Agency Headquarter Hospital Meshti Mela, Orakzai Agency Progress Report ober-ember, 217 Website: merf-pakistan.org Email: info@merf-pakistan.org
I. Executive Summary Re-vitalization and strengthening health care services under public private partnership in this regard MOU signed between MERF and Directorate of Health FATA. II. MAJOR ACTIVITIES PERFORMED A. Service Delivery Performance against Key Performance Indicators for the reporting period starting ober 1st 217 and ended ember 31st 217 in AHQ Hospital Mishti Mela. i. OPD SERVICES During the reporting period, Outpatient care was provided at AHQ Hospital Mishti Mela in the following specialities: 1. General Medicine 2. General Surgery 3. Paediatrics 4. Gynaecology 5. Orthopaedics 6. Otorhinolaryngology (ENT) 7. Ophthalmology (Eye) 8. Dentistry The OPD services were provided by team of Specialists & Consultants. In the daily OPDs, patients with communicable diseases (ARI, Diarrheal diseases etc) as well as chronic illnesses (Diabetes, Hypertension, CHF, Arthritis, Asthma etc) were provided healthcare services. It was also ensured to improve the sick child management with a focus on acute respiratory tract infections & control of diarrheal diseases by utilizing IMNCI (integrated management of neonatal & childhood illnesses) guidelines. Due to the provision of quality of services, trust among the community is building day by day which resulted in increased caseload than previous quarter despite the extreme harsh weather (snowfall started during the month of ember). Patients from Lower Orakzai Agency have also started visiting the hospital who were previously reluctant to come due to sectarian tension. This caseload will further increase once the roads to various areas like Ghuljo and Daburi starts getting regularly opened. During the reporting period (, 217), a total of 8,74 (Males: 4,66, females: 4,8) consultations were conducted; out of which 3,22 (Male: 1913, female: 1289) consultations were conducted for children. MERF has provided free-of-cost medication to all patients in OPD, Inpatient and A&E. 2
Monthly OPD 4 35 3 25 2 15 1 5 OPD Consultations - Quarterely 1 3381 8 395 6 2264 874 6671 4 2 Q-1 ENT OPD PAEDIATRICS OPD EYE OPD PAEDIATRICS OPD Q-2 3
i. ACCIDENT & EMERGENCY (A&E) SERVICES A & E Consultations Quarterly A & E Consultation 8 7 6 711 5 664 534 4 3 2 1 195 19 185 18 175 17 165 16 155 15 199 1646 Q-1 Q-2 During the reporting period, the A&E department remained fully functional on 24/7 basis. The said department remained opened during the Eid & Muharram holidays to provide emergency services. During the quarter, a total of 1,99 cases were seen and treated at A&E department. Out of these, 5 patients with Myocardial Infarction, 5 cases of gun-shot injuries, 19 with Ischemic Heart disease, 2 with Fractures, 76 with Road Traffic Accidents were treated. 11 cases each of Status Asthmaticus & Status Epilepticus cases were also treated. All the patients were provided free-of-cost medicine & referral services. MYOCARDIAL INFARCTION HEART ATTACK ROAD TRAFFIC ACCIDENT - RTA 4
ii. MATERNAL AND CHILD HEALTH CARE SERVICES MNCH Services 16 14 12 1 8 6 4 2 MNCH Services - Quarterly 141 93 91 3 29 3 ANC 17 Deliveries 3 4 35 3 25 2 15 1 5 357 325 112 76 17 ANC C-Sections Deliveries Q1 6 C-Section Q2 During the reporting period, quality maternal, neonatal & child healthcare services were provided to the beneficiaries. Ante-natal care clinic, supported by a 24/7 functional Labor Room and roundthe-clock availability of obstetrical surgical team was ensured. During the quarter, a total of 325 ante-natal consultations were provided. 76 Spontaneous Vaginal Deliveries (SVDs) were also conducted in the LR, whereas, 6 complicated cases were managed by Caesarean Section (Csection). Twin babies kept in baby warmer after delivery 5
iii. INDOOR/ADMISSION SERVICES Admissions Admissions - Quarterly 18 16 14 159 164 12 1 113 8 6 4 2 5 45 4 35 3 25 2 15 1 5 436 34 Q1 Q2 The out-patient and A&E department was backed up by a fully functional in-patient care facility at the AHQ hospital. During the reporting period, a total of 436 patients were admitted in the wards who received treatment under different specialties functional at the hospital. The wards were fully equipped & staffed to provide round the clock services to the admitted patients. Consultants/Specialists conducted morning & evening rounds to closely supervise the management of the patients. In face of the harsh weather conditions, proper insulation of the wards along with adequate heating system was ensured to provide a comfortable environment for the patients. 6
iv. SURGERIES Surgeries Surgeries - Quarterly 8 7 6 18 16 7 5 156 14 12 54 1 4 8 3 32 2 6 78 4 1 2 Q1 Q2 During the reporting quarter, a total of 156 surgeries were performed for various specialties like General surgery, Ophthalmology (Eye), Otorhinolaryngology (ENT), Obstetrics. The performed surgeries included Laparotomies, Cholecystectomies, Appendectomies, C-Sections and Inguinal & Umbilical Herniorrhaphies. In ophthalmology, Cataract extractions with IOL, Dacryocystorhinostomy (DCR), Pterygium were some of the performed surgeries. In ENT, Tonsillectomies, Septoplasties were performed. All the surgeries were conducted under strict Infection Control with the support of Consultant Anesthetist. ENT Surgery General Surgery 7
ENT Surgery v. General Surgery DENTAL DEPARTMENT In the dental department MERF has provided services through two (2) dental surgeons. Keeping in mind the high prevalence of Hepatitis B and C in the area, MERF has implemented a strict protocol of patient screening. During the reporting period a total of 69 consultations were provided, in which 199 tooth extractions, 187 Root Canal Treatment (RCTs), 172 fillings & 17 dental surgical procedures were performed. PAEDIATRICS OPD 8
B. DIAGNOSTIC SERVICES i. LABORATORY SERVICES During the reporting quarter, new equipment was procured to strengthen the clinical laboratory at the AHQ hospital. The laboratory remained functional on 24/7basis to perform a large variety of investigations supporting Out-patient, In-patient & A&E services. During the reporting period, a total of 6,546 investigations were performed. Laboratory Investigations 25 2 Lab Investigations - Quarterly 7 238 2361 6 1877 15 6546 5 4 3 1 2 5 2519 1 Q1 Q2 9
ii. ULTRASONOGRAPHY In the second quarter, MERF procured ultrasound machines and started the U/S scans for general as well as obstetrical/gynecological patients. A total of 866 scans were performed during the quarter for ante-natal patients as well as other patients requiring the services. Ultrasonographies 5 45 4 35 3 25 2 15 1 5 456 278 132 iii. Electrocardiography (ECG) ECG services were made available by MERF at the AHQ hospital. During the reporting quarter a total of 257 ECGs were performed for patients from Out-patient, In-patient & A&E departments. ECG - Quarterly ECG 95 9 85 88 91 8 75 78 7 3 25 2 15 1 5 257 177 Q1 Q2 1
C.PHARMACY All the pharmacies established at the AHQ hospital remained functional during the reporting quarter and ensured continuous free-of-cost provision of medicine to all the patients attending OPD, IPD & A&E. In the second quarter as well MERF has kept its Pharmacies services open round the clock 24/7 respectively in OPD, emergency and wards. OPD Pharmacy Main Warehouse Record keeping at Satellite pharmacy 11
D. HOSPITAL CLEANLINESS Cleanliness of the hospital remained a priority task at the AHQ-Hospital. A team of cleaners is made available at the hospital to keep the premises clean including all the service areas. For waste management, color-coded bin system is established for segregation of waste at the point of generation followed by its appropriate disposal. 12
III. HR Recruitment and Deployment MERF has recruited and deployed the following clinical and non-clinical staff at AHQ hospital Mishti Mela Serial No 1 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 2 Name of Positions Hospital Administrator Consultant/Specialist Medical Officers Female Medical Officers Dental Surgeon Data Manager Staff Nurse /LHVs Pharmacist Clinical Technicians HR Assistant Security Incharge Security Guards Computer Operators Ward Attendants Sweepers/Laundury Dai / Aya Log officer Finance officer Store Keeper Drivers Total Approved positions in Budget 1 6 12 3 1 1 2 2 26 1 1 1 7 2 23 1 1 1 2 3 151 Status 1 1 18 4 2 1 25 2 25 1 1 1 5 2 22 7 1 1 2 2 16 13
IV. CHALLENGES 1. Significant delay in fund release from Directorate of Health Services FATA; leading to delay in staff salary payment. 2. Caseload decreased during the month of ember 217 due to extreme cold weathers. Temporary arrangement were made for heating which is too costly. Centralized heating system will be essential as permanent solution. 3. Notification of Steering Committee of the project & sub-committee at agency level are pending. Need to notify these committees to provide oversight for the project. 4. Need of additional medical equipment. This is pending due to delay funds disbursement. 5. Need of hospital furniture. This is pending due to delay in funds disbursement. 6. Non-availability of electricity leading to non-functioning X-Ray and other medical equipment. Currently two 3 KVAs generators were provided but that cannot run the heavy medical equipment like X-ray machine. 7. TESCO express-line and Solar panel installation are still pending 8. Security issues. Threats to the hospital have been received during the month of ember which lead to the partial closure of the hospital for few days. 14