Swiss Cooperation Programme: Financial Support for the Health Sector 2012–2017

LITHUANIAN – SWISS COOPERATION PROGRAMME: FINANCIAL SUPPORT FOR THE HEALTH SECTOR 2012–2017

LITHUANIAN - SWISS COOPERATION PROGRAMME The implementation of this five-year Lithuanian- Swiss Cooperation Programme of particular importance would not have been so successful if not for the excellent inter-institutional and team work. We express our sincere gratitude to all those who have helped to turn the visions into reality: the teams of the Ministry of Finance of the Republic of Lithuania, the Central Project Management Agency and all executing agencies (hospitals) whose great work and knowledge make us feel delighted and proud of the results achieved.

LITHUANIAN - SWISS COOPERATION PROGRAMME TABLE OF CONTENTS

1. Introduction...... 3 2. Lithuanian-Swiss Cooperation Programme: Financial support for the health sector...... 4 • Previous experience of cooperation with Switzerland...... 5 3. Programme ‘Improvement of perinatal and neonatal health care services in Lithuania’...... 6 • Modern medical equipment...... 7 • Essential medical equipment...... 7 • Modern medical equipment. Equipment for universal check-ups...... 8 • Modern medical equipment. Equipment for providing specialised obstetric and neonatal services...... 9 • Modern resuscitation vehicles for safe transportation of neonates...... 10 • Necessary repairs of health care establishment...... 11 • Diagnostics and treatment guidelines in obstetrics and neonatology...... 12 • Improvement of professional qualification...... 13 • Computer database of pregnant and delivering women and neonates health (NGN IS)...... 14 • Simulation classrooms / rooms...... 15 4. Programme ‘Introduction of energy efficient technologies into the Lithuanian hospitals providing perinatal and neonatal services’...... 16 • Alytus Region S. Kudirkos hospital...... 17 • Kaunas Clinical hospital...... 18 • Kėdainiai hospital...... 19 • Klaipėda University hospital...... 20 • Kaunas Republican hospital...... 21 • Lithuanian University of Health Sciences hospital Kaunas clinics ...... 22 • Marijampolė hospital...... 23 • Mažeikiai hospital...... 24 • P. Mažylis Maternity Home, Affiliate of Kaunas Clinical hospital...... 25 • Pasvalys hospital...... 26 • Raseiniai hospital...... 27 • Telšiai Regional hospital...... 28 • Panevėžys Regional hospital...... 29 • Šiauliai Regional hospital...... 30 • Tauragė hospital...... 31 • Trakai hospital...... 32 • Ukmergė hospital...... 33 • Utena hospital...... 34 • Children’s Hospital, Affiliate of Vilnius University hospital Santariškės Clinics..... 35 • Vilkaviškis hospital...... 36 • Vilnius Maternity Home...... 37 • Vilnius City Clinical hospital...... 38 • Vilnius University hospital Santariškės Clinics...... 39 • Visaginas hospital...... 40 5. Evaluation of patient satisfaction with conditions in hospitals participating in the programme...... 41

LITHUANIAN - SWISS COOPERATION PROGRAMME Introduction

What can be more important than the health of a mother and a newborn child? What can be more significant that the arrival of a new life into this world and the joy of a happy mother? These rhe- torical questions need no answer. We feel delighted and express words of sincere gratitude to the Swiss Confederation. With the help of its support, excellent, cosy and safe conditions have been created for pregnant and delivering women and neonates at Lithuanian hospitals.

Aurelijus Veryga Minister of Health of the Republic of Lithuania

The health of pregnant and delivering women and neonates is one of the most sensitive spheres of health care in each country. Therefore, I would first of all like to thank the Swiss people for the opportunity given to enhance this sphere in Lithuania, and all those who have contributed to the implementation of this Programme in our country. The care of pregnant and delivering women and neonates in Lithuania today is of a very high standard equalling that of the most advanced countries in the world. The activities of the Programme will allow each pregnant and delivering woman to receive quality health care and ensure infants take their first steps into this world safely.

Gytė Sirgedienė Head of the International Projects Management Division, Ministry of Health of the Republic of Lithuania

LITHUANIAN - SWISS COOPERATION PROGRAMME 3 2. Lithuanian-Swiss Cooperation Programme: Financial support for the health sector

The Ministry of Health of the Republic of Lithuania has prepared and implemented two prog rammes in the health sector:  Introduction of energy-efficient technologies into In a referendum, Lithuanian hospitals the Swiss people  Improvement of perinatal and neonatal health assigned funds to the European states, care services in Lithuania including Lithuania, and General objective of the programmes: to im- the health sector received prove the quality and accessibility of health care ser- as much as 72%, or the vices for pregnant and delivering women and neona largest share, of the programme's tes. The programme ‘Introduction of energy efficient support. technologies into the Lithuanian hospitals’ is also aimed at contributing to the reduction of environmental pollution in Lithuania. Programmes implementation period: 2012–2017 Funds granted to the programmes: CHF 53.647 mln. / ~ EUR 48 mln. CHF 45.600 mln.: Swiss financial support CHF 8.047 mln.: Co-financing from the Republic of Lithuania  Support agreements for the granting of financial support for the implementation of the health sector programmes were signed on 20 December 2011.  Project implementation agreements with 17 executing agencies (hospitals) were signed on 12 June 2012. Another 10 Lithuanian hospitals joined the Programme in 2013 and 2015. The support also contributes directly to the Lithuanian Governmental Programme's objectives: to improve perinatal and neonatal health care services in Lithuania and to introduce energy efficient technologies into Lithuanian hospitals that provide perinatal and neonatal health care services.

As many as 27 Lithuanian hospitals providing perinatal and neonatal health care services situated throughout the territory of the country are participating in the Programme.

LITHUANIAN - SWISS COOPERATION PROGRAMME

4 Previous experiences of cooperation with Switzerland

► In 1994–1996, the Swiss Government granted 4.6 mln. Swiss francs in financial support to the Neonatology project. The funds were used for the procurement of modern medical equipment and staff training at the country’s eight largest hospitals providing perinatal and neonatal health care services. This created the preconditions for developing a new support system for pregnant and delivering women and neonates, helped to reduce neonatal, infant and perinatal mortality, and improved the qualification of the medical personnel.

► In 1997–1999, the Swiss Government granted 4 mln. Swiss francs in financial support to the Pediatric Intensive Care and Pediatric Anesthesia project. The support funds were used to supply five Pediatric Resuscitation and Intensive Care Units and two Pediatric Anesthesia Units at the Vilnius and Kaunas university hospitals and Klaipėda, Panevėžys and Šiauliai regional hospitals with medical equipment, staff training and for the establishment of a transport system. This created the preconditions for the development of a new structure to provide care to severely ill children and a system for transporting children throughout the country and ensured qualified and safe care for severely and critically ill children.

Pictures showing medical equipment used at the hospitals for more than 20 years

LITHUANIAN - SWISS COOPERATION PROGRAMME

5 3. Programme ‘Improvement of perinatal and neonatal health care services in Lithuania’

► Funds granted to the programme: CHF 31.294 mln. / ~ EUR 27 mln. CHF 26.600 mln.: Swiss financial support CHF 4.694 mln.: Co-financing from the Republic of Lithuania ► Executing agency: Lithuanian University of Health Sciences hospital Kaunas clinics ► Beneficiaries: 27 Lithuanian hospitals

Results after programme implementation:

27 hospitals supplied with modern medical equipment necessary for providing quality services

3 vehicles with special equipment for safe transportation of neonates purchased

Premises of 9 healthcare establishments repaired

More than 4,000 participants improved their professional qualifications and modern technology usage skills

72 diagnostics and treatment guidelines in obstetrics and neonatology developed

Computer database on the health of pregnant and delivering women and neonates developed and prepared for usage

LITHUANIAN - SWISS COOPERATION PROGRAMME

6 Modern medical equipment

From 2013 to February 2017, 27 Lithuanian hospitals providing perinatal and neonatal health care services were supplied with modern medical equipment necessary for The medical equipment supplied to the 27 providing quality services. The hospitals received a total of hospitals was worth 108 different items of medical equipment for more than more than EUR 21.4 mln. All the medical equipment acquired during EUR 21.4 mln. the project can be divided into three groups: essential medical equipment, equipment for universal check-ups and equipment for providing specialised obstetric and neonatological services. Essential medical equipment Modern medical equipment is necessary for ensuring the provision of quality safe obstetric and neonatological inpatient services in cases of low perinatal risk and for evaluating the condition of healthy neonates. State-of-the-art essential medical equipment, such as delivery and functional beds, gynaecological chairs, cardiotocographs, heated neonatal resuscitation tables, and beds for neonates, incubators, etc., were supplied to all of the hospitals participating in the programme.

of female 87% patients think that the establishments are supplied with appropriate medical equipment*

LITHUANIAN - SWISS COOPERATION PROGRAMME

7 Modern medical equipment Equipment for universal check-ups

1. A pregnancy ultrasound scan is an ultrasound test for checking the presence of any deviations from the normal development of a pregnancy. The purpose of the scan is to determine and show to the patient (and the family) that the ► foetus is alive, accurately date the pregnancy, specify the expected delivery date, check for the number of foetuses, etc. (Picture showing a portable ultrasound scanner with sensors appropriate for obstetrics) 2. Screening for neonatal critical congenital heart defects is carried out for neonates delivered at full term to identify neonates who may have a critical congenital heart defect, to perform an early diagnosis or find the possibility of its existence, and to refer the neonate to a ► pediatric cardiologist and/or cardiac surgeon for consul- tation and immediate treatment. In 2016, 98.9% of neonates underwent this screening. (Picture showing a neonatal vital signs monitor (EKG,

breathing, blood pressure, SaO2) 3. Universal neonate hearing screening is a test carried out using a medical device that records neonates' otoacoustic emissions to perform the earliest possible detection of congenital hearing loss. The percentages ► of neonates that underwent this screening in 2015 and 2016 were 99.3% and 98.2% respectively. (Picture showing an otoacoustic emission storage device for hearing screening in neonates) 4. Neonatal eye screening involves a red reflex test of the eye ground in neonates (from the gestational age of 35 weeks) for the purpose of the timely detection of ► congenital opacities in the optical media or other eye dis- eases that prevent the development of vision. In 2015 and 2016, this screening covered 97.9% and 96.8% of neonates respectively. (Picture showing a direct ophthalmoscope) 5. Screening for neonatal jaundice involves the measurement of bilirubin levels in the blood and can be carried out using a special device that works using complicated optical algorithms. Tests have proven that this screening reduces the need for blood sample tests in infants with jaundice. Transcutaneous bilirubinome- ► try helps to evaluate which neonates need more accurate testing for jaundice, i.e. determining the bilirubin level in the venous or capillary blood serum. This measurement is also helpful for evaluating the indications for rapid and aggressive treatment of neonates with severe jaundice. (Picture showing a transcutaneous bilirubinometer)

LITHUANIAN - SWISS COOPERATION PROGRAMME

8 Modern medical equipment Equipment for providing specialised obstetric and neonatal services

Modern medical equipment is required for providing quality specialised obstetric ‘During the project, we aimed to purchase state-of- the-art medical equipment models recognised around and neonatological services for women or the world and with long service lives. This was an foetuses diagnosed with pathologies du excellent opportunity for almost all Lithuanian medical ring pregnancy or delivery, or for prema- establishments providing obstetric and neonatological ture and ill neonates. inpatient services to substantially update their The Vilnius and Kaunas Perinatology equipment, which was more than 20 years old’. Centres were supplied with the most comp Prof. Mindaugas Kliučinskas Manager of the project ‘Improvement of perinatal licated and top-quality medical equipment, and neonatal health care services in Lithuania’, including fetoscopes, lasers for foetal sur- Head of the Obstetrics and Gynaecology Delivery gery, brain activity registration and freezing Department at the Lithuanian University of Health equipment for neonates, a video laryngo- Sciences hospital Kaunas clinics scope with a set of spatulas for neonates, ultrasound devices with sensors for neonates (for brain, heart and abdomen echoscopy), a laminar with an integrated microscope and a chorion villi processing system, etc.. This equipment will enable the provi- of specialists 91% think that sion of safe tertiary medical equipment has care services to neo- improved significantly nates and mothers. A during 2012-2016* video laryngoscope with a set of spatulas for neonates allows intubating a neonate where intubation is impeded or an anomaly of the upper respiratory tract exists. The equipment will enable complicated surgeries on hospitals' smallest patients. The new equipment has also contribu ted to the increased quality and reliability of diagnostics. Some of the less-complicated medical equipment assigned to this group, such as neonatal vital sign monitors, vital sign monitors for adults, stationary ultrasound machines with the Doppler scan function and obstetric sensors, portable ultrasound machines, etc., has also been delivered to hospitals in Lithuania's largest cities that 97% of specialists are satisfied accommodate me with the current sets dium-risk deliveries. of equipment*

LITHUANIAN - SWISS COOPERATION PROGRAMME

9 Modern resuscitation vehicles for the safe transportation of neonates

Three modern, spacious and comfortable re ‘These vehicles are intended for the transfer of suscitation vehicles with up-to-date special neonates from smaller hospitals to tertiary care equipment for the transportation of neonates institutions, where the spectrum of neonatal are successfully being used in Lithuania’s three health care services is considerably broader. largest hospitals, i.e. the Children’s Hospital Neonates with especially low birth weight require (an affiliate of the Vilnius University Hospital special conditions, and the new resuscitation Santariškės Clinics), the Lithuanian University of vehicles meet all possible requirements’. Health Sciences Hospital Kauno klinikos, and the Doctor Antanas Pužas, Klaipėda University Hospital. Head of the Neonatal Resuscitation and Intensive Care Unit of Lithuanian University All of the resuscitation vehicles are supplied with of Health Sciences Hospital Kaunas clinics special medical equipment for the transportation of neonates, i.e. a cot for the transportation of neonates and a stationary platform for securing the cot. The vehicles also have a neonatal resuscita- of respon tion system and other medical equipment, such as 98% dents believe that the an injection infusion pump, an artificial breathing transportation of machine, a transport incubator and a transport vi- neonates is safe* tal signs monitor. Neonates with especially low birth weight re- ‘The new resuscitation quire special conditions, and these vehicles meet vehicles have contributed to modern safety standards. The new resuscitation considerable improvements in the quality vehicles have contributed to considerable improve- of emergency aid and health care services ments in the quality of emergency aid and health for neonates’, said representatives of the care services for neonates. hospitals with delight.

LITHUANIAN - SWISS COOPERATION PROGRAMME

10 Necessary repairs for health care establishments

Nine Lithuanian hospitals underwent necessary repairs. Value of works, No. Name of hospital / Description of works EUR Telšiai Regional Hospital 1 Reconstruction of internal water supply and sewer systems 88,041 Repair of premises Mažeikiai Hospital 2 Fire protection system 63,591 Outfitting of premises for transfer of female patients from ambulance Lithuanian University of Health Sciences Hospital Kaunas clinics 3 Reconstruction of internal water supply and sewer systems 781,260 Repair of premises Klaipėda University Hospital 4 355,791 Reconstruction of internal water supply and sewer systems Vilnius City Clinical Hospital 5 20,261 Filling of cracks and façade painting Vilnius Maternity Home 6 Change of doors in premises of obstetric unit 61,159 Change of cold, hot, circulation and fire water supply mains Kaunas Clinical Hospital 7 Reconstruction of internal water supply and sewer systems 289,130 Repair of premises Marijampolė Hospital 8 46,715 Reconstruction of internal water supply and sewer systems Trakai Hospital Repair of premises 9 141,370 Reconstruction of internal water supply and sewer systems Interior doors and installation

Before After

LITHUANIAN - SWISS COOPERATION PROGRAMME

11 Diagnostics and treatment guidelines in obstetrics and neonatology

A total of 72 diagnostic and treatment guidelines in ‘These guidelines can be approved obstetrics and neonatology developed by a large team and used in practice for providing of specialists will allow for the standardisation of the perinatological aid in all Lithuanian diagnostics and treatment of the most relevant pathologies health care establishments, and they can in these spheres and will give an opportunity for pregnant become teaching aids as well’. and delivering women and neonates to receive health care Prof. Gražina Drąsutienė, services of a better quality. The developed guidelines are Head of the Clinic of Obstetrics and unique in that, for the first time in Lithuania, they include Gynaecology of the Vilnius University a detailed description of processes and interventions rather Faculty of Medicine than just a list, a list of audit indicators, an implementation scheme for health care establishments, and information for female patients. The development of these guidelines is a unique example of teamwork involving different medical professionals. The guidelines were prepared by working groups including specialists from hospitals in Vilnius, Kaunas, Marijampolė and Šiauliai that provide perinatal and neonatal services. A total of 72 working groups were established to match the number of guidelines. The working groups consisted of competent specialists, including neonatologists, gynaecologists and obstetricians. The developed guidelines were reviewed by specialists, the heads and members of the working groups, reviewers and representatives of the public. Anaesthetists, cardiologists, infectologists, endocrinologists, gastroenterologists and neurologists also assisted in the development and review of the guidelines. Each guideline consists of five parts: a description of the guideline, a description of procedures, a description of its implementation, an audit description, and information for the public. Members of the public also contributed to the development of the last part. Their insights helped to draw up clear and easily comprehensible recommendations. The guidelines were reviewed and insights were provided by representatives of two non-governmental organisations, in particular Padedu augti (Helping to Grow) and Tėvystės centras (Parenthood Centre). The guidelines are available here: of the ► https://sam.lrv.lt/lt/veiklos-sritys/programos-ir 93% health -projektai/sveicarijos-paramos-programa care establishments All the guidelines and their summaries have also been have adapted and apply published in the electronic manual: the guidelines* ► http://metodikos.lt/

‘Guided by the principles of medicine relying on evidence- based science and good clinical practice, a multidisciplinary team of specialists developed 72 guidelines in cooperation with patient representatives. This has allowed for the improvement of the quality and safety of services provided to mothers and neonates and the reduction of disparities between separate health care establishments. We hope that this will increase the trust of our women and their family members and their satisfaction with the competence and professionalism of specialists working in the sensitive sphere of perinatology’. Prof. Rūta Jolanta Nadišauskienė, Head of the Clinic of Obstetrics and Gynaecology at the Lithuanian University of Health Sciences Hospital Kaunas clinics

LITHUANIAN - SWISS COOPERATION PROGRAMME

12 Improvement of professional qualifications

In 2015 and 2016, 4,257 participants from 32 Lithuanian hospitals improved their qualification during modern training devoted to professionals working with pregnant ‘The knowledge gained at training is and delivering women and neonates. The sum assigned to used in everyday practice by different all training activities amounted to EUR 2.076 mln. specialists working as a team’. Audronė Kuodienė, Training was conducted in five regions of Lithuania, Director of Marijampolė Hospital i.e. the cities of Vilnius, Kaunas, Klaipėda, Panevėžys and Šiauliai. The training gathered a large number of obstetricians, nurses of all specialities, neonatologists, obstetricians/gynaecologists, anaesthetists/reanimatologists, and interns who participate in the provision of obstetric, gynaecological and neonatal services. The team that organised the training used a unique and interactive methodology to conduct the course, which made the course themes and the teaching methodology particularly accept- able and understandable. The organisers of the training claim that this was one of the most successful projects ever implemented in Lithuania, and that all the targets set at the beginning of the project were achieved. Training was organised for 8 topics: ■ Conflict management and communication with patients: 888 participants of respondents ■ Resuscitation of neonates: 503 participants 98% think that the programme had a favourable ■ Modern initial obstetric care: 375 participants effect on their professional ■ Stabilisation of neonates’ conditions and preparation for development* transportation: 275 participants ■ Modern specialised obstetric care: 296 participants ■ Training of personnel of hospitals seeking the status of a hospital favourable for neonates: 1,680 participants ■ First pregnancy trimester ultrasound practice: 90 participants ■ Second pregnancy trimester ultrasound practice: 150 participants

LITHUANIAN - SWISS COOPERATION PROGRAMME

13 Computer database of pregnant and delivering women and neonates health (NGN IS)

The ‘Perinatal and Neonatal Health Data Processing computer of preg- Information System’ (NGN IS) database This has provided nant and delivering women and neonate health will al- a possibility for the low for the improvement of the collection of statistical computerised collection, data on the health of pregnant and delivering women accumulation, storage and analysis and neonates and the expansion of the possibilities for of data on pregnant and delivering the general use and analysis of said collected data. All women and neonates, their registration and search, and the collection and Lithuanian health care establishments will be able to storage of personal and clinical use NGN IS, which will contribute to the reduction of the information. administrative burden on hospital personnel in collecting and processing data on pregnant and delivering women and neonates. The NGN IS' functions are aimed at optimising the collection and processing of data at health care establishments that provide obstetric and neonatal services, as well as the drawing up and analysis of statistical reports and their submission to any institutions concerned. NGN IS was developed with a view to ensure the centralised collection and processing of electronic information on the health of pregnant and delivering women and neonates for the purpose of improving the quality of health care and for statistics. The system has enabled all health care establishments providing obstetric, gynaecological and neonatal services to record data on the observation and treatment of pregnant and delivering women and neonates and receive immediate and timely information on a particular patient and the health care services provided to that patient at different health care establishments. Currently, the data collected in a person’s medical record in paper format is being transferred to the information system to ensure access to the universal electronic health information (ESI) database. The data collected in NGN IS is transferred automatically to other information systems and registers, which has accelerated ESI data exchange and given access to this data to different health care specialists entitled to see the statistical data of a specific patient or depersonalised information. The NGN IS can be logged into here: ► https://ngn.lt/

LITHUANIAN - SWISS COOPERATION PROGRAMME

14 Simulation classrooms / rooms

Simulation classrooms have been established in seven Lithuanian hospitals, i.e. Klaipėda University The teaching aids (mannequins) and Hospital, Lithuanian University of Health Sciences algorithms and scenarios of clinical situations for independent learning Hospital Kaunas Clinics (2), Panevėžys Republican are designed to create a system of Hospital, Šiauliai Republican Hospital, the Children’s on-the-job training that will allow the Hospital (an affiliate of the Vilnius University Hospital medical personnel to simulate rare Santariškės Clinics), and Vilnius University Hospital but very threatening clinical situations, leading to the continuous re- Santariškės Clinics. newal of their knowledge and skills. The establishment of the simulation classrooms will enable the hospitals to regularly repeat and im prove the skills gained in training, thereby ensuring the continuity of the activities under Lithuanian-Swiss Cooperation Programme (i.e. practical implementation of the guidelines in obstetrics and neonatology and improvement of the personnel’s qualification). ► The possibility has been ensured for health care professionals providing health care services to improve their qualification without leaving a health care establishment. ► Delivery wards (suites) have been installed as spaces containing essential medical equipment where personnel can improve their skills according to a clear guideline during their free time. ► The presence of video and audio controls has ensured the possibility of internal and external audits and the remote communication and control of new skills. ► The sets of urgent situations (with the possibility of change) allow all professionals providing obstetric and neonatological services in Lithuania to improve their skills in a standard way with the possibility of changing the clinical tasks/situations.

LITHUANIAN - SWISS COOPERATION PROGRAMME

15 4. Programme ‘Introduction of energy efficient technologies into the Lithuanian hospitals providing perinatal and neonatal health case services’

► Funds granted to the programme: CHF 22.353 mln. / ~ EUR 21 mln. CHF 19.000 mln.: Swiss financial support CHF 3.353 mln.: Co-financing from the Republic of Lithuania ► Executing agencies: 24 Lithuanian hospitals

Results after programme implementation:

Thermal insulation of hospital buildings improved (roofs and exterior walls renovated and insulated, windows and doors replaced)

Heating stations and internal heating systems modernised

Alternative energy sources such as solar cells, heating pumps and photovoltaic power stations systems installed

Ventilation and air conditioning systems modernised / installed

Electricity supply systems (with LED lighting) modernised / installed

Medical gas (oxygen, vacuum, compressed air) supply systems installed

Ambient air pollution reduced, and microclimate and energy efficiency improved

LITHUANIAN - SWISS COOPERATION PROGRAMME

16 Alytus Region S. Kudirkos Hospital

Project implementation period: 2013–2017 ‘A modern and cosy Project budget: EUR 439,261 environment in the Obstetrics and Gynaecology Unit is like a Activities implemented during the project: hospital's business card for a young family. ► Replacement of windows and doors The advantages of the excellent state-of-the-art ► Modernisation of the heating station ventilation system and quality lighting have already ► Modernisation of the ventilation system been felt by the patients and personnel of the unit. ► Installation of lighting with LED lights The implementation of this energy-efficient project in ► Installation of solar cell and heat pump the hospital marks the start of serious systemic work. In addition to all of these advantages, Mother systems Nature will indeed thank us for our environmentally- ► Installation of a photovoltaic power plant friendly approach if annual carbon monoxide emissions to the environment are reduced by more than 14 tonnes’. Artūras Vasiliauskas, Director

LITHUANIAN - SWISS COOPERATION PROGRAMME

17 Kaunas Clinical Hospital

Project implementation period: 2012–2017 Project budget: EUR 2,206,283 Activities implemented during the project: ► Insulation of exterior walls (including the base) ► Replacement of doors and windows ► Insulation of the floor slab bordering the exterior ‘The arrival of a new life is a miracle ► Reconstruction of the heating system that gives so much joy to everyone. ► Replacement of the heating station We are proud that the support under ► Reconstruction of the ventilation system the Lithuanian-Swiss Cooperation ► Modernisation of the internal electricity Programme has made the Neonatal Unit supply system of the Kaunas Clinical Hospital even cosier and more attractive to delivering ► Installation of medical gas systems women, their relatives and personnel’. Gediminas Abeciūnas, Director

Before

After

LITHUANIAN - SWISS COOPERATION PROGRAMME

18 Kėdainiai Hospital

Project implementation period: 2012–2017 Project budget: EUR 476,373

Activities implemented during the project: ‘The patients and the ► Insulation of exterior walls (including the base) personnel have noticed positive changes in the Obstetric Unit. Not only does the ► Insulation of the roof (including roof renovation) renovated hospital building have great appeal, the ► Reconstruction of the heating system reconstructed heating and ventilation system and modern lighting are pleasing as well’. ► Renovation of the outdoor heating pipelines Artūras Gudavičius, ► Renovation of the ventilation system Head of the Obstetrics and ► Installation of lighting with LED lights Gynaecology Unit

Before After

LITHUANIAN - SWISS COOPERATION PROGRAMME

19 Klaipėda University Hospital

Project implementation period: 2012–2017 Project budget: EUR 2,513,898

Activities implemented during the project: ‘The improved thermal ► Insulation of exterior walls (including the base) insulation of the building of the Obstetrics and Gynaecology Department, ► Insulation of the floor slab bordering on the the energy efficiency measures installed, the exterior system for improving the microclimate of the premises and an upgraded medical engineering ► Insulation of the roof (including roof renovation) system have all produced a cosier and more ► Replacement of windows and doors comfortable environment for both the personnel ► Reconstruction of the heating system and the patients and their newborns’. Raimondas Šiaulys, Head of the ► Reconstruction of the ventilation system (instal- Obstetrics and Gynaecology lation of a heat recovery ventilation system) Department ► Reconstruction of the heating station ► Modernisation of the internal electricity supply system ► Installation of a compressed air, vacuum and oxygen supply system ► Installation of façade finishes (fibrocement sheets) on the existing hollow ceramic brick wall

Before After

LITHUANIAN - SWISS COOPERATION PROGRAMME

20 Clinic of Obstetrics and Gynaecology ‘Christian Maternity Hospital’ of Kaunas Republican Hospital

Project implementation period: 2012–2017 Doc. Dr. Linas Vitkus, General Manager of the Kaunas Project budget: EUR 485,353 Republican Hospital, is delighted that a country such as Switzerland Activities implemented during the project: has given excellent opportunities for Lithuanian ► Insulation of the roof (including roof renovation) health care establishments to go hand in hand with ► Replacement of windows and doors European medicine. Owing to the programme, the quality of obstetric and gynaecological services ► Reconstruction of the heating system has improved considerably at the Kaunas ► Reconstruction of the ventilation system Republican Hospital, where the equipment and technology were modernised and ► Reconstruction of the heating station the infrastructure underwent ► Modernisation of the internal electricity supply renovation. system ► Installation of a compressed air and oxygen ‘The most distinct aspect noticed by patients is supply system the particularly improved microclimate ► Installation of lighting with LED lights of the premises. Previously, the ventilation ► Installation of solar cell and heat pump was almost non-functional and there were systems no heat or power savings’. Virgilijus Rudzinskas, Head of the Clinic of Obstetrics and Gynaecology ‘Christian Maternity Hospital’

LITHUANIAN - SWISS COOPERATION PROGRAMME

21 Lithuanian University of Health Sciences Hospital Kaunas Clinics

Project implementation period: 2012–2017 Project budget: EUR 2,377,435 ‘The renovated utility systems in the Clinic of Obstetrics and Gynaecology will Activities implemented during the project: ensure even better and more comfortable ► Replacement of exterior doors conditions for families with newborns, and ► Reconstruction of the heating system more comfortable work and rest spaces for personnel. The installed innovations ► Reconstruction of the heating station will enable the effective use of solar energy ► Modernisation of the heating mains and the saving of funds that can be used to ► Reconstruction of the heat recovery ventilation system improve health care services. The renovated ► Modernisation of the internal electricity supply system, Obstetrics and Gynaecology Unit has including the installation of lighting with LED lights become one of the most modern buildings ► Installation of a compressed air, vacuum and oxygen among the Kaunas Clinic's old buildings and will serve as an example for renovating supply system other buildings of this hospital’. ► Installation of solar cell, heat pump and photovoltaic Povilas Ruginis, power plant systems Project Construction Engineer

LITHUANIAN - SWISS COOPERATION PROGRAMME

22 Marijampolė Hospital

Project implementation period: 2012–2017 Project budget: EUR 980,836 ‘The renovation and Activities implemented during the project: outfitting of the premises of the ► Reconstruction of the ventilation system Marijampolė Hospital Obstetrics Unit ► Reconstruction of the heating system during the project's implementation has not only created an appropriate, comfortable and ► Modernisation of the internal electricity cosy environment meeting the highest standards supply system, including the installation of for the hospital’s smallest patients and their lighting with LED lights mothers, but has also improved the working conditions for the personnel’. ► Installation of a compressed air, vacuum and Audronė Kuodienė, Director oxygen supply system with feed gas panels ► Installation of solar cell, heat pump and photovoltaic power plant systems

LITHUANIAN - SWISS COOPERATION PROGRAMME

23 Mažeikiai Hospital

Project implementation period: 2012–2017 Project budget: EUR 1,085,781 ‘We are delighted about the insulation of the exterior walls Activities implemented during the project: and the renovation of the heating system as they have made the hospital warmer ► Insulation of exterior walls (including and more attractive on the outside. The new the base) ventilation and air conditioning system allows ► Renovation of the heating system, including for the maintenance of an optimal microclimate, the heating station which is needed to ensure the good condition of newborns. The Obstetrics and Neonatology Unit ► Renovation of the ventilation system by has become more modern and comfortable adding cooling equipment with improved conditions for patients and ► Connection of medical gases to the system work, and the services we provide have acquired a new quality’. Albinas Lidžius, Director Before

After

LITHUANIAN - SWISS COOPERATION PROGRAMME

24 P. Mažylis Maternity Home, Affiliate of Kaunas Clinical Hospital

Project implementation period: 2012–2017 Project budget: EUR 507,130 ‘The Maternity Home has become even cosier, lighter and warmer not only from the smiles Activities implemented during the project: of the personnel and patients, but also from ► Repair of the heating system the flawlessly installed LED lighting and the new ventilation and water heating systems. ► Renovation of the ventilation system We are grateful to people who have devoted ► Renovation of the mechanical (forced draught) much effort, time and funds to implement system the Lithuanian-Swiss programme’. ► Installation of lighting with LED lights Staf ot the Affiliate ► Installation of solar cells and a heat pump system

LITHUANIAN - SWISS COOPERATION PROGRAMME

25 Pasvalys Hospital

Project implementation period: 2012–2017 ‘The whole roof of the building of the Project budget: EUR 224,218 Obstetrics and Gynaecology Unit is shining with solar cells where the photovoltaic Activities implemented during the project: power plant was installed. The premises ► Installation of a vacuum station and a supply have been equipped with LED lights system and an air conditioning and ventilation ► Renovation of the ventilation system system. The vacuum, compressed air and ► Installation of lighting with LED lights oxygen supply systems have undergone reconstruction. The microclimate in the ► Overhaul of the oxygen supply and compressed rooms has improved considerably, and air system delivering women and neonates now have ► Installation of solar cell, heat pump and excellent conditions’. photovoltaic power plant systems Rolandas Rastauskas, Chief Physician

LITHUANIAN - SWISS COOPERATION PROGRAMME

26 Raseiniai Hospital

Project implementation period: 2013–2017 Project budget: EUR 374,417 Activities implemented during the project: ► Insulation of the base walls ‘The programme has made ► Modernisation of the heating system, the Obstetrics and Gynaecology Unit cosy and modern: an up-to-date including the upgrading of the hot ventilation and oxygen supply system was water supply system provided, the wards have been equipped with ► Modernisation of the ventilation system LED lighting, and a computerised personnel call ► Modernisation of the internal electricity system has been put in place. We are glad to also have had an opportunity to acquire modern supply system, including LED lighting and alternative sources of energy’. ► Installation of an oxygen supply system Vidmantas Merkliopas, ► Installation of solar cell, heat pump and Director photovoltaic power plant systems

LITHUANIAN - SWISS COOPERATION PROGRAMME

27 Telšiai Regional Hospital

Project implementation period: 2012–2017 ‘The works involved the Project budget: EUR 1,159,981 insulation of the walls and the roof of the hospital’s Obstetrics Unit, Activities implemented during the project: the replacement of windows and doors, ► Insulation of exterior walls (including the base), the renovation of the heating and ventilation system, and the replacement of the lighting including the insulation of the floor above the base fixtures with LED lights. If not for the opportunity ► Insulation of the roof to benefit from the Swiss cooperation project, ► Replacement of windows and doors the hospital would not have had the capacity to complete works of this scale independently. Our ► Renovation of the heating system hospital has become cosier, warmer and more ► Installation of a heating station attractive for residents not only of our district but also of the whole region’. ► Modernisation of the ventilation system Alma Vitkienė, Director ► Modernisation of the electricity supply system, including the installation of lighting with LED lights ► Modernisation of the medical gas, vacuum and oxygen supply system ► Installation of solar cell, heat pump and photovoltaic power plant systems

After

Before

LITHUANIAN - SWISS COOPERATION PROGRAMME

28 Panevėžys Regional Hospital

Project implementation period: 2012–2017 Project budget: EUR 1,259,825 ‘I’d especially like to express my pleasure with the considerably improved working Activities implemented during the project: conditions. Following the renovation ► Insulation of exterior walls (including the base) in the wards and premises, we have the ► Insulation of the roof (including roof renovation) possibility of changing the microclimate as needed. The hospital building and roof ► Insulation of the attic have been insulated and the ventilation ► Replacement and insulation of the heating main has been upgraded with a heat recovery pipelines in the attic system. Photovoltaic power plant and solar ► Replacement of windows and glass blocks cell systems have been installed as well. ► Replacement of exterior and ante-room doors We believe that these measures will have ► Replacement and insulation of the internal an economic effect by saving the hospital's funds. All of these measures have made water mains it possible to ensure the safe provision of ► Modernisation of the ventilation system (by obstetric and neonatological services to our adding cooling equipment and installing a patients in a comfortable environment’. heat recovery system) Albinas Ivonaitis, Head of the Obstetrics ► Installation of lighting with LED lights and Gynaecology Clinic ► Installation of solar cell, heat pump and photovoltaic power plant systems

After

Before

LITHUANIAN - SWISS COOPERATION PROGRAMME

29 Šiauliai Republican Hospital

Project implementation period: 2013–2017 Project budget: EUR 509,805 ‘The programme's funds have been used to improve the Activities implemented during the project: infrastructure of the clinic: to install ► Installation of lighting with LED lights modern lighting with LED lights and a solar cell and heat pump system. These ► Installation of a solar cell system measures will not only save funds but ► Installation of a heat pump system also reduce air pollution as well’. Prof. Dr. Linas Rovas, Director of the Woman and Child Clinic

LITHUANIAN - SWISS COOPERATION PROGRAMME

30 Tauragė Hospital

Project implementation period: 2012–2017 Project budget: EUR 506,535 ‘The renovated Obstetrics Unit has changed beyond recognition: the heating Activities implemented during the project: and ventilation systems have undergone ► Replacement of windows reconstruction, and medical gas systems ► Reconstruction of the heating system and state-of-the-art energy efficiency technologies using solar energy (solar cells, ► Reconstruction of the hot water supply pipelines heat pumps and a photovoltaic power ► Reconstruction of the ventilation system (by plant) have been installed’. installing a heat recovery ventilation system) Irmantas Mockus, Director ► Modernisation of the internal electricity supply system ► Installation of a medical gas system ► Installation of solar cell, heat pump and photovoltaic power plant systems

LITHUANIAN - SWISS COOPERATION PROGRAMME

31 Trakai Hospital

Project implementation period: 2012–2017 ‘We are delighted Project budget: EUR 752,711 that the Lithuanian-Swiss Cooperation Programme has helped the Activities implemented during the project: public undertaking Trakai Hospital with its ► Insulation of exterior walls (including the base) renovation and the improvement of the quality of its services. Following the reconstruction of the ► Insulation of the roof (including roof renovation) façade, the appearance of the entire unit has changed ► Replacement of windows and exterior doors and the premises have become warmer and nicer. A spacious delivery unit with the latest equipment was ► Replacement of the heating system, including installed thanks to the project. Thus, we have great modernisation of the hot water supply system hopes that we will work with increased intensity ► Replacement of the electricity system and see more delivering women’. Antanas Česnulevičius, ► Installation of lighting with LED lights Director ► Renovation of the ventilation system (including installation of access to the superstructure) ‘The renovation works have improved the apparance of the Obstetrics and Gynaecology Unit ► Installation of medical gases very much. The premises have become spacious and comfortable, and we are pleased with the excellent air conditioning system’. Vilija Variakojienė, Before Head of the Obstetrics and Gynaecology Unit

After

LITHUANIAN - SWISS COOPERATION PROGRAMME

32 Ukmergė Hospital

Project implementation period: 2015–2017

Project budget: EUR 397,965 ‘The installation of a compressed air, Activities implemented during the project: vacuum and oxygen supply system and solar cell, heat pump and photovoltaic ► Installation of a vacuum supply system power plant systems has been completed ► Reconstruction of the hot water supply pipelines successfully at the hospital. These activities ► Installation of a solar cell system will enable the reduction of environmental ► Installation of a heat pump system pollution and energy and cash savings’. ► Installation of a photovoltaic power plant Rimvydas Civilka, Chief Physician

LITHUANIAN - SWISS COOPERATION PROGRAMME

33 Utena Hospital

Project implementation period: 2015–2017 Project budget: EUR 397,965 ‘We thank the Lithuanian-Swiss Cooperation Programme for its support Activities implemented during the project: with installing an energy-efficient ► Installation of a solar cell system technology that will allow us to reduce ► Installation of a heat pump system environmental pollution, improve the ► Installation of a photovoltaic power plant microclimate and achieve energy efficiency in the hospital units that provide perinatal and neonatal health care services’. Dalius Drunga, Director

LITHUANIAN - SWISS COOPERATION PROGRAMME

34 Children’s Hospital, affiliate of Vilnius University Hospital Santariškės Clinics

Project implementation period: 2012–2017 Project budget: EUR 431,209 ‘Until now the ventilation system of the Neonatology Centre could Activities implemented during the project: only guarantee air ventilation, but there was no ► Reconstruction of the ventilation air conditioning or humidification. After the system was modernised, the conditions in the premises accommodating our system hospital’s smallest patients meet hygiene standards: the air is not ► Compressed air supply equipment too dry and the rooms are not too hot in the summer. An appropriate ambient temperature is very important, especially for premature ► Vacuum supply equipment newborns, as their thermoregulatory centre is not yet fully developed. ► Compressed air, vacuum and oxygen They get well more quickly in good environmental conditions. supply systems with gas feed panels The LED lighting, solar cell and heat pump system and photovoltaic power plant that were installed will improve ► Installation of lighting with LED lights working conditions for the personnel, reduce operating expenses ► Installation of a solar cell system and cut lighting energy consumption in half, thus contributing to increased economic efficiency’. ► Installation of a heat pump system Prof. Dr. Juozas Raistenskis, ► Installation of a photovoltaic Director power plant

LITHUANIAN - SWISS COOPERATION PROGRAMME

35 Vilkaviškis Hospital

Project implementation period: 2013–2017 Project budget: EUR 546,240 ‘We are delighted that Activities implemented during the project: the funds of the programme have made our hospital more modern ► Insulation of exterior walls, including the base and that, from now on, we can ensure ► Replacement of windows a cosy environment meeting the highest standards for pregnant and delivering women and ► Repair of the heating system neonates. After the renovation, delivering women ► Modernisation of the ventilation system (by and newborns will receive more up-to-date services installing a heat recovery ventilation system) of a better quality no less than of health care services provided at hospitals in the big cities. As repairs on ► Modernisation of the internal electricity the building are completed, the operating expenses supply system, including LED lighting will decrease from those sustained before the project ► Installation of a compressed air, vacuum implementation, which will allow the hospital to save funds. The premises have become cosier and oxygen supply system and warmer, and the visual appearance of ► Installation of a solar cell system the hospital has changed as well’. Linas Blažaitis, ► Installation of a heat pump system Chief Physician

Before After

LITHUANIAN - SWISS COOPERATION PROGRAMME

36 Vilnius Maternity Home

Project implementation period: 2012–2017 Project budget: EUR 1,150,503 A c t i v it i e s i mp l e me nt e d du r i n g t h e p r o j e c t: ‘Owing to the programme, we have renovated the heating, ► Reconstruction of the heating system ventilation, electricity and medical gas supply systems and ► Renovation of the ventilation system installed LED lighting over a short period. The renovation ► Modernisation of the internal electricity of these utility systems and the installation of LED lighting supply system, including the installation have resulted in reduced energy consumption. We now of lighting with LED lights already feel the cost savings. If not for this support, we ► Reconstruction of Heating Station No. 2 would not have achieved these results for many years yet’. Kornelija Mačiulienė, Director ► Compressed air, vacuum and oxygen supply system

LITHUANIAN - SWISS COOPERATION PROGRAMME

37 Vilnius City Clinical Hospital

Project implementation period: 2012–2017 Project budget: EUR 240,697 ‘The modern ventilation system installed in the Neonatology Unit maintains optimal air temperature Activities implemented during the project: in the intensive care wards. The environment is warm ► Reconstruction and restoration of the and fresh, and there is no need for airing the rooms the old way – by opening the windows constantly. ventilation system This would cause many inconveniences for the care ► Installation of lighting with LED lights of ill newborns, especially premature ones. The lighting installed under the Swiss programme in the Delivery Units and delivery rooms has not only made patients feel cosy and warm, it has also improved working conditions for medical personnel. The arduous work of a medical professional requires special care and good lighting. Moreover, the new light sources consume less energy, thus enabling the hospital to save funds’. Neonatologist, Dr. Violeta Drejerienė, Head of the Neonatology Unit

LITHUANIAN - SWISS COOPERATION PROGRAMME

38 Vilnius University Hospital Santariškės Clinics

Project implementation period: 2015–2017 Project budget: EUR 365,525 Activities implemented during the project: ‘A photovoltaic power plant, a solar cell system and three heat pumps ► Installation of a solar cell system (air – water) have been installed on the roof of the ► Installation of a heat pump system Obstetrics and Surgery Unit. The solar cell system will ► Installation of a photovoltaic power convert solar energy into thermal energy for the preparation of hot water, and the heat pumps, absorbing heat from the plant environment, will also transfer it to the building's hot water system. The photovoltaic power plant will supply electricity to the heat pumps and the pumps of the solar cell system, and also meet other needs of the hospital. The integration of the solar cell and heat pump systems with the heating station of the building will perform the additional function of preparing hot water, which will reduce hot water preparation in the heating station by up to 50 percent. The installed systems will ensure a considerable reduction of environmental pollution

(CO2) and contribute to the main objectives and indicators of the programme’. Valdas Kavalnis, Head of the Project Management Division

LITHUANIAN - SWISS COOPERATION PROGRAMME

39 Visaginas Hospital

Project implementation period: 2013–2017 Project budget: EUR 524,552 ‘This programme is an Activities implemented during the project: excellent opportunity to create the best conditions for delivering women, ► Renovation of the heating system neonates and their relatives in Lithuania’s ► Modernisation of the ventilation system outlying cities. We are happy that the Obstetrics and Gynaecology Unit of our hospital ► Installation of lighting with LED lights has become cosy, warm and comfortable ► Installation of a solar cell system for delivering women and the personnel ► Installation of a heat pump system working here’. Kastytis Matulevičius, ► Installation of a photovoltaic power plant Director

LITHUANIAN - SWISS COOPERATION PROGRAMME

40 Evaluation of patient satisfaction with conditions in hospitals participating in the Programme

An evaluation of patient satisfaction with conditions in hospitals participating in the Programme* commis sioned by the Ministry of Health was carried out to Patient satisfaction evaluate the effect of Lithuanian-Swiss Cooperation with obstetric services Programme on the improvement of obstetric and neo- increased from natological services in Lithuania. The interim stage 14 % (2007) of evaluation was 2015 Q1, and the final stage was in 2016 Q4 – 2017 Q1. to (2016) 51 % The survey has found that general patient satisfaction with obstetric services increased from 14% (2007) to 51% (2016). The growing satisfaction with obstetric services is determined by the following factors: more delivering women are very satisfied with the professionalism of the medical personnel and the attention devoted to delivering women and neonates; delivering women notice the new diagnostics and treatment equipment and appre- ciate the increased comfort in the rooms (most delivering women confirm that stable air and water temperature suitable for hygiene is maintained in the wards and that the rooms have appropriate ventilation and lighting). The medical personnel has also taken note of the improving treatment and nursing conditions: their absolute majority note that the professional training organised during Lithuanian-Swiss Cooperation Programme for financial support to the health care sector has had a positive influence on their professional development.

LITHUANIAN - SWISS COOPERATION PROGRAMME

41 LITHUANIAN - SWISS COOPERATION PROGRAMME

42 LITHUANIAN - SWISS COOPERATION PROGRAMME LITHUANIAN - SWISS COOPERATION PROGRAMME