HOSPITAL DEVELOPMENT

Background: Quality health facilities have become buzzword in recent times with increasing health awareness among people in general. In-order to satisfactorily meet public demand, State proposes a number of strategies including up gradation of health institutions to L1, L2 and L3 level, declaring deserving institutions to Healthy Hospital and Hygienic Hospital (H4) level and further up gradation of some of those hospitals to ISO level. The State Mandate proposes promoting select L2 and L3 institutions to H4 level and select H4 institutions to ISO level. The ISO level hospitals are expected to be equitable, affordable, accountable and responsible to the peoples need. Moreover, it should strive to provide preventive, promotive, qualitative and secondary level of curative health care services to its patients. 1.The H4 Strategy : A Healthy and Hygienic hospital denotes much more than just a clean hospital. It mainly focuses on the client satisfaction and non-clinical aspects of health service; like environmental security, housekeeping, laundry services, waste disposal etc. 1.a. Branding H4 Institutions: The assessment of the health institutions follows a stringent procedure. The following steps are followed prior to the declaration of H4 institution. A score sheet with a total of 400 points is maintained to assess non-clinical service provisions Any institution acquiring more than 75% is declared as H4 hospital Institutions squiring marks between 50 % to 75% are considered average Institutions below 50% is marked as poor

1.b. Establishing Branding Procedure: Every hospital would be assessed twice annually (preferably in the month of April & Nov) and given a performance rating score. 2/3 selected RKS members as decided by Member Secretary along with representative from District, who will conduct the joint assessment. All the services in the hospital are to be analysed based on the given indicators. These are designed in such a way that the aim is to improve the hospital and not to count failures. Result of the assessment must be shared with all other members of RKS in next Governing body meeting. Further the RKS will be sensitised to implement the activity as per the approved hospital PIP. A nodal officer for each hospital will be appointed who will monitor the entire process from April to November. The successful hospital will be certified H4.

2. Development of Annual Hospital PIP: Annual PIP for each hospital is a tool for hospital specific planning to reach H4 level. The objective of this is to conceive, develop, implement and monitor a set of initiatives that would ensure hospitals to provide people friendly and good quality clinical and non-clinical services enhancing clients satisfaction. 2.a. Need for Hospital Development Plan: Funds provided to districts were not used due to the lack of an annual plan with clearly laid out activities. Activities were adhoc and unplanned. User Fee collected was lying unutilised

2.b. Features of Hospital PIP: RKS Annual Budget is being prepared in tune with the funds available at respective institutions i.e. RKS and other untied grants under NRHM as well as user fees collected at the respective institutions. Annual action plan is done in month of April duly approved by the RKS governing body.

2.c. Status & Plan: The hospital PIP is being prepared since last two years covering all institutions starting at DHH level to block level. This year the State is planning to cover all the institutions across Odisha and bring it up to the PHC level.

3. Strengthening Non-clinical Services: Non clinical services plays a vital role in any hospital. The various kinds of services that the patients look in a hospital include: 2. Housekeeping and cleanliness services 3. Hospital linen and laundry services 4. Security services 5. Ambulance Service 6. Dietary Services 7. Help Desk 8. Bio-medical Waste Management 9. Basic amenities such as, drinking water, sitting lounge etc.

Issues The maintenance of the established facilities has been a major challenge. While the non-recurring costs incurred in managing the hospital is mostly managed from the RKS funds, it becomes difficult to meet the high recurring costs without the grants. However, as per the State Mandate, all the health institutions must be equipped with the above facilities to reach to H4 level and subsequently ISO level. Principles Outsource: All the non-clinical services incurring recurring expenses will be outsourced. Lump Sum Grant: A lump sum amount depending on the level of the hospital and bed strength will be paid to each health institution to meet daily expenses. Priority Activity: RKS governing body will carry out its expenses priority wise. Annul Action Plan: An annual action plan will be developed and approved by RKS governing body for implementation.

Bed Strength L3 Institutions = 30 31-60 61-100 101-160 161-200 201-300 > 300 L 2 Institutions

No of Institutes 78 28 12 12 11 3 1

Grant 40,000 60,000 75,000 1,00,000 125,000 175,000 3,00,000

4. Up-gradation of Selected Hospitals to ISO Standards Every health care center is critical to health care service delivery. An ISO certification is very important as it helps to achieve a certified level of quality, sustainability of the achieved level of services and improvement on a continuous basis that needs consistency in approach with due commitment . Selected hospitals are being promoted for ISO certification under NRHM Orissa. It entails that necessary provisions are made relating to availability of adequate manpower with necessary skill sets, capacities, availability of equipments, drugs and consumables and civic facilities, proper hospital management (according to standards of intervention) along with quality health care. 4.a. Status: DHH, Puri has been up graded to ISO (9001 -2008) certified in March 09. In the year 2010- 2011, 3 DHH, 10 SDH/AH and 5 PHC/CHC were proposed to be upgraded in the PIP. In the due course we have planned to develop 8 DHH.

Presently 6 DHHs are provided with full time technical supervision by the technical support partner, Ontario Solution Pvt. Ltd and 2 DHHs are being provided with part time technical supervision by Medica Synergie. Out of the 9 DHHs, four DHH (Anugul , Kandhamal, Keonjhar and Koraput) are in High Focus districts and rest four are in other districts like Bhubneswar , Jajpur , Mayurbhanj and Balasore.

4.b. Plan: For the year 2011- 12, the State aims at maintaining all existing ISO standard 9 DHHs.

4.c. Basic Roles of Technical Support Partners: To provide technical supervision support to the hospital in developing tools for quality improvement and maintaining the quality of health care. To support the healthcare facility on site through presence of competent personnel, holding a certified status of lead auditor of ISO 9001 from recognized accrediting body e.g NABET, IRCA. Institutional set up Hospital Development Team at State level consists of a Consultant (Medical), Consultant General Management and Support Staff. This team provides oversee functions of all hospitals in the State. At all 32 DHH level, Hospital Managers are proposed to be placed to deliver and monitor activities under the H4 concept. Senior Hospital Manager along with Hospital Manager will be appointed at selected State level hospitals like, RGH, Rourkela, Capital Hospital, three Government Medical Colleges, Sishu Bhawan and Cancer Hospital, Cuttack. At District level hospitals, the Hospital Managers will be placed under the administrative control of ADMO to carry out all activities relating to hospital development. ADMO (PH) with the support of respective BPOs supervises the functioning of H4 aspects in hospitals at block and sub- block level. Five Senior Hospital Managers and fourteen Hospital Managers have been recruited at the District level.

5. BIO MEDICAL WASTE MANAGEMENT Background The regulatory framework for bio- medical management is provided by the Bio-Medical Rules (prepared in 1998; amended in 2000 and 2003) which is mandatory for all institutions that generate bio-medical waste like hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood banks.

Current Status IEC materials on bio medical waste management protocol with instruction for service providers have been displayed in most hospitals. Basic awareness on bio medical waste management system created Containment area has been established and operational in majority of the hospitals however that need repair and renovation. Colour bins are used in many hospitals but not in all strategic points. Bio medical waste management has been outsourced to agencies in DHHs and SDHs and outsourced in 17 out of 32 DHH. Consumables and other logistics are being provided to all hospitals out of state budget.

Issues: Basic awareness level of service providers low No proper containment area at block CHC and PHC level Irregular procurement of essentials like colour bins, plastic bags, gloves etc. Safety measures like use of protective gears and vaccination not used and poor co-ordination with urban local bodies No standardized display of IEC materials

Proposed strategies; Institutional arrangements at state and districts require strengthening for effective implementation including training and capacity building of staff Formation and strengthening of sanitation committee in all hospitals under RKS to implement, monitor, and supervise bio medical waste management activities Bio medical waste management system developed as per policy guideline in all institutions Bio medical waste management units outsourced in 32 DHH Effective coordination to be established with urban local bodies for proper disposal of solid waste

Time Frame Strategies and Activities 2011 Promoting H4 Brand Output Q1 Q2 Q3 Q4

Conduct H4 campaigns involving local RKS

Budget in B.10.3 (NRHM Initiatives)

All L3 and 50 % of L2 institutions branded as H4

Ensuring Non-Clinical Services 145 L3 and 438 L2 institutions are providing housekeeping, cleanliness services, hospital linen, laundry, security, Budget in B.3.2 (NRHM Initiatives) ambulance, dietary services, help desk, bio-medical waste management. All institutions up to block level have comprehensive plans with work plan and budget allocation Development of hospital PIP 100% institutions with Budget in B.7 (NRHM Initiatives) plans Recurring Grants to L2 & L3 institutions RKS to prioritise the activity in hospital PIPOutsource non-clinical services Maintaining ISO Standards Nine DHHs (Anugul, Kandhamal, Keonjhar Koraput, Bhubneswar, Jajpur, Mayurbhanj, Puri and Balasore.

Budget in B.18.2 (NRHM Initiatives)

Nine DHHs maintained as per ISO standards

Bio Medical Waste Management (Budget in B.18.2 (NRHM Initiatives) IEC AND AWARENESS ACTIVITIES
Q-1 Q-2 Q-3 Q-4

Development of proto type Prototypes for standardization developed signage and IEC materials Display of signage and IEC Posters and signage on BMW protocol materials in all hospitals displayed in all strategic location

INFRASTRUCTURAL DEVELOPMENT Repair and renovation of Containment areas repaired through existing containment area under AMG AMG MONITORING AND SUPERVISION Strengthening of state bio State BMW Cell established and equipped medical waste management cell with HR - BMW Engineer and Prog Asst under OHSP Formation and strengthening of All hospitals have functional sanitation sanitation committee in all committee to hospitals as part of RKS monitor and supervise the BMW activities