
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21. CONT…
Act:
• Continue using the criteria, revisit the low risk criteria and
specify. Expand the test to other physicians who are
willing to participate. Consider a triage area for patients
who cannot go home but are not ready to be admitted.
• For the next cycle, establish triage area and revise criteria
for low risk.
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22. Count ..
• The strength of the PDSA approach is rooted in its
ability to test changes on a small scale.
• By testing on a small scale, changes can be rapidly
seen at small expense, and experiences and feedback
quickly gained to improve the action.
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23. What is quality or effective health
care?
Quality or effective health care
• There are many different definitions of quality in
health care.
• Definitions of quality of care include such
characteristics as efficiency, efficacy, effectiveness,
equity, accessibility, comprehensiveness, acceptability,
timeliness,
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24. Contu..
• Other attributes to describe quality health care
include provisions of education for the patient and
family about pertinent health issues, inclusion of the
patient and family in treatment planning and
decision-making and patient satisfaction.
• Ensuring safety and support in the care environment,
reducing mortality and morbidity and improving the
quality of life and functional health status of the
patient may also be seen as quality attributes.
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25. Cont…
Problems of quality of care
• Problems in quality can relate to the structure,
process or outcomes of care.
Structure encompasses such features of the setting as
the number and types of personnel the age and type of
equipment and other facilities and aspects of
organization such as committee structures.
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26. Cont…
• Process :
* includes the activities involved in providing and
receiving care. Process indicators of quality may
involve such aspects as timeliness, continuity and
patient compliance.
* The process by which care is delivered is also
important, although a good process may not always
lead to high quality outcomes.
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27. • Outcomes of care involve the effects of health care
on the health status of the patient and may include
measures of quality of life, functional status and
patient satisfaction.
• There has been increasing interest in not only
examining the structure and the process of care, but
also in determining the outcomes of care.
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28. 5.3Health facility culture and system
performances
• Defining organizational culture
• Organizational culture:
• is a pattern of basic assumptions that a group has
invented, discovered or developed in learning to cope
with its problems of external adaptation and internal
integration
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29. • is represented in a system of shared values
defining what is important
• is represented in norms defining appropriate
attitudes and behaviors, that guide each
individual’s attitudes and behaviors. (Joann
Keyton, 2005)
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30. 5.4 Management of Referrals
Health facility level
• Each health facility will have a focal person for
referral with the following roles and responsibilities:
• Coordinates the overall referral activities within the health
facility
• Records and reports the referral activities to facility
management
• Compiles, analyzes, and interprets referral data to improve the
referral service
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31. • Involvement in the quality assurance programs of the
referral system by participating in regular review meetings
within and outside the health facility.
• Performs supportive supervision
• Ensures feedbacks are sent back to referring health facility
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32. Cont…
Regional and Woreda health offices
• Regions create mechanisms to improve community
awareness of the referral system through community
communications channels, use of health extension
workers
• Ensure emergency medical services are given without any
restriction
• Design mechanisms for coordination of referral activities
within the region and feedback system
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33. • Regions create mechanisms to improve community awareness
of the referral system through community communications
channels, use of health extension workers
• Ensure emergency medical services are given without any
restriction
• Design mechanisms for coordination of referral activities
within the region and feedback system
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34. Con….
• Designate regional focal person /unit to oversee the
referral activities
• Receive, compile, and analyze data and gives feedback to
facilities to improve the referral system
• Hold regular meetings in the region to analyze reports
,hears referral complaints, distributes guidelines, and
increases public awareness
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35. Cont…
The Ethiopian Referral system
Roles and responsibilities of the referring health
professional
• Should know what, whom, when and where to refer
• Should fill the referral form with all the necessary
information and attach relevant documents
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36. • Explains to the patient the rationale, reasons for choice of
doctor or facility, preparation, expected cost, and possible
outcome of referral
• Should be available to answer queries from the referral
coordinator or receiving facility about the referral if necessary
• Secures result of the referral
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37. Cont….
Roles and responsibilities of the referral coordinator
• Responsible for both referrals out and received
referrals
• Facilitates scheduling based on the level of priority
for consultation, i.e. emergency, urgent and routine
cases
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38. • Utilizes the following communication methods:
letter, telephone, email, photocopied reports sending,
personal contacts, etc.
• Ensures the availability of service or professionals at
the receiving health facility before referral
• Facilitates transportation for emergency cases
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39. Con…..
Roles and responsibilities of the referring facility
• Performs a situation analysis regarding the process of
referral in the facility
• Ensures that staff are well aware of the referral system
• Ensures continuous supply of standardized referral forms
are available
• Keeps directory of health services and facilities in the
defined geographic area
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40. • Ensures proper recording of all referral activities
• Devises mechanisms to track referrals
• Provides transportation in emergency conditions
• Assigns referral coordinator with clear roles and
responsibilities
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41. Cont….
Roles and responsibilities of receiving health
professional
• Responds promptly to consultation requests
• Reports in detail all pertinent findings and
recommendations to the referring health worker and
may outline opinion to the patient (feedback with all
required information and recommendation)
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42. • Communicate with the patient or family
• Does not attempt by word or deed to
undermine the role of the referring health
worker
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43. cont….
Responsibilities of the receiving
facility
• Conducts situation analysis of the current referral
process to identify gaps and strengths
• Assigns referral coordinator with clear roles and
responsibilities
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44. • Devises follow up plans and ensures the plans are
communicated to the referring facility /professional
• Ensures staff at points of entry clearly understand
the referral process
• Provides continuing education about the referral
process to staff and the community
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45. Cont..
• Ensures referred patients are seen by appropriate professionals
• All investigations and documents attached with the referral
form from the referring facility should be considered to protect
patients from unnecessary cost
• Ensures that all prescheduled referrals are attended without
undue delay
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46. GROUP MEMBER
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