LITHUANIAN SWISS COOPERATION PROGRAMME: FINANCIAL SUPPORT FOR THE HEALTH SECTOR 2012 2017
The implementation of this five-year LithuanianSwiss Cooperation Programme of particular importance would not have been so successful if not for the excellent inter-institutional and team work. We express our sincere gratitude to all those who have helped to turn the visions into reality: the teams of the Ministry of Finance of the Republic of Lithuania, the Central Project Management Agency and all executing agencies (hospitals) whose great work and knowledge make us feel delighted and proud of the results achieved.
TABLE OF CONTENTS 1. Introduction... 3 2. Lithuanian-Swiss Cooperation Programme: Financial support for the health sector... 4 Previous experience of cooperation with Switzerland... 5 3. Programme Improvement of perinatal and neonatal health care services in Lithuania... 6 Modern medical equipment... 7 Essential medical equipment... 7 Modern medical equipment. Equipment for universal check-ups... 8 Modern medical equipment. Equipment for providing specialised obstetric and neonatal services... 9 Modern resuscitation vehicles for safe transportation of neonates... 10 Necessary repairs of health care establishment... 11 Diagnostics and treatment guidelines in obstetrics and neonatology... 12 Improvement of professional qualification... 13 Computer database of pregnant and delivering women and neonates health (NGN IS)... 14 Simulation classrooms / rooms... 15 4. Programme Introduction of energy efficient technologies into the Lithuanian hospitals providing perinatal and neonatal services... 16 Alytus Region S. Kudirkos hospital... 17 Kaunas Clinical hospital... 18 Kėdainiai hospital... 19 Klaipėda University hospital... 20 Kaunas Republican hospital... 21 Lithuanian University of Health Sciences hospital Kaunas clinics... 22 Marijampolė hospital... 23 Mažeikiai hospital... 24 P. Mažylis Maternity Home, Affiliate of Kaunas Clinical hospital... 25 Pasvalys hospital... 26 Raseiniai hospital... 27 Telšiai Regional hospital... 28 Panevėžys Regional hospital... 29 Šiauliai Regional hospital... 30 Tauragė hospital... 31 Trakai hospital... 32 Ukmergė hospital... 33 Utena hospital... 34 Children s Hospital, Affiliate of Vilnius University hospital Santariškės Clinics... 35 Vilkaviškis hospital... 36 Vilnius Maternity Home... 37 Vilnius City Clinical hospital... 38 Vilnius University hospital Santariškės Clinics... 39 Visaginas hospital... 40 5. Evaluation of patient satisfaction with conditions in hospitals participating in the programme... 41
Introduction What can be more important than the health of a mother and a newborn child? What can be more significant that the arrival of a new life into this world and the joy of a happy mother? These rhetorical questions need no answer. We feel delighted and express words of sincere gratitude to the Swiss Confederation. With the help of its support, excellent, cosy and safe conditions have been created for pregnant and delivering women and neonates at Lithuanian hospitals. Aurelijus Veryga Minister of Health of the Republic of Lithuania The health of pregnant and delivering women and neonates is one of the most sensitive spheres of health care in each country. Therefore, I would first of all like to thank the Swiss people for the opportunity given to enhance this sphere in Lithuania, and all those who have contributed to the implementation of this Programme in our country. The care of pregnant and delivering women and neonates in Lithuania today is of a very high standard equalling that of the most advanced countries in the world. The activities of the Programme will allow each pregnant and delivering woman to receive quality health care and ensure infants take their first steps into this world safely. Gytė Sirgedienė Head of the International Projects Management Division, Ministry of Health of the Republic of Lithuania 3
2. Lithuanian-Swiss Cooperation Programme: Financial support for the health sector The Ministry of Health of the Republic of Lithuania has prepared and implemented two programmes in the health sector: Introduction of energy-efficient technologies into Lithuanian hospitals Improvement of perinatal and neonatal health care services in Lithuania General objective of the programmes: to improve the quality and accessibility of health care services for pregnant and delivering women and neonates. The programme Introduction of energy efficient technologies into the Lithuanian hospitals is also aimed at contributing to the reduction of environmental pollution in Lithuania. Programmes implementation period: 2012 2017 In a referendum, the Swiss people assigned funds to the European states, including Lithuania, and the health sector received as much as 72%, or the largest share, of the programme's support. Funds granted to the programmes: CHF 53.647 mln. / ~ EUR 48 mln. CHF 45.600 mln.: Swiss financial support CHF 8.047 mln.: Co-financing from the Republic of Lithuania Support agreements for the granting of financial support for the implementation of the health sector programmes were signed on 20 December 2011. Project implementation agreements with 17 executing agencies (hospitals) were signed on 12 June 2012. Another 10 Lithuanian hospitals joined the Programme in 2013 and 2015. The support also contributes directly to the Lithuanian Governmental Programme's objectives: to improve perinatal and neonatal health care services in Lithuania and to introduce energy efficient technologies into Lithuanian hospitals that provide perinatal and neonatal health care services. As many as 27 Lithuanian hospitals providing perinatal and neonatal health care services situated throughout the territory of the country are participating in the Programme. 4
Previous experiences of cooperation with Switzerland In 1994 1996, the Swiss Government granted 4.6 mln. Swiss francs in financial support to the Neonatology project. The funds were used for the procurement of modern medical equipment and staff training at the country s eight largest hospitals providing perinatal and neonatal health care services. This created the preconditions for developing a new support system for pregnant and delivering women and neonates, helped to reduce neonatal, infant and perinatal mortality, and improved the qualification of the medical personnel. In 1997 1999, the Swiss Government granted 4 mln. Swiss francs in financial support to the Pediatric Intensive Care and Pediatric Anesthesia project. The support funds were used to supply five Pediatric Resuscitation and Intensive Care Units and two Pediatric Anesthesia Units at the Vilnius and Kaunas university hospitals and Klaipėda, Panevėžys and Šiauliai regional hospitals with medical equipment, staff training and for the establishment of a transport system. This created the preconditions for the development of a new structure to provide care to severely ill children and a system for transporting children throughout the country and ensured qualified and safe care for severely and critically ill children. Pictures showing medical equipment used at the hospitals for more than 20 years 5
3. Programme Improvement of perinatal and neonatal health care services in Lithuania Funds granted to the programme: CHF 31.294 mln. / ~ EUR 27 mln. CHF 26.600 mln.: Swiss financial support CHF 4.694 mln.: Co-financing from the Republic of Lithuania Executing agency: Lithuanian University of Health Sciences hospital Kaunas clinics Beneficiaries: 27 Lithuanian hospitals Results after programme implementation: 27 hospitals supplied with modern medical equipment necessary for providing quality services 3 vehicles with special equipment for safe transportation of neonates purchased Premises of 9 healthcare establishments repaired More than 4,000 participants improved their professional qualifications and modern technology usage skills 72 diagnostics and treatment guidelines in obstetrics and neonatology developed Computer database on the health of pregnant and delivering women and neonates developed and prepared for usage 6
Modern medical equipment From 2013 to February 2017, 27 Lithuanian hospitals providing perinatal and neonatal health care services were supplied with modern medical equipment necessary for The medical equipment supplied to the 27 providing quality services. The hospitals received a total of hospitals was worth 108 different items of medical equipment for more than more than EUR 21.4 mln. All the medical equipment acquired during EUR 21.4 mln. the project can be divided into three groups: essential medical equipment, equipment for universal check-ups and equipment for providing specialised obstetric and neonatological services. Essential medical equipment Modern medical equipment is necessary for ensuring the provision of quality safe obstetric and neonatological inpatient services in cases of low perinatal risk and for evaluating the condition of healthy neonates. State-of-the-art essential medical equipment, such as delivery and functional beds, gynaecological chairs, cardiotocographs, heated neonatal resuscitation tables, and beds for neonates, incubators, etc., were supplied to all of the hospitals participating in the programme. of female 87% patients think that the establishments are supplied with appropriate medical equipment* 7
Modern medical equipment Equipment for universal check-ups 1. A pregnancy ultrasound scan is an ultrasound test for checking the presence of any deviations from the normal development of a pregnancy. The purpose of the scan is to determine and show to the patient (and the family) that the foetus is alive, accurately date the pregnancy, specify the expected delivery date, check for the number of foetuses, etc. (Picture showing a portable ultrasound scanner with sensors appropriate for obstetrics) 2. Screening for neonatal critical congenital heart defects is carried out for neonates delivered at full term to identify neonates who may have a critical congenital heart defect, to perform an early diagnosis or find the possibility of its existence, and to refer the neonate to a pediatric cardiologist and/or cardiac surgeon for consultation and immediate treatment. In 2016, 98.9% of neonates underwent this screening. (Picture showing a neonatal vital signs monitor (EKG, breathing, blood pressure, SaO 2 ) 3. Universal neonate hearing screening is a test carried out using a medical device that records neonates' otoacoustic emissions to perform the earliest possible detection of congenital hearing loss. The percentages of neo nates that underwent this screening in 2015 and 2016 were 99.3% and 98.2% respectively. (Picture showing an otoacoustic emission storage device for hearing screening in neonates) 4. Neonatal eye screening involves a red reflex test of the eye ground in neonates (from the gestational age of 35 weeks) for the purpose of the timely detection of congenital opacities in the optical media or other eye diseases that prevent the development of vision. In 2015 and 2016, this screening covered 97.9% and 96.8% of neonates respectively. (Picture showing a direct ophthalmoscope) 5. Screening for neonatal jaundice involves the measu rement of bilirubin levels in the blood and can be carried out using a special device that works using complicated optical algorithms. Tests have proven that this screening reduces the need for blood sample tests in infants with jaundice. Transcutaneous bilirubinometry helps to evaluate which neonates need more accurate testing for jaundice, i.e. determining the bilirubin level in the venous or capillary blood serum. This measurement is also helpful for evaluating the indications for rapid and aggressive treatment of neonates with severe jaundice. (Picture showing a transcutaneous bilirubinometer) 8
Modern medical equipment Equipment for providing specialised obstetric and neonatal services Modern medical equipment is required for providing quality specialised obstetric and neonatological services for women or foetuses diagnosed with pathologies during pregnancy or delivery, or for premature and ill neonates. also contributed to the increased quality and reliability of diagnostics. Some of the less-complicated medical equipment assigned to this group, such as neonatal vital sign monitors, vital sign monitors for adults, stationary ultrasound machines with the Doppler scan function and obstetric sensors, portable ultrasound machines, etc., has also been delivered to hospitals in Lithuania's largest cities that accommodate medium-risk deliveries. of specialists 91% think that medical equipment has improved significantly during 2012-2016* The Vilnius and Kaunas Perinatology Centres were supplied with the most complicated and top-quality medical equipment, including fetoscopes, lasers for foetal surgery, brain activity registration and freezing equipment for neonates, a video laryngoscope with a set of spatulas for neonates, ultrasound devices with sensors for neonates (for brain, heart and abdomen echoscopy), a laminar with an integrated microscope and a chorion villi processing system, etc.. This equipment will enable the provision of safe tertiary care services to neonates and mothers. A video laryngoscope with a set of spatulas for neonates allows intubating a neonate where intubation is impeded or an anomaly of the upper respiratory tract exists. The equipment will enab le complicated surgeries on hospitals' smallest patients. The new equipment has 97% of specialists are satisfied with the current sets of equipment* During the project, we aimed to purchase state-ofthe-art medical equipment models recognised around the world and with long service lives. This was an excellent opportunity for almost all Lithuanian medical establishments providing obstetric and neonatological inpatient services to substantially update their equipment, which was more than 20 years old. Prof. Mindaugas Kliučinskas Manager of the project Improvement of perinatal and neonatal health care services in Lithuania, Head of the Obstetrics and Gynaecology Delivery Department at the Lithuanian University of Health Sciences hospital Kaunas clinics 9
Modern resuscitation vehicles for the safe transportation of neonates Three modern, spacious and comfortable resuscitation vehicles with up-to-date special equipment for the transportation of neonates are successfully being used in Lithuania s three largest hospitals, i.e. the Children s Hospital (an affiliate of the Vilnius University Hospital Santariškės Clinics), the Lithuanian University of Health Sciences Hospital Kauno klinikos, and the Klaipėda University Hospital. All of the resuscitation vehicles are supplied with special medical equipment for the transportation of neonates, i.e. a cot for the transportation of neonates and a stationary platform for securing the cot. The vehicles also have a neonatal resuscitation system and other medical equipment, such as an injection infusion pump, an artificial breathing machine, a transport incubator and a transport vital signs monitor. Neonates with especially low birth weight require special conditions, and these vehicles meet modern safety standards. The new resuscitation vehicles have contributed to considerable improvements in the quality of emergency aid and health care services for neonates. These vehicles are intended for the transfer of neonates from smaller hospitals to tertiary care institutions, where the spectrum of neonatal health care services is considerably broader. Neonates with especially low birth weight require special conditions, and the new resuscitation vehicles meet all possible requirements. Doctor Antanas Pužas, Head of the Neonatal Resuscitation and Intensive Care Unit of Lithuanian University of Health Sciences Hospital Kaunas clinics of respondents 98% believe that the transportation of neonates is safe* The new resuscitation vehicles have contributed to considerable improvements in the quality of emergency aid and health care services for neonates, said representatives of the hospitals with delight. 10
Necessary repairs for health care establishments Nine Lithuanian hospitals underwent necessary repairs. No. 1 2 3 4 5 6 7 8 9 Name of hospital / Description of works Telšiai Regional Hospital Reconstruction of internal water supply and sewer systems Repair of premises Mažeikiai Hospital Fire protection system Outfitting of premises for transfer of female patients from ambulance Lithuanian University of Health Sciences Hospital Kaunas clinics Reconstruction of internal water supply and sewer systems Repair of premises Klaipėda University Hospital Reconstruction of internal water supply and sewer systems Vilnius City Clinical Hospital Filling of cracks and façade painting Vilnius Maternity Home Change of doors in premises of obstetric unit Change of cold, hot, circulation and fire water supply mains Kaunas Clinical Hospital Reconstruction of internal water supply and sewer systems Repair of premises Marijampolė Hospital Reconstruction of internal water supply and sewer systems Trakai Hospital Repair of premises Reconstruction of internal water supply and sewer systems Interior doors and installation Value of works, EUR 88,041 63,591 781,260 355,791 20,261 61,159 289,130 46,715 141,370 Before After Before After 11
Diagnostics and treatment guidelines in obstetrics and neonatology A total of 72 diagnostic and treatment guidelines in obstetrics and neonatology developed by a large team of specialists will allow for the standardisation of the diagnostics and treatment of the most relevant pathologies in these spheres and will give an opportunity for pregnant and delivering women and neonates to receive health care services of a better quality. The developed guidelines are unique in that, for the first time in Lithuania, they include a detailed description of processes and interventions rather than just a list, a list of audit indicators, an implementation scheme for health care establishments, and information for female patients. These guidelines can be approved and used in practice for providing perinatological aid in all Lithuanian health care establishments, and they can become teaching aids as well. Prof. Gražina Drąsutienė, Head of the Clinic of Obstetrics and Gynaecology of the Vilnius University Faculty of Medicine The development of these guidelines is a unique example of teamwork involving different medical professionals. The guidelines were prepared by working groups including specialists from hospitals in Vilnius, Kaunas, Marijampolė and Šiauliai that provide perinatal and neonatal services. A total of 72 working groups were established to match the number of guidelines. The working groups consisted of competent specialists, including neonatologists, gynaecologists and obstetricians. The developed guidelines were reviewed by specialists, the heads and members of the working groups, reviewers and representatives of the public. Anaesthetists, cardiologists, infectologists, endocrinologists, gastroenterologists and neurologists also assisted in the development and review of the guidelines. Each guideline consists of five parts: a description of the guideline, a description of procedures, a description of its implementation, an audit description, and information for the public. Members of the public also contributed to the development of the last part. Their insights helped to draw up clear and easily comprehensible recommendations. The guidelines were reviewed and insights were provided by representatives of two non-governmental organisations, in particular Padedu augti (Helping to Grow) and Tėvystės centras (Parenthood Centre). The guidelines are available here: https://sam.lrv.lt/lt/veiklos-sritys/programos-ir -projektai/sveicarijos-paramos-programa All the guidelines and their summaries have also been published in the electronic manual: http://metodikos.lt/ of the 93% health care establishments have adapted and apply the guidelines* Guided by the principles of medicine relying on evidencebased science and good clinical practice, a multidisciplinary team of specialists developed 72 guidelines in cooperation with patient representatives. This has allowed for the improvement of the quality and safety of services provided to mothers and neonates and the reduction of disparities between separate health care establishments. We hope that this will increase the trust of our women and their family members and their satisfaction with the competence and professionalism of specialists working in the sensitive sphere of perinatology. Prof. Rūta Jolanta Nadišauskienė, Head of the Clinic of Obstetrics and Gynaecology at the Lithuanian University of Health Sciences Hospital Kaunas clinics 12
Improvement of professional qualifications In 2015 and 2016, 4,257 participants from 32 Lithuanian hospitals improved their qualification during modern training devoted to professionals working with pregnant and delivering women and neonates. The sum assigned to all training activities amounted to EUR 2.076 mln. Training was conducted in five regions of Lithuania, i.e. the cities of Vilnius, Kaunas, Klaipėda, Panevėžys and Šiauliai. The knowledge gained at training is used in everyday practice by different specialists working as a team. Audronė Kuodienė, Director of Marijampolė Hospital The training gathered a large number of obstetricians, nurses of all specialities, neonatologists, obstetricians/gynaecologists, anaesthetists/reanimatologists, and interns who participate in the provision of obstetric, gynaecological and neonatal services. The team that organised the training used a unique and interactive methodology to conduct the course, which made the course themes and the teaching methodology particularly acceptable and understandable. The organisers of the training claim that this was one of the most successful projects ever implemented in Lithuania, and that all the targets set at the beginning of the project were achieved. Training was organised for 8 topics: Conflict management and communication with patients: 888 participants of respondents Resuscitation of neonates: 503 participants 98% think that the programme had a favourable Modern initial obstetric care: 375 participants effect on their professional Stabilisation of neonates conditions and preparation for development* transportation: 275 participants Modern specialised obstetric care: 296 participants Training of personnel of hospitals seeking the status of a hospital favourable for neonates: 1,680 participants First pregnancy trimester ultrasound practice: 90 participants Second pregnancy trimester ultrasound practice: 150 participants 13
Computer database of pregnant and delivering women and neonates health (NGN IS) This has provided a possibility for the computerised collection, accumulation, storage and analysis of data on pregnant and delivering women and neonates, their registration and search, and the collection and storage of personal and clinical information. The Perinatal and Neonatal Health Data Processing Information System (NGN IS) computer database of pregnant and delivering women and neonate health will allow for the improvement of the collection of statistical data on the health of pregnant and delivering women and neonates and the expansion of the possibilities for the general use and analysis of said collected data. All Lithuanian health care establishments will be able to use NGN IS, which will contribute to the reduction of the administrative burden on hospital personnel in collecting and processing data on pregnant and delivering women and neonates. The NGN IS' functions are aimed at optimising the collection and processing of data at health care establishments that provide obstetric and neonatal services, as well as the drawing up and analysis of statistical reports and their submission to any institutions concerned. NGN IS was developed with a view to ensure the centralised collection and processing of electronic information on the health of pregnant and delivering women and neonates for the purpose of improving the quality of health care and for statistics. The system has enabled all health care establishments providing obstetric, gynaecological and neonatal services to record data on the observation and treatment of pregnant and delivering women and neonates and receive immediate and timely information on a particular patient and the health care services provided to that patient at different health care establishments. Currently, the data collected in a person s medical record in paper format is being transferred to the information system to ensure access to the universal electronic health information (ESI) database. The data collected in NGN IS is transferred automatically to other information systems and registers, which has accelerated ESI data exchange and given access to this data to different health care specialists entitled to see the statistical data of a specific patient or depersonalised information. The NGN IS can be logged into here: https://ngn.lt/ 14
Simulation classrooms / rooms Simulation classrooms have been established in seven Lithuanian hospitals, i.e. Klaipėda University Hospital, Lithuanian University of Health Sciences Hospital Kaunas Clinics (2), Panevėžys Republican Hospital, Šiauliai Republican Hospital, the Children s Hospital (an affiliate of the Vilnius University Hospital Santariškės Clinics), and Vilnius University Hospital Santariškės Clinics. The teaching aids (mannequins) and algorithms and scenarios of clinical situations for independent learning are designed to create a system of on-the-job training that will allow the medical personnel to simulate rare but very threatening clinical situations, leading to the continuous renewal of their knowledge and skills. The establishment of the simulation classrooms will enable the hospitals to regularly repeat and improve the skills gained in training, thereby ensuring the continuity of the activities under Lithuanian-Swiss Cooperation Programme (i.e. practical implementation of the guidelines in obstetrics and neonatology and improvement of the personnel s qualification). The possibility has been ensured for health care professionals providing health care services to improve their qualification without leaving a health care establishment. Delivery wards (suites) have been installed as spaces containing essential medical equipment where personnel can improve their skills according to a clear guideline during their free time. The presence of video and audio controls has ensured the possibility of internal and external audits and the remote communication and control of new skills. The sets of urgent situations (with the possibility of change) allow all professionals providing obstetric and neonatological services in Lithuania to improve their skills in a standard way with the possibility of changing the clinical tasks/situations. 15
4. Programme Introduction of energy efficient technologies into the Lithuanian hospitals providing perinatal and neonatal health case services Funds granted to the programme: CHF 22.353 mln. / ~ EUR 21 mln. CHF 19.000 mln.: Swiss financial support CHF 3.353 mln.: Co-financing from the Republic of Lithuania Executing agencies: 24 Lithuanian hospitals Results after programme implementation: Thermal insulation of hospital buildings improved (roofs and exterior walls renovated and insulated, windows and doors replaced) Heating stations and internal heating systems modernised Alternative energy sources such as solar cells, heating pumps and photovoltaic power stations systems installed Ventilation and air conditioning systems modernised / installed Electricity supply systems (with LED lighting) modernised / installed Medical gas (oxygen, vacuum, compressed air) supply systems installed Ambient air pollution reduced, and microclimate and energy efficiency improved 16
Alytus Region S. Kudirkos Hospital Project implementation period: 2013 2017 Project budget: EUR 439,261 Replacement of windows and doors Modernisation of the heating station Modernisation of the ventilation system Installation of lighting with LED lights Installation of solar cell and heat pump systems Installation of a photovoltaic power plant A modern and cosy environment in the Obstetrics and Gynaecology Unit is like a hospital's business card for a young family. The advantages of the excellent state-of-the-art ventilation system and quality lighting have already been felt by the patients and personnel of the unit. The implementation of this energy-efficient project in the hospital marks the start of serious systemic work. In addition to all of these advantages, Mother Nature will indeed thank us for our environmentallyfriendly approach if annual carbon monoxide emissions to the environment are reduced by more than 14 tonnes. Artūras Vasiliauskas, Director 17
Kaunas Clinical Hospital Project implementation period: 2012 2017 Project budget: EUR 2,206,283 Insulation of exterior walls (including the base) Replacement of doors and windows Insulation of the floor slab bordering the exterior Reconstruction of the heating system Replacement of the heating station Reconstruction of the ventilation system Modernisation of the internal electricity supply system Installation of medical gas systems The arrival of a new life is a miracle that gives so much joy to everyone. We are proud that the support under the Lithuanian-Swiss Cooperation Programme has made the Neonatal Unit of the Kaunas Clinical Hospital even cosier and more attractive to delivering women, their relatives and personnel. Gediminas Abeciūnas, Director Before After 18
Kėdainiai Hospital Project implementation period: 2012 2017 Project budget: EUR 476,373 Insulation of exterior walls (including the base) Insulation of the roof (including roof renovation) Reconstruction of the heating system Renovation of the outdoor heating pipelines Renovation of the ventilation system Installation of lighting with LED lights The patients and the personnel have noticed positive changes in the Obstetric Unit. Not only does the renovated hospital building have great appeal, the reconstructed heating and ventilation system and modern lighting are pleasing as well. Artūras Gudavičius, Head of the Obstetrics and Gynaecology Unit Before After 19
Klaipėda University Hospital Project implementation period: 2012 2017 Project budget: EUR 2,513,898 Insulation of exterior walls (including the base) Insulation of the floor slab bordering on the exterior Insulation of the roof (including roof renovation) Replacement of windows and doors Reconstruction of the heating system Reconstruction of the ventilation system (installation of a heat recovery ventilation system) Reconstruction of the heating station Modernisation of the internal electricity supply system Installation of a compressed air, vacuum and oxygen supply system The improved thermal insulation of the building of the Obstetrics and Gynaecology Department, the energy efficiency measures installed, the system for improving the microclimate of the premises and an upgraded medical engineering system have all produced a cosier and more comfortable environment for both the personnel and the patients and their newborns. Raimondas Šiaulys, Head of the Obstetrics and Gynaecology Department Installation of façade finishes (fibrocement sheets) on the existing hollow ceramic brick wall Before After 20
Clinic of Obstetrics and Gynaecology Christian Maternity Hospital of Kaunas Republican Hospital Project implementation period: 2012 2017 Project budget: EUR 485,353 Insulation of the roof (including roof renovation) Replacement of windows and doors Reconstruction of the heating system Reconstruction of the ventilation system Reconstruction of the heating station Modernisation of the internal electricity supply system Installation of a compressed air and oxygen supply system Installation of lighting with LED lights Installation of solar cell and heat pump systems Doc. Dr. Linas Vitkus, General Manager of the Kaunas Republican Hospital, is delighted that a country such as Switzerland has given excellent opportunities for Lithuanian health care establishments to go hand in hand with European medicine. Owing to the programme, the quality of obstetric and gynaecological services has improved considerably at the Kaunas Republican Hospital, where the equipment and technology were modernised and the infrastructure underwent renovation. The most distinct aspect noticed by patients is the particularly improved microclimate of the premises. Previously, the ventilation was almost non-functional and there were no heat or power savings. Virgilijus Rudzinskas, Head of the Clinic of Obstetrics and Gynaecology Christian Maternity Hospital 21
Lithuanian University of Health Sciences Hospital Kaunas Clinics Project implementation period: 2012 2017 Project budget: EUR 2,377,435 Replacement of exterior doors Reconstruction of the heating system Reconstruction of the heating station Modernisation of the heating mains Reconstruction of the heat recovery ventilation system Modernisation of the internal electricity supply system, including the installation of lighting with LED lights Installation of a compressed air, vacuum and oxygen supply system Installation of solar cell, heat pump and photovoltaic power plant systems The renovated utility systems in the Clinic of Obstetrics and Gynaecology will ensure even better and more comfortable conditions for families with newborns, and more comfortable work and rest spaces for personnel. The installed innovations will enable the effective use of solar energy and the saving of funds that can be used to improve health care services. The renovated Obstetrics and Gynaecology Unit has become one of the most modern buildings among the Kaunas Clinic's old buildings and will serve as an example for renovating other buildings of this hospital. Povilas Ruginis, Project Construction Engineer 22
Marijampolė Hospital Project implementation period: 2012 2017 Project budget: EUR 980,836 Reconstruction of the ventilation system Reconstruction of the heating system Modernisation of the internal electricity supply system, including the installation of lighting with LED lights Installation of a compressed air, vacuum and oxygen supply system with feed gas panels Installation of solar cell, heat pump and photovoltaic power plant systems The renovation and outfitting of the premises of the Marijampolė Hospital Obstetrics Unit during the project's implementation has not only created an appropriate, comfortable and cosy environment meeting the highest standards for the hospital s smallest patients and their mothers, but has also improved the working conditions for the personnel. Audronė Kuodienė, Director 23
Mažeikiai Hospital Project implementation period: 2012 2017 Project budget: EUR 1,085,781 Insulation of exterior walls (including the base) Renovation of the heating system, including the heating station Renovation of the ventilation system by adding cooling equipment Connection of medical gases to the system Before We are delighted about the insulation of the exterior walls and the renovation of the heating system as they have made the hospital warmer and more attractive on the outside. The new ventilation and air conditioning system allows for the maintenance of an optimal microclimate, which is needed to ensure the good condition of newborns. The Obstetrics and Neonatology Unit has become more modern and comfortable with improved conditions for patients and work, and the services we provide have acquired a new quality. Albinas Lidžius, Director After 24
P. Mažylis Maternity Home, Affiliate of Kaunas Clinical Hospital Project implementation period: 2012 2017 Project budget: EUR 507,130 Repair of the heating system Renovation of the ventilation system Renovation of the mechanical (forced draught) system Installation of lighting with LED lights Installation of solar cells and a heat pump system The Maternity Home has become even cosier, lighter and warmer not only from the smiles of the personnel and patients, but also from the flawlessly installed LED lighting and the new ventilation and water heating systems. We are grateful to people who have devoted much effort, time and funds to implement the Lithuanian-Swiss programme. Staf ot the Affiliate 25
Pasvalys Hospital Project implementation period: 2012 2017 Project budget: EUR 224,218 Installation of a vacuum station and a supply system Renovation of the ventilation system Installation of lighting with LED lights Overhaul of the oxygen supply and compressed air system Installation of solar cell, heat pump and photovoltaic power plant systems The whole roof of the building of the Obstetrics and Gynaecology Unit is shining with solar cells where the photovoltaic power plant was installed. The premises have been equipped with LED lights and an air conditioning and ventilation system. The vacuum, compressed air and oxygen supply systems have undergone reconstruction. The microclimate in the rooms has improved considerably, and delivering women and neonates now have excellent conditions. Rolandas Rastauskas, Chief Physician 26
Raseiniai Hospital Project implementation period: 2013 2017 Project budget: EUR 374,417 Insulation of the base walls Modernisation of the heating system, including the upgrading of the hot water supply system Modernisation of the ventilation system Modernisation of the internal electricity supply system, including LED lighting Installation of an oxygen supply system Installation of solar cell, heat pump and photovoltaic power plant systems The programme has made the Obstetrics and Gynaecology Unit cosy and modern: an up-to-date ventilation and oxygen supply system was provided, the wards have been equipped with LED lighting, and a computerised personnel call system has been put in place. We are glad to also have had an opportunity to acquire modern and alternative sources of energy. Vidmantas Merkliopas, Director 27
Telšiai Regional Hospital Project implementation period: 2012 2017 Project budget: EUR 1,159,981 Insulation of exterior walls (including the base), including the insulation of the floor above the base Insulation of the roof Replacement of windows and doors Renovation of the heating system Installation of a heating station Modernisation of the ventilation system Modernisation of the electricity supply system, including the installation of lighting with LED lights Modernisation of the medical gas, vacuum and oxygen supply system Installation of solar cell, heat pump and photovoltaic power plant systems After The works involved the insulation of the walls and the roof of the hospital s Obstetrics Unit, the replacement of windows and doors, the renovation of the heating and ventilation system, and the replacement of the lighting fixtures with LED lights. If not for the opportunity to benefit from the Swiss cooperation project, the hospital would not have had the capacity to complete works of this scale independently. Our hospital has become cosier, warmer and more attractive for residents not only of our district but also of the whole region. Alma Vitkienė, Director Before 28
Panevėžys Regional Hospital Project implementation period: 2012 2017 Project budget: EUR 1,259,825 Insulation of exterior walls (including the base) Insulation of the roof (including roof renovation) Insulation of the attic Replacement and insulation of the heating main pipelines in the attic Replacement of windows and glass blocks Replacement of exterior and ante-room doors Replacement and insulation of the internal water mains Modernisation of the ventilation system (by adding cooling equipment and installing a heat recovery system) Installation of lighting with LED lights Installation of solar cell, heat pump and photovoltaic power plant systems I d especially like to express my pleasure with the considerably improved working conditions. Following the renovation in the wards and premises, we have the possibility of changing the microclimate as needed. The hospital building and roof have been insulated and the ventilation has been upgraded with a heat recovery system. Photovoltaic power plant and solar cell systems have been installed as well. We believe that these measures will have an economic effect by saving the hospital's funds. All of these measures have made it possible to ensure the safe provision of obstetric and neonatological services to our patients in a comfortable environment. Albinas Ivonaitis, Head of the Obstetrics and Gynaecology Clinic After Before 29
Šiauliai Republican Hospital Project implementation period: 2013 2017 Project budget: EUR 509,805 Installation of lighting with LED lights Installation of a solar cell system Installation of a heat pump system The programme's funds have been used to improve the infrastructure of the clinic: to install modern lighting with LED lights and a solar cell and heat pump system. These measures will not only save funds but also reduce air pollution as well. Prof. Dr. Linas Rovas, Director of the Woman and Child Clinic 30
Tauragė Hospital Project implementation period: 2012 2017 Project budget: EUR 506,535 The renovated Obstetrics Unit has changed beyond recognition: the heating and ventilation systems have undergone reconstruction, and medical gas systems and state-of-the-art energy efficiency technologies using solar energy (solar cells, heat pumps and a photovoltaic power plant) have been installed. Irmantas Mockus, Director Replacement of windows Reconstruction of the heating system Reconstruction of the hot water supply pipelines Reconstruction of the ventilation system (by installing a heat recovery ventilation system) Modernisation of the internal electricity supply system Installation of a medical gas system Installation of solar cell, heat pump and photovoltaic power plant systems 31
Trakai Hospital Project implementation period: 2012 2017 Project budget: EUR 752,711 Insulation of exterior walls (including the base) Insulation of the roof (including roof renovation) Replacement of windows and exterior doors Replacement of the heating system, including modernisation of the hot water supply system Replacement of the electricity system Installation of lighting with LED lights Renovation of the ventilation system (including installation of access to the superstructure) Installation of medical gases Before We are delighted that the Lithuanian-Swiss Cooperation Programme has helped the public undertaking Trakai Hospital with its renovation and the improvement of the quality of its services. Following the reconstruction of the façade, the appearance of the entire unit has changed and the premises have become warmer and nicer. A spacious delivery unit with the latest equipment was installed thanks to the project. Thus, we have great hopes that we will work with increased intensity and see more delivering women. Antanas Česnulevičius, Director The renovation works have improved the apparance of the Obstetrics and Gynaecology Unit very much. The premises have become spacious and comfortable, and we are pleased with the excellent air conditioning system. Vilija Variakojienė, Head of the Obstetrics and Gynaecology Unit After 32
Ukmergė Hospital Project implementation period: 2015 2017 Project budget: EUR 397,965 Installation of a vacuum supply system Reconstruction of the hot water supply pipelines Installation of a solar cell system Installation of a heat pump system Installation of a photovoltaic power plant The installation of a compressed air, vacuum and oxygen supply system and solar cell, heat pump and photovoltaic power plant systems has been completed successfully at the hospital. These activities will enable the reduction of environmental pollution and energy and cash savings. Rimvydas Civilka, Chief Physician 33
Utena Hospital Project implementation period: 2015 2017 Project budget: EUR 397,965 Installation of a solar cell system Installation of a heat pump system Installation of a photovoltaic power plant We thank the Lithuanian-Swiss Cooperation Programme for its support with installing an energy-efficient technology that will allow us to reduce environmental pollution, improve the microclimate and achieve energy efficiency in the hospital units that provide perinatal and neonatal health care services. Dalius Drunga, Director 34
Children s Hospital, affiliate of Vilnius University Hospital Santariškės Clinics Project implementation period: 2012 2017 Project budget: EUR 431,209 Reconstruction of the ventilation system Compressed air supply equipment Vacuum supply equipment Compressed air, vacuum and oxygen supply systems with gas feed panels Installation of lighting with LED lights Installation of a solar cell system Installation of a heat pump system Installation of a photovoltaic power plant Until now the ventilation system of the Neonatology Centre could only guarantee air ventilation, but there was no air conditioning or humidification. After the system was modernised, the conditions in the premises accommodating our hospital s smallest patients meet hygiene standards: the air is not too dry and the rooms are not too hot in the summer. An appropriate ambient temperature is very important, especially for premature newborns, as their thermoregulatory centre is not yet fully developed. They get well more quickly in good environmental conditions. The LED lighting, solar cell and heat pump system and photovoltaic power plant that were installed will improve working conditions for the personnel, reduce operating expenses and cut lighting energy consumption in half, thus contributing to increased economic efficiency. Prof. Dr. Juozas Raistenskis, Director 35
Vilkaviškis Hospital Project implementation period: 2013 2017 Project budget: EUR 546,240 Insulation of exterior walls, including the base Replacement of windows Repair of the heating system Modernisation of the ventilation system (by installing a heat recovery ventilation system) Modernisation of the internal electricity supply system, including LED lighting Installation of a compressed air, vacuum and oxygen supply system Installation of a solar cell system Installation of a heat pump system We are delighted that the funds of the programme have made our hospital more modern and that, from now on, we can ensure a cosy environment meeting the highest standards for pregnant and delivering women and neonates. After the renovation, delivering women and newborns will receive more up-to-date services of a better quality no less than of health care services provided at hospitals in the big cities. As repairs on the building are completed, the operating expenses will decrease from those sustained before the project implementation, which will allow the hospital to save funds. The premises have become cosier and warmer, and the visual appearance of the hospital has changed as well. Linas Blažaitis, Chief Physician Before After 36
Vilnius Maternity Home Project implementation period: 2012 2017 Project budget: EUR 1,150,503 Reconstruction of the heating system Renovation of the ventilation system Modernisation of the internal electricity supply system, including the installation of lighting with LED lights Reconstruction of Heating Station No. 2 Compressed air, vacuum and oxygen supply system Owing to the programme, we have renovated the heating, ventilation, electricity and medical gas supply systems and installed LED lighting over a short period. The renovation of these utility systems and the installation of LED lighting have resulted in reduced energy consumption. We now already feel the cost savings. If not for this support, we would not have achieved these results for many years yet. Kornelija Mačiulienė, Director 37
Vilnius City Clinical Hospital Project implementation period: 2012 2017 Project budget: EUR 240,697 Reconstruction and restoration of the ventilation system Installation of lighting with LED lights The modern ventilation system installed in the Neonatology Unit maintains optimal air temperature in the intensive care wards. The environment is warm and fresh, and there is no need for airing the rooms the old way by opening the windows constantly. This would cause many inconveniences for the care of ill newborns, especially premature ones. The lighting installed under the Swiss programme in the Delivery Units and delivery rooms has not only made patients feel cosy and warm, it has also improved working conditions for medical personnel. The arduous work of a medical professional requires special care and good lighting. Moreover, the new light sources consume less energy, thus enabling the hospital to save funds. Neonatologist, Dr. Violeta Drejerienė, Head of the Neonatology Unit 38
Vilnius University Hospital Santariškės Clinics Project implementation period: 2015 2017 Project budget: EUR 365,525 Installation of a solar cell system Installation of a heat pump system Installation of a photovoltaic power plant A photovoltaic power plant, a solar cell system and three heat pumps (air water) have been installed on the roof of the Obstetrics and Surgery Unit. The solar cell system will convert solar energy into thermal energy for the preparation of hot water, and the heat pumps, absorbing heat from the environment, will also transfer it to the building's hot water system. The photovoltaic power plant will supply electricity to the heat pumps and the pumps of the solar cell system, and also meet other needs of the hospital. The integration of the solar cell and heat pump systems with the heating station of the building will perform the additional function of preparing hot water, which will reduce hot water preparation in the heating station by up to 50 percent. The installed systems will ensure a considerable reduction of environmental pollution (CO 2 ) and contribute to the main objectives and indicators of the programme. Valdas Kavalnis, Head of the Project Management Division 39
Visaginas Hospital Project implementation period: 2013 2017 Project budget: EUR 524,552 Renovation of the heating system Modernisation of the ventilation system Installation of lighting with LED lights Installation of a solar cell system Installation of a heat pump system Installation of a photovoltaic power plant This programme is an excellent opportunity to create the best conditions for delivering women, neonates and their relatives in Lithuania s outlying cities. We are happy that the Obstetrics and Gynaecology Unit of our hospital has become cosy, warm and comfortable for delivering women and the personnel working here. Kastytis Matulevičius, Director 40
Evaluation of patient satisfaction with conditions in hospitals participating in the Programme Patient satisfaction with obstetric services increased from 14 % (2007) to 51 % (2016) An evaluation of patient satisfaction with conditions in hospitals participating in the Programme* commissioned by the Ministry of Health was carried out to evaluate the effect of Lithuanian-Swiss Cooperation Programme on the improvement of obstetric and neonatological services in Lithuania. The interim stage of evaluation was 2015 Q1, and the final stage was in 2016 Q4 2017 Q1. The survey has found that general patient satisfaction with obstetric services increased from 14% (2007) to 51% (2016). The growing satisfaction with obstetric services is determined by the following factors: more delivering women are very satisfied with the professionalism of the medical personnel and the attention devoted to delivering women and neonates; delivering women notice the new diagnostics and treatment equipment and appreciate the increased comfort in the rooms (most delivering women confirm that stable air and water temperature suitable for hygiene is maintained in the wards and that the rooms have appropriate ventilation and lighting). The medical personnel has also taken note of the improving treatment and nursing conditions: their absolute majority note that the professional training organised during Lithuanian-Swiss Cooperation Programme for financial support to the health care sector has had a positive influence on their professional development. 41
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