EFFECTIVE TRANSFORMATION

Saving Lives - One Step at a Time.

Reporting the Report.

It might seem a dull process but the results are exciting  - lives are being saved.

 

Nick and the team visit each health unit quarterly and measure them according to set criteria. Good  practice is praised and weaknesses discussed. This painstaking approach is yielding results. Oberabic Health Centre II was visited in March. Here is the report. As well as the nuts and bolts, this report gives a glimpse onto life at Oberabic, how to get phone reception, a clinical case  and -- a very special person -- a baby born in the new unit!

Oberabic Supervision Report 23/3/2017

 

Dr. Nicolas Laing (DHC), Assistant Akwero Fiona, and intern Florence Oyet visited the facility. It’s worth noting that for the previous month they were operating without the in-charge Christopher, who was away on annual leave. Chis is due to return 4/4/2017

 

Gloria takes an important phone call under the Papaya tree – the only place with good reception!

 

Spot check Organisational score

3/2017             40/47  4^th out of 10 health Centres reviewed. Still good
12/2016          40/47  2^nd out of 10 Health Centres reviewed, well done
10/2016          39/47 = 83%    2^nd of 10 health centres reviewed – well done
7/2016             40/48 = 83%    1^st of 10 health centres reviewed – great job!
4/2016             33/44 = 75%
9/2015             26/44 = 59%

 Positives
- Still well organized, scoring highly amongst all our health centres
- New nursing assistant Alex settling in very well. I’m confident he can work out well.
- Continuing to pay one nursing assistant via cost share which is encouraging 6 months down the line
- Numbers averaging around 400 monthly, not increasing any more but still good. We don’t expect  any increases from here as the district spraying program has been completed in the area and this should have a drastic effect on malaria in the area (if it hasn’t already), with patient numbers potentially even dropping a little. I still believe 400 monthly is realistic when malaria drops
- Toilets clean
- Staffing now improved with new nursing assistant on board
- New Hepatitis B testing and vaccination initiative going well, now charging 2000 per test or vaccine which has reduced numbers a lot to a manageable level (previously could be 100 on vaccination days, now 5-20)
- Drug accountability excellent, no errors found on reviewing 3 common drugs
- Family planning still maintaining good numbers
- Antenatal numbers very high
- Broke delivery record with 11 deliveries in month of March.
- New family planning project generated 800,000 UgSh first month, likely to increase to 1.2 million plus for the next few months.

Services delivered Monthly (Ranges given from December to Feb)

Outpatients                            400-500
Antenatal consultations       50-70
Deliveries                                6-11
Family planning methods      20-45
Outreaches                              4x monthly
Child vaccination                   30-50
Hepatitis B test and vax        5-20 weekly

  

One of the first babies born in the new maternity unit.

 

Issues
- Still not adequate hand washing? have added one but still need 2 more
- Not using stock book still which is disappointing.
- No duty roster still
- Patients latrine was very dirty. Discussed with staff that cleaner is neglecting some jobs, need to follow up on this and make sure is done well
- HIV test kits expired, few remaining

Medical Quality

Spot Check Score

3/16    20/29 =  69%               5^th of 10 health centres reviewed
12/16 14/29 = 48%               8^th of 10 health centres reviewed
10/16  23/29 = 79%              1^st of 10 health centres reviewed
7/16    12/23 = 52%              7^th of 10 health centres reviewed
4.16     11/23 = 48%
8.15 4/15         = 23%

Positives
- Antibiotic percentage between 40-50% for both adults and Children. Improvement from last time
- Nurse at midwife now seeing most of the patients, very few seen by nursing assistant.
- Remains the top performing diocese health centre under Marie Stopes.
- Drugs per patient improved to 2.5, still not back to old levels
- No longer giving antibiotics for URTI
- Guideline following improved to 70% but still not good enough.

Shortfalls
- Folic acid just ran out due to high number of antennal. Essential stock outs like this must not happen
- Not following guidelines properly for some conditions
- Still not performing as well as they previously were – hoping for greater improvement next time.

 



Abalo face and ankles were swollen. The urine dipstick showed huge protein and small blood, and she was treated with steroids and a diuretic. It’s amazing what you can do in the bush!

Recommendations achieved (from last assessment)

-          Do between 5 and 10 deliveries a month on average over the next 2 months. Well done all!

-          (Diocese discussed with DHO) Start charging 2000 equipment fee for hep vaccines Done, no problems

-          Reduce Hepatitis B vaccines and testing to under 30 per day on Tuesdays and Thursdays to make more realistic for staff Done, now 5-20 only

-          Start Maternity Project Well done, initial assessment by voucher plus good, and 800,000 made first month

-          - Sort out housing situation for Jennifer, by her sleeping in a different house (New nursing assistant living in hut no problems.

-           Complete maternity and toilet block construction (February 2016)

-          - Christopher and Gloria to plan for Annual Leave (Chris already taken, Gloria planned well done)

Recommendations  not achieved (from last assessment)

-          Get written document by man who gifted land to health center, allowing some of his children free treatment for a few years from now. Still not done

-          Buy 2 new hand washing buckets and set them up (Only one bought)

-          Improve prescribing quality back to over 75% on our assessment. This is the most important performance indicator for staff and we expect great improvement in this area. Not achieved, only 70% achieved

New Recommendations

-          Average over 1 million shillings monthly on Voucher plus project (May 2017)

-          Improve guidelines following – over 75% on (May 2017)

-          Have in place the 3 extra handwashing basins (May 2017)

-          Over 50 antenatal visits monthly (May 2017)

-          Average over 8 deliveries monthly for March, April, May (May 2017)

-          Increase costshare by 500 shillings for all age groups (May 2017)

-          Be completing stock books monthly (May 2017)

-          No stock outs of essential medications (May 2017)

  

The assessment continues to be good, with a small slide in quality probably because of the lack of the in-charge there. The diversity of services continues to impress; with OPD, antenatal, deliveries, family planning, vaccination and outreaches all thriving. The quality of prescribing still needs some improvement but is better than last time.  

God Bless, Dr. Nicolas Laing
Health Co-ordinator, Diocese of Northern Uganda