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1 | P a g e HFMT Concept Note

Health Facility Management Team

HFMT Concept Note

Suleman Qazi Waqas Sheikh

September, 2010


Contents

Background .................................................................................................................................................................. 3 The Input ..................................................................................................................................................................... 6 The Process .................................................................................................................................................................. 6

LRH-II ...................................................................................................................................................................... 6 Health Facility Management Team......................................................................................................................... 6 Visit Report ............................................................................................................................................................. 6

The Output .................................................................................................................................................................. 8 Community Monitoring .......................................................................................................................................... 9

Annexure ................................................................................................................................................................... 11 Annex 1: Health Facility Management Teams ...................................................................................................... 11 Annex 2: Vacancy positions .................................................................................................................................. 13 BPS-01 to BPS-20 .................................................................................................................................................. 13 Annex 3: TORs of District Health Management Teams ........................................................................................ 17


Background

Under the Community Dimension of the LRH2 there is a component of Health Facility Management, as shown in the project conceptual framework below. As you can see that within the ‘Process’ box in the center, on the right hand side the corresponding capacity to this facility management is Monitoring, given at No. 4. We elaborate the concept in a bit detail below.

Figure 1:The Conceptual Framework of LRH-II For our purpose we have identified four requisites for the operationalization of any health facility. These are Management Systems Human Resources Services Physical Ambiance


Figure 2: Four aspects of any health facility Unpacking these four dimensions we could identify a number of attributes. A. Management Systems 1. HMIS 2. LMIS 3. Medicine record 4. Inventory record 5. Attendance 6. Disposal of wastes 7. Protocols 8. Health education material 9. JDs and Performance Appraisal 10. Budget B. Human Resources: This should capture the quantity and quality aspects of staff. By quantity we mean the number of staff required, allocated, appointed/posted and present on duty.


Quality refers to skill of the staff in areas such as counseling (use of IEC/BCC), rational therapeutics, use of HMIS, use of EmOC protocols, etc. C. Services

Preventive 1. Health promotion?? 2. ANC 3. PNC 4. Growth Monitoring 5. Health education/Counseling 6. Blood transfusion 7. EmOC 8. Laboratory (CPC, Urine D/R, Xray, Ultrasound, Pregnancy test, VDRL, HIV) 9. Immunization for mother and children 10. IYCF

Curative

1. Treatment of common ailments 2. PAC 3. Treatment of STIs 4. Ambulatory 5. Referral 6. Minor OT

D. Physical Ambiance - FFF

1. Identification of Health Facility 2. Declaration of range of services available 3. Toilet facility (separate for females) 4. Waiting area 5. Privacy at treatment site 6. Privacy for lactation 7. Drinking water


The Input

Training and orientation on concept of Health Facility Management Team Participatory development and agreement on measurements of interest and indicators Technical and logistics support from Lead offices in Islamabad and District Khairpur.

The Process

The team of leaders visiting a health facility will arrange a visit to the designated health facility. Following report format will be used for record keeping and follow up.

LRH-II

Health Facility Management Team

Visit Report

Step 1: Name of Health Facility:___________________; Taluka:________________________ Date of Visit:______________________; Team Members Who Visited: ________________________________________________________________________________________________________________________________________________________________________________________________________________________ Note: in score column below, for every positive finding mark “1” otherwise give a “0” score

Aspect Theme Question Score

A. Management Systems

1. HMIS/DHIS

Was report sent to higher office previous month?

2. Logistic Management

Is there regularity between last three consecutive supplies of contraceptives?

Is there a push system (mark 0) or pull system (mark 1) of supplies in place?

3. Medicine record

Ferrous sulphate tablet out of stock?

4. Inventory record

Are bin cards indicating expiry of medicines?

5. Attendance

Attendance register maintained till last working day?


6. Disposal of wastes

Protocols on waste management available?

7. Protocols

Are Basic Obstetric Care Protocols Displayed?

8. Health education material

Maternal Health/Family Planning related posters displayed?

9. JDs and Performance Appraisal

Hard copies of Job Descriptions available at facility?

10. Budget

Updated Record of requisitions available?

11. Supervision Record of supervisors visit in last 4 months available?

B. Human Resources

Proportion of positions vacant: (Refer to Annex: 2)

Did the care provider receive any training on RH (EmOC; Family Planning) during last 36 months?

Staff received any training on HMIS during last 36 months?

C. Services

Preventive

Ante Natal Care (ANC) Updated Record Available?

PNC

Updated Record Available?

Growth Monitoring Updated Record Available?

Health education/Counseling


Blood transfusion

Reagents for blood grouping available?

A blood donors’ register maintained?

EmOC Injection Magnesium Sulphate available?

Laboratory Pregnancy test kits available?

Immunization for mother and children


IYCF

Curative

Post Abortion Care (PAC) Available?


Treatment of STIs

Are STI management guidelines available?

Ambulatory services Available?

Referral services Available?

Minor OT

Functional?

D. Physical Ambiance – (Family Friendly Facility)

Identification of Health Facility (Board etc.)?

Display of range of services available?

Separate Toilet facility for females?

Waiting area for females?

Privacy at treatment site

Privacy for lactation ?

Drinking water available?

Step 2: Plan action against the weaknesses identified

Weakness/Issue Identified Action Required? Who will do it? By When?

Next Date of Visit:________________ Please deposit a copy of this report to Lead Office Khairpur within 2 days of your visit

The Output

The diagram below shows that over time the 4 aspects are to be improved with the passage of time.


Community Monitoring

In order to assimilate and involve the community in developing the Health Facility, Village Assemblies (VA) have been devised as the requisite tool. Owing to the acceptability of VAs, it is imperative that this tool be used to involve the community. Without community participation, the temporal improvement will bear no effect on the overall improvement of health status. Village Assembly (VA) is an open forum for villagers under the auspices of respective village organization(s) to

discuss and resolve their common issues harmonize their collective efforts to foster grassroots initiatives for sustainable

development at local level

Components Improvements Required Status after 4 weeks

Health Facility

Facility Management

Human Resource

Physical Ambiance

Services Facility Management

Human Resource

Physical Ambiance

Services

MCHC Chondko

BHU Khuhra

BHU New

Goth Sa hto

BHU Sadr Ji -

Bhatyoon

MCHC Thari Mirwah

BHU Hussainabad

BHU Akri Lady Wellington Hospital


Considering the above mentioned goal, VAs will be coupled with the monthly visits of each HFMT. This will ensure that both the supply side issues and demand side requirements are addressed promptly.

• Monitoring Form

Supply Side

• Village Assemblies

Demand Side

HFMT Process


Annexure

Annex 1: Health Facility Management Teams

Health Facility

Taluka Peer Leaders Peers CLIG Total #

MCHC Chondko

Nara Muzaffer Panhwer Muhammad Ilyas Sahto,

Bilquees Burdi Balouch,

Dr Tasleem Khamisani,

Sarfraz Ali Soomro,

Syed Inayat Ali Shah

Jamila Khatoon,

Fida Hussain Buriro,

Farzana Shar,

Mehdi Shah

10

BHU Khuhra Gambat Khadim Mirani Qurban Ali Bhayo, Dr Zulfiqar Ali Dharejo, Bushra Bhangar, Dr Fazal Muhammad Memon

Haleem Ullah Soomro Qurat Ul aen Shaikh Nusrat Parveen Gilal

8

BHU New Goth Sahto

Sobho Dero

Mazhar Shaikh Abdul Waheed Mallah, Manzoor Hussain Larik, Rubina Shar, Ikhtiar Hus0ain Khaskheli

Sunfroz Shaikh, Maqsood Ali Channa, Nazir Shaikh

8

BHU Sadr Ji - Bhatyoon

Kingri Zamir H Lashari Shabnam Naz Palh, Sahib Khan Bhand, Atta Hussain Solangi, Iqbal Ahmed Morejo, Farah Naz Chandio

M. Mohammad Iqbal Channa Mukhtiar Ali Buriro, Haseena Lashari, Habibullah Mallah, Manzoora Memon

11

MCHC Thari Mirwah

Thari Mirwah

Inayat Ullah Jogi, Shahar Bano Shar

Zulfiqar Ali Gilal, Manzoor Ujjan, Abdul Aziz Khuhro

Mohammad Ameen Khaskheli Dr. Wazeer Hussain Phul, Abdul Jabbar Islami Hameeda Khaskheli Sobia Ameen Avida Jogi

11

BHU Hussainabad

Kot Diji Mehak Zahra, Dr. Zubeda

Aumir Abbas Mangi, Safdar Ali Bhatti, Shahida Perveen, Ali Murad Kalhoro

6

BHU Akri Faiz Ganj Nawaz Phulpoto Noor Hussain Shar, Agha Nadia, Ganhwari Balouch, Dr Aijaz Ali Samo

Mumtaz Hussian Chana, Dr. Akhtar Baig Aisha Khand Zubeda Burdi

10


Ishrat Parveen Abida

Lady Wellington Hospital

Khairpur Rana Shah, Akram Shaikh, Naheed Akhtar

Sanam Naz Palh, Fozia Hanif Arain, Dr Manzoor Ahmed Bugti

Advocate Khursheed Shehnaz Mughal Aftab Shar

6

TOTAL 70


Annex 2: Vacancy positions

BPS-01 to BPS-20

SANCTIONED FILLED & VACANCY POSITION BPS-01 TO BPS-20.

EDO HEALTH OFFICE KHAIRPUR.

S.NO TYPE OF HEALTH FACILITIES

NAME OF POST BPS

SAN

CTI

ON

ED

STR

ENG

TH

Field

VA

CA

NC

Y

01 RHC/THQ.

MS 19 1 1 -

DMS 19 1 1 -

AMS 19 1 1 -

Sr. RMO 19 1 1 -

Chief WMO 19 2 2 -

Opthalmologist 18 1 - 1

Aneathistist 18 1 - 1

ENT. Specilist 18 1 - 1

Surgeon 18 1 - 1

Skin Specialist 18 1 1 -

Gynaecologist 18 1 - 1

Pathalogist 18 1 - 1

Physician 18 1 - 1

Paediatrician 18 1 1 -

SMO 18 4 2 2

Dy. THO Curative 18 1 - 1

Dy. THO Preventive 18 1 - 1

SWMO 18 3 - 3

Sr. Dental Surgeon 18 1 1 -

MO 17 4 4 -

CMO 17 2 2 -

Dental Surgeon 17 1 - 1


Staff Nurse 16 7 7 -

Health Technician 9 2 2 -

Dental Tech: 9 1 1 -

ECG Tech: 9 1 1 -

LHV: 9 2 2 -

X-Ray Tech: 9 2 2 -

Dispensar 9 7 7 -

Lab: Assistant 7 2 2 -

Junior Clerk 7 1 1 -

Purchi Clerk 7 2 2 -

Dental Assistant 5 1 1 -

Driver 4 1 1 -

Nursing Ordely 4 1 1 -

OT Attendent 3 1 1 -

Ward Servant 2 10 10 -

Dai 1 3 3 -

Naib Qasid 1 4 4 -

Cook 1 1 1 -

Malhi 1 1 1 -

Chowkedar 1 2 2 -

Sanitary Worker 1 4 4 -

02 RHC

MS 19 1 1 -

DMS 19 1 1 -

Sr. RMO 19 1 1 -

Chief WMO 19 1 1 -

Opthalmologist 18 1 - 1

02 RHC. Ranipur

Aneathistist 18 1 1 -

SMO 18 4 3 1

SWMO 18 1 1


Dental Surgeon 17 1 1 -

WMO 17 1 1 -

MO 17 3 2 1

Staff Nurse 16 1 1 -

Dental Tech: 9 2 2 -

LHV: 9 1 1 -

Health Tech: 9 2 2 -

X-Ray Tech: 9 1 1 -

Dispensar 9 7 7 -

Lab: Assistant 7 1 1 -

Health Inspector 7 1 1 -

Junior CLerk 7 1 1 -

Mid Wife 6 1 1 -

Driver 4 3 3 -

Ward Servant 2 6 6 -

Dai 6 2 2 -

Naib Qasid 1 3 3 -

Sanitary Petrol 1 1 1 -

Malhi 1 1 1 -

Water Carear 1 1 1 -

Cook 1 1 1 -

Chowkedar 1 2 2 -

Sanitary Worker 1 5 5 -

03 BHU

SMO 18 1 - 1

MO 17 1 1 -

Health Technician 9 2 2 -

Dispensar 9 3 3 -

Mid Wife 6 1 1 -

Attendent 2 1 1 -

Malhi 1 1 1 -


Chowkidar 1 1 1 -

Naib Qasid 1 2 2 -

Sanaitary Worker 1 1 1 -


Annex 3: TORs of District Health Management Teams

District Health Management Team

Terms of Reference Checklist

Terms of Reference: 1. To prepare a Strategic Management Plan for the Health Sector in the district that is in line with and directly supporting national, provincial and district social sector policies and helping Pakistan in achieving MDGs 1.1. To prepare and/or endorse five -Year Health Sector Plans for the district 1.2. To review the Strategic Plan periodically in order to bring it in line with current realities and expected challenges in the future. 2. To prepare and/or endorse evidence-based Annual District Health Plans, comprising but not limited to the following: 2.1. Resources Management Plan 2.1.1. Human Resource Management Plan 2.1.2. Financial Plans 2.1.3. Facilities & Asset Management Plan 2.1.4. Logistics & Services plan 2.2. Activity work plans along with action plans with deadlines and timetables 2.3. Inter-sectoral & Inter-agency Collaboration Plan(s) including Systems for Public Private Partnerships. 3. To ensure effective management and implementation of Five Year/Annual District Health Plans. 4. To establish effective monitoring and evaluation systems to assess the performance of health systems and services in the district using, among other tools, DHIS. 4.1. To produce evidence-based Annual District Health Sector Performance Report. 5. To establish an effective Referral System in the district. 6. To effectively and efficiently utilize DHMT’s operational allocation.

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