strengthening specialized clinical services in the pacific

Strengthening Specialized Clinical Services in the Pacific www.sscsip.org



Overview of presentation

• Background info abut SSCSiP• What SSCSiP is about• Activities in the Northern Pacific• Regionalism lens • Lessons learnt • Way forward



Project Scope

• Level of clinical support beyond that of the primary health care worker

Examples: surgery, internal medicine, paediatrics, anaesthetics and trauma/critical care, obstetrics and

gynaecology.• The personnel providing specialised clinical

services - medical specialists, nursing officers, biomedical technicians, radiographers etc


Service delivery modalities

• Offshore referrals

• In-country through visiting teams

• In-country though local specialists

Issues• cost-effective and equitable -

agreed medical and equity guidelines); patient outcomes

• Planning (Not Demand driven, no objective needs analysis, poor hosting, lack of coordination) evaluation of patient outcomes; adjunct services

• Lack of skill/knowledge transfer from visiting specialist to local clinicians.



Example of Regionalism

PICs identifying a common issue of concern

PICs identifying a common issue of concern

PICs & Development partners coming together to discuss identify a solution – SCS Project

PICs & Development partners coming together to discuss identify a solution – SCS Project

Project design reviewed & endorsed by MoH, and Pacific Island Ministers Meeting

Project design reviewed & endorsed by MoH, and Pacific Island Ministers Meeting

Australian Government Funding

FNU as implementing agency

Australian Government Funding

FNU as implementing agency

SSCSiP ProjectSSCSiP Project



Coverage



SSCSiP Team • Secretariat (Based at FNU – Fiji Islands)

– Dean, PM manager, Health planner, M&E coord, Project coord, Biomed engineer, clinical advisors

• Budget of 1.2 Million AUD p.a• Next phase June 2012 – Dec 2014

– Planning, managing and evaluating SCS (VT, OR)– Information system for SCS (OR, VT, patient

outcomes)– HRH planning and capacity development (SCS)– Responding to urgent needs (VT, locums)



SSCSiP Governance• Secretaries/CEO of MoH and Directors of clinical services from 14 PICs• Annual meeting



Achievements to date

• Started in June 2011 (11 mo old) • Collection of Baseline data

– SA of SCS, Mapping of Clinician’s profiles, Mapping of biomedical services capacity, Costing studies

• Planning workshops (Palau, FSM & RMI)– ToR for visiting teams, preparedness checklists,

evaluation of visiting teams, offshore referral policies



Achievements

• Supported capacity building initiatives for clinicians & nurses (gastroenterology – FSM)

• Responded to urgent needs:– Locums (Palau) – pediatrician & obstetrician – Biomed equip maintenance (Palau & FSM)– Ophthalmology scholarship (FSM)



Mapping of biomedical services capacity

1.Equipment Management

Policy and Procedures

Procurement

Inventory

Minimum Equipment Standards

Disposal of Old EquipmentDonated Equipment guidelinesNew Technology Assessment

2. National Repair Capacity

Service Contracts

MOH/Private Sector balance

MOH Engineers

MOH Senior Biomeds

MOH Biomeds

MOH Trainees

Succession Planning?Repair Facilities

Urgent Spare Parts procurement?Adequate Tools/Test Equipment

Work Recording Systems?

Management Reports?

Equipment Identification?

Biomedical Budget allocation?

3. Hospital Repair Capacity

Regular Preventive maintenance?Safety &Function Checks?

Check Due Date marking?

Job Documentation

Total Equipment Inventory?

Total Inventory Value?

Equipment waiting diagnosis?

Equipment waiting spares?

Equipment waiting disposal?

Service manual availability?

Specialised test equipment?



Northern pacific situational analysis

1.Equipment Management Current Status

Palau Pohnpei Kosrae Yap Chuuk Majuro RMI

Policy and Procedures Policy Being Developed Procedures No

Being Developed Yes Yes No No

Procurement Contracts Yes Specs Yes

Contracts OK Specs Not OK

No Yes Contracts OK Specs Not OK

Contracts No Specs Not sure

Inventory Being Developed Being Developed No Yes HC’s No Hospitals Yes

Yes

Minimum Equipment Standards

Being Developed HC’s NoHospitals Not Sure

No No HC’s Yes Hospitals No

HC’s Yes Hospitals: Being Developed

Disposal of Old Equipment Not sure Yes No No Yes No

Donated Equipment guidelines

No Not Sure No No No No

New Technology Assessment

No Not Sure Not Sure No No No



Country scores

Recruited a BME – work with PIC; coordinate BEMI BME; BMT training



Total Dr (locals + expats) per 10,000 population



Areas of specialization for local Drs



Total no. of specialists (locals + expats)



Reflections & the way forward

• …

strengthening specialized clinical services in the pacific

Documents

specialized clinical

directors of clinical

forward slide

equipment identification

clinical advisors budget

agency sscsip project

pacific island ministers

equipment management