Primary Health Care Services UNRWA June 23, 2011
Overview A network of 28 primary health care centers (1/2 of them inside camps) Primary Health Care Services Basic Package: MCH, NCD, General, essential medications Diagnostic services: Basic Laboratory & Radiology Additional services: Oral Health, Gynecology, Cardiology, Ophtalmology. School Health Program
Assessment of the services in 2009 & 2010
General Findings Centralization of the management of the health centers. Fragmented supervision of the health department. No intermediate management & support at area level. Heavy & complicated reporting mechanism.
Increase by 13% in 2009 as compared to 2007 Number of consultations yearly Total number of consultation per day 3900 3800 3700 3600 3500 3400 3300 3200 3100 2007 2008 2009 Year Total
Organization of flow of patients Clinics are Crowded Bottleneck happens between 8am to 11:30/12pm Patients try to come as early as possible (to receive prompt attention and leave quickly) Health staff handle paper work from 11:00 till the end of the working day
Medical Consultations Average number of consultations per day per medical officer is 107 Distribution of Visits Regular visits 40% Walk-in visits 31% Patients visiting clinics for paper work 26% Non necessary visits / non medical reason 3% No Defined System to Control patient Flow Long waiting time Pressure of patients Impacts the quality of health care Short contact time (2.5-6 min)
Management of Medical Supplies Frequent stock rupture of medications Prescription Behavior Health Center Related Over prescription of some medications mainly Analgesics, NSAID Polypharmacy for the elderly & collected by relatives Short consultation time Patient Related Lack of health education Store for emergency use (Analgesics etc) Repeated psychosomatic complaints Others Dispense medications prescribed by outside physicians Dispense medications post-hospitalization Security
Patient Satisfaction Survey Results Stratified Random Sample of 1618 patients from all centers. 62% of the patients are satisfied or very satisfied from services in Health Centers. 38.4% think that waiting time is good/very good 56.20% think that consultation time with MO is good/very good Variations among health centers
Primary Health Care Reform
Objectives of Reform Improve Access to health care services Improve Quality of services Increase Community Ownership & Trust of services Better Monitoring & Control
Governance Restructuring of the health department At central level LFO: shift from Micromanagement of operations to a more strategic and developmental role. Decentralization of the operations to the area level: Area Health Coordinators with a supporting team Strengthening the capacity of the management at the level of health centers. At the health center level Categorization of the health centers (small, medium, large, Polyclinic) Redefining the right skill-mix in health centers Defining the reporting lines
Health Workforce Review of the job descriptions and grading of the health posts. Capacity Building of the staff Managerial Training of Managers of Health Centers Technical Training of Medical Officers on management of common medical problems in primary care. Training on management of cardiovascular diseases (both Medical Officers and Nurses).
Service Delivery Type of services Strengthening existing programs through long term projects: Monaco Cardiovascular project Introduce new services through long term projects: Diabetes Mellitus, Pulmonary Diseases, Mental health New Approach: Family Health Teams Organization of Work Improve the workflow in the health centers through an appointment and triage system Review of Technical Instructions Distribution of Tasks among staff ensuring efficiency and maintaining effectiveness of the service.
Service Delivery Quality of the Services Quality Standards (MoPH-Canadian) Assessment of 2 centers done & development of a Quality Improvement Plan. Improve Quality of the Doctor Consultation. Ensure efficient management of supply chain of medical supplies/medications Improve the physical structure, equipment Upgrade the equipment & Furniture Rehabilitation of health centers (minor, major through separate projects) Safe Environment: An assessment of occupational risks was done in 4 health centers and will be followed by development of Occupational Safety & Health Program.
Filling Patient Basic Information Add Patient 04 تموز 11 Electronic Health System (UNRWA) 16
Health Information System E-Health Integrated Module Master Patient Index Computerized Appointment system NCD/MCH modules Pharmacy Module Challenges Logistical (electricity, network etc) Computer literacy of the staff Community Acceptance Staff Resistance
Communication & Partnership Health Awareness Campaigns Anemia Rational Use of Medications Healthy Nutrition (NEXT) Coordination Groups/Networks General NGO Coordination Network Mental Health Coordination Network Elderly Coordination Network Partnership with Ministry of Public Health