Joint WHO Meetings with Ministry of Health on the WHO Integrated Management for Emergency and Essential Surgical Care

Transcription

1 Report Facilitators Meeting Joint WHO Meetings with Ministry of Health on the WHO Integrated Management for Emergency and Essential Surgical Care February, 2007 Muscat, 1

2 Contents...Pages 1. Executive Summary Background Objectives Third International Anaesthesia and Critical Care Conference WHO meeting for facilitators Discussions Recommendations and Action Plan Conclusions Acknowledgements Annexes...7 Annex 1: Participants list Annex 2: Programme Agenda Annex 3: WHO training tools for improving skills of health personnel (Available at 2

3 1. Executive summary A Joint WHO-Ministry of Health (MoH) meeting on the WHO Integrated Management for Emergency and Essential Surgical Care (IMEESC) for Facilitators was held during February, 2007 in Oman. In addition the WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC) was shared and the WHO IMEESC toolkit was introduced in the Third Oman International Anaesthesia and Critical Care Conference. The overall objective of this meeting was to strengthen capacities of health personnel in emergency and essential surgical care (EESC). The emergency, essential surgical and anaesthesia care is available at the tertiary and secondary care level, but require standardization and quality assurance through better referral system and continuing professional development. There is often delayed access to life saving surgical and anaesthesia interventions at the Primary Healthcare facilities. The issue of patient and health personnel safety in emergency and surgical and anaesthesia practices was highlighted. The focus should be on first referral hospitals, including strengthening the referral services. There is an interest to develop a guideline for Oman for trauma and emergency, but there is no consensus among the specialists as they have been trained by various trauma programs in USA, U.K and Cuba. There is a need for strengthening medical and nursing students training skills on emergency and essential surgical care towards reducing death and disability in trauma, pregnancy related complications and infection (including HIV). The generic WHO Best Practice Protocols on Clinical Procedures Safety and Guidance towards training curriculum could meet the need for a standardized training. The meeting concluded with a consensus by MoH and WHO country office and IMEESC was seen as a way towards improving the first referral level health facility s services. A committee (Task force) on EESC will be established to develop strategies for rolling out the IMEESC package in line with the GIEESC. There was a consensus to, integrate the EESC to first referral Health Facility and local adaptation of the WHO IMEESC toolkit for strengthening capacities through a standardized training for the frontline health personnel performing life saving emergency and surgical (including anaesthesia) interventions in Oman. 3

4 2. Background Oman is located in the extreme southeast corner of the Arabian Peninsula. The population is more than 2.3 million of which slightly less than a quarter (23.9%) are expatriates. The most densely populated areas are Muscat and Al Batinah, comprising 55% of the population. The rest of the population is scattered in the remaining vast area which is a big challenge for provision of health and other public services. The MoH is the main provider of preventive and curative health care with 49 hospitals and 4483 beds in The Ministry of Defence, the Royal Oman Police, Petroleum Development of Oman and Sultan Qaboos University Hospital also provide health services with 5 hospitals and 601 beds. The private sector plays a small role consisting of mostly private clinics and three private hospitals (two in Muscat and one in Dhofar). Although the private sector has a small role, the government is interested in stimulating its growth. The ratio of physicians per population has increased from about 0.2 in 1970 to 16.4 in The ratio of general practitioners to specialists has been around 2.0 for the past 5 years. The ratio of other health personnel has also been continuously increasing and currently stands at 37 per for nurses, 1.8 per population for dentists and 3.0 per for pharmacists. Oman is heavily dependent on expatriate workers in the health sector, but Sultan Qaboos University Medical College and various MoH training institutes for nurses and other health professions have opened to train Omani health professionals. The health system in Oman is divided into four levels: national, regional, wilayat and local. All the policies and strategies for the public health programmes are planned and developed at the national, regional and wilayat levels. Since many patients continue to visit hospitals for primary health care, efforts are being made to streamline the referral system. Hospital autonomy for selected regional hospitals was introduced in 2001 to improve the cost effectiveness and efficiency of hospital services. Oman s health system is dominated by the public sector (accounting for more than 98% of the hospital beds). The Government covers all Omanis and expatriates working in the public sector. The MoH has just established a National Hospital Accreditation Committee and expects to have international accreditation for all the hospitals. Road traffic accidents are a major concern. In 2003, there were road traffic accidents, with the rate of injuries at 289 per and 25 deaths per population. More than 14% of deaths among people aged 15 years and above are due to road traffic accidents. The annual cost of these accidents to the health system has been estimated to be at least RO 3.3 million or 3% of the health budget. Because of the impact of road traffic accidents on the health system as well as on the tremendous amount of DALYs lost, greater efforts should be made to promote road safety. Little information is available on disabilities in Oman as it is not included in the health information system. Currently, 68% of all infant deaths in hospitals are neonatal deaths. Hospital records show 229 neonatal deaths in 2003, mainly caused by congenital anomalies (36%), fetal malnutrition, disorders related to short gestation, low birth weight, slow fetal growth (21%) and birth asphyxia (14%). Congenital anomalies were also the leading cause of death for infants between the age of 29 days and 1 year (17.9%) followed by septicaemia (12.3%), inflammatory diseases of the central nervous system (7.5%) and asphyxia (4.7 %). The MoH has undertaken extensive work on human resources development for planning and production of normal health personnel. However, there is a need for the development of managerial and leadership skills, continuing and systematic on-the-job training of health personnel and training of health staff in the areas of priority advanced health technologies and information

5 3. Objectives Joint WHO and MoH Facilitators Meeting on Integrated Management for Emergency & Essential Surgical (IMEESC) Care Participate in the Third Oman International Anaesthesia and Critical Care Conference to: - Share the WHO Global Initiative for Emergency and Essential Surgical Care - Introduce the WHO IMEESC toolkit in the Technical session on education and training - To have informal side meetings during the two-day anaesthesia conference. 4. Third International Anaesthesia and Critical Care Conference WHO/HQ/EHT/CPR and WHO/EMRO were requested by the WR Oman and MoH Oman, to participate in the Third International Anaesthesia and Critical Care Conference at Oman, which has approximately 400 participants representing 150 countries. WHO/ HQ and WHO/EMRO made the Key Note address on the Challenges of the GIEESC for the inaugural session of the Third International Anaesthesia and Critical Care Conference The WHO IMEESC toolkit for training and distance learning was presented in the technical session of the Third International Anaesthesia and Critical Care Conference The WHO IMEESC toolkit was introduced, its applicability demonstrated in the day to day practice, training, and guidance on policy decisions at all levels of healthcare aiming to reduce death and disability in trauma, pregnancy related complications and infections (including HIV). 5. Joint WHO with MoH Facilitators Meeting on Integrated Management for Emergency and Essential Surgical Care A Joint WHO and MoH, Facilitators Meeting was held on WHO IMEESC. The meeting participants represented key policy makers from MoH, health providers (surgeons and anaesthesiologists), and WHO/ country office/regional Office/Headquarters. 6. Discussions The discussions were on the following issues: At the tertiary and secondary care level there is access to emergency, surgical and anaesthesia care, which require standardization and quality assurance through better referral system and continuing professional development There is often delayed access to life saving surgical and anaesthesia interventions at the primary and secondary healthcare facilities The issue of patient and health personnel safety in emergency, surgical and anaesthesia practices was highlighted WHO generic guidelines can be adapted for patient consent, hand hygiene, operation room and emergency room settings, checklists prior to anaesthesia and surgery, equipment, planning for disasters, waste management towards patient safety There is an interest to develop a guideline for Oman for trauma and emergency, but there is no consensus among the specialists who have been trained by various trauma programs in USA, U.K and Cuba. There is a need for strengthening medical and nursing students training skills on emergency and essential surgical care towards reducing death and disability in trauma, pregnancy related complications and infection (including HIV). The WHO IMEESC tool could meet the need for a standardized training. 5

6 Experience of introduction and implementation of the WHO IMEESC training project in 17 countries was shared. 7. Recommendations and Action Plan This meeting resulted in the following recommendations and action plan: MoH to conduct a situation analysis for health care facilities on emergency and surgical care using the generic WHO Needs Assessment tool for resource limited healthcare facilities. Policy decision on the adaptation of the WHO IMEESC tool kit for Oman. A training workshop to be organized to demonstrate the use of the WHO generic tools for a standardized training Develop a task force on emergency and surgical and anaesthesia care. Taskforce to include health care personnel from multi-disciplines which are responsible for surgical and anaesthesia life saving interventions. Collaborate with WHO for training of trainers in Oman and for local adaptation of WHO IMEESC kit for implementation It was recommended that that all levels of health care facilities (including Primary Health Care) should be involved in the IMEESC. 8. Conclusions The meeting concluded with a consensus by MoH and WHO country office that EESC could be utilized towards improving the first referral level health facility s services. It was recommended to establish a committee (Task force) on EESC, in order to develop strategies for rolling out the IMEESC package in line with the GIEESC, to integrate the EESC to first referral Health Facility and to adapt the WHO IMEESC toolkit to Oman to strengthen capacities through a standardized training for the frontline health personnel performing life saving emergency and surgical (including anaesthesia) interventions in Oman. 9. Acknowledgment and collaborations for support - MoH Oman - WHO country office Oman, and WHO/EMRO - Departments of Essential Health Technologies, Evidence and Information for Policy (Patient Safety), Making Pregnancy Safer, Violence and Injury Prevention, Child and Adolescent Health, WHO 6

7 Annex 1:Participants list in the meetings Dr Ali Jaffar, Advisor, (unable to attend) Department of Health Affairs MoH Directorate of primary health care Dr Abdul W Zarouk Senior Consultant Department of Aneasthesia Royal Hospital Muscat, Dr Taha M Al-Lawati Sr Specialist, Surgical Oncologist Department of General Surgery Royal Hospital Al Khuwair Dr Mohan Mathews, Sr Consultant, Anaesthesia, Royal Hospital Al Khuwair WHO Mr Hassan Shawareb (unable to attend) WR Oman (acting) Dr Ruth M Mabry Technical Officer WHO Country Office Muscat, Dr Nabila Metwali Regional Adviser, Blood Safety, Laboratory & Imaging WHO/EMRO Dr Meena Cherian Project: Emergency & Essential Surgical Care Clinical Procedures Unit (CPR) Department of Essential Health Technologies World Health Organization, Geneva, Switzerland tel: ; fax: cherianm@who.int; Dr Ali Mastiani, Sr consultant, Neurosurgery, Khoula Hospital Al Khuwair Dr Hamed Al Kindi, Senior Consultant and Head of Dept, Accident and Emergency, Department of Anesthesia Khoula Hospital Al Khuwair Dr Ashok Sumant Senior Consultant and Head Department of Aneasthesia and ICU Khoula Hospital Mina Al Fahal Muscat, Dr Irfan Farook, Adviser, Hospital Administration, Dept of Hospital Affairs 7

8 Annex 2. Program Agenda - WHO Meeting and discussions with WHO Country Office and EMRO Regional Office - Joint WHO and Ministry of Health Facilitators meeting on IMEESC - Introduce and facilitate the use of the WHO IMEESC tool kit - Discussions on Collaborative approach to surgical training on emergency and essential surgical procedures and linked equipment - Recommendations and follow up action plan - Conclusions of meetings - Key Note address on the Challenges of the Global Initiative for Emergency and Essential Surgical Care at the inauguration of the Third Oman International Anaesthesia and Critical Care Conference. - Presentation of the WHO Integrated Management for Emergency and Essential Surgical care tools in the technical session of the Third Oman International Anaesthesia and Critical Care Conference. 8

9 Annexe3: WHO training tools for improving skills of health personnel Needs Assessment and Evaluation Form for RR ese ssoouu rcr ce LLi ii mm iit itte edd HH eaal e ll tthh t CC aar ree FFaa cic ii ll lii ittyy t Essential Emergency Equipment in Emergency Room* *At an entry point in any health facility such as: Emergency room/ Admission room / Treatment room/ Casualty room 1. Name/Address of Health Care Facility Country 2. Type of Health Care Facility (please check one) Primary or First referral level facility/ District Hospital/Rural Hospital Health Centre 3. Human Resources in emergency room (please indicate number of health staff) Doctors Nurses Clinical or Health officers Technicians Paramedical staff 4. Physical Resource (a) Infrastructure Yes No Is there an area or room designated for emergency care? Is there running water? If yes: Interrupted / Uninterrupted (please circle one) Is there an electricity source? If yes: Interrupted / Uninterrupted (please circle one) (b) Equipment Is a list of essential emergency care equipment available? Yes No Is following available - Oxygen Cylinder: Interrupted /Uninterrupted (please circle one) - Oxygen Concentrator: Interrupted /Uninterrupted (please circle one) - Equipment for oxygen administration available (tubes, masks) Essential Emergency (EE) Equipment Yes, in some equipment Yes, in all equipment No Are the EE equipment in working order? Is there access to repair if equipment fails? Is there access to repair within the health care facility? Is there access to repair outside the health care facility? - If yes, how far (in km): 1-25 / / / >200 (please circle one) Is there an agreement for the maintenance of the equipment with the supplier? Do the health care staff in the emergency room get training in the use of the equipment? Is information available on supply, repair, and spare parts for the equipment? 5. Quality, safety, access and use Are the best practice protocols for management of essential emergency procedures available? Are the protocols for safe appropriate use of equipment in essential emergency procedures available? Yes, in some procedures Yes, in all procedures No How often is room to room inspection performed to ensure that EE equipment and supplies required for the essential emergency procedures are available and functioning? (please circle one) Daily / weekly / monthly / 6-monthly / yearly / once in years / never Are the information, education and training materials on emergency procedures and equipment available in the emergency room for health care staff use? Are there introductions of any new procedures/interventions? - If yes, which procedure/intervention: (please specify) Has referral to other health facility decreased because of skills and knowledge of procedures and intervention? Are records maintained? 6. Policy Is there a policy to promote training for health care staff in the essential emergency management of trauma, obstetric care and anaesthesia? Is there a policy to update the protocols for the emergency management of trauma and obstetric care adapted to local needs? Are there any guidelines on donation, procurement, and maintenance of all EE equipment? Is there a list of extra health personnel to be contacted in disaster situations? For guidance use WHO generic list of Essential Emergency Equipment Department of Essential Health Technologies World Health Organization, 20 Avenue Appia, 1211, Geneva 27,Switzerland Fax: Internet: Yes Yes No No 9

10 WHO Generic Essential Emergency Equipment List Checklist describes minimum requirements for emergency and essential surgical care at the first referral health facility Capital Outlays Quantity Date checked Resuscitator bag valve and mask (adult) Resuscitator bag valve and mask (paediatric) Oxygen source (cylinder or concentrator) Mask and Tubings to connect to oxygen supply Light source to ensure visibility (lamp and flash light) Stethoscope Suction pump (manual or electric) Blood pressure measuring equipment Thermometer Scalpel # 3 handle with #10,11,15 blade Scalpel # 4 handle with # 22 blade Scissors straight 12 cm Scissors blunt 14 cm Oropharyngeal airway (adult size) Oropharyngeal airway (paediatric size) Forcep Kocher no teeth cm Forcep, artery Kidney dish stainless steel appx. 26x14 cm Tourniquet Needle holder Towel cloth Waste disposal container with plastic bag Sterilizer Nail brush, scrubbing surgeon's Vaginal speculum Bucket, plastic Drum for compresses with lateral clips Examination table Wash basin Renewable Items Suction catheter sizes 16 FG Tongue depressor wooden disposable Nasogastric tubes 10 to 16 FG Batteries for flash light (size C) Intravenous fluid infusion set Intravenous cannula # 18, 22, 24 Scalp vein infusion set # 21, 25 Syringes 2ml Syringes 10 ml Disposable needles # 25, 21, 19 Sharps disposal container Capped bottle, alcohol based solutions Sterile gauze dressing Bandages sterile Adhesive Tape Needles, cutting and round bodied Suture synthetic absorbable Splints for arm, leg Urinary catheter Foleys disposable #12, 14, 18 with bag Absorbent cotton wool Sheeting, plastic PVC clear 90 x 180 cm Gloves (sterile) sizes 6 to 8 Gloves (examination) sizes small, medium, large Face masks Eye protection Apron, utility plastic reusable Soap Inventory list of equipment and supplies Best practice guidelines for emergency care Supplementary equipment for use by skilled health professionals Laryngoscope handle Laryngoscope Macintosh blades (adult) Laryngoscope Macintosh blades (paediatric) IV infusor bag Magills Forceps (adult) Magills Forceps (paediatric) Stylet for Intubation Spare bulbs and batteries for laryngoscope Endotrachael tubes cuffed (# 5.5 to 9) Endotrachael tubes uncuffed (# 3.0 to 5.0) Chest tubes insertion equipment Cricothyroidectomy 10

11 This list was compiled from the following WHO resources: WHO training manual: Surgical Care at the District Hospital WHO Emergency Relief Items, Compendium of Basic Specifications* WHO/UNFPA Essential drugs and other commodities for reproductive health services. WHO Essential Trauma Care Guidelines * For specifications refer to this book Department of Essential Health Technologies World Health Organization, 20 Avenue Appia, 1211, Geneva 27,Switzerland Internet: 11