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INFRASTRUCTURE MANAGEMENT IN THE REPUBLIC OF UGANDA THE PROJECT ON IMPROVEMENT OF HEALTH SERVICE THROUGH THE PROJECT ON IMPROVEMENT OF HEALTH SERVICE THROUGH HEALTH INFRASTRUCTURE MANAGEMENT IN THE REPUBLIC OF UGANDA PROJECT COMPLETION REPORT PROJECT COMPLETION REPORT DECEMBER, 2014 DECEMBER, 2014 JAPAN INTERNATIONAL COOPERATION AGENCY(JICA) INTERNATIONAL TECHNO CENTER CO., LTD. KAIHATSU MANAGEMENT CONSULTING, INC. THE PROJECT ON IMPROVEMENT OF HEALTH SERVICE THROUGH HEALTH INFRASTRUCTURE MANAGEMENT IN THE REPUBLIC OF UGANDA PROJECT COMPLETION REPORT CONTENTS 1. Outline of the Project ............................................................................................................. 1 1-1 Introduction ........................................................................................................................... 1 1-2 Objectives and Outputs of the Project ................................................................................. 1 1-3 Project Activities ................................................................................................................... 1 1-3-1 5S-CQI-TQM ................................................................................................................... 2 1-3-2 User Training Activities ................................................................................................. 4 1-3-3 Maintenance of Medical Equipment ............................................................................. 6 1-3-4 Impact Assessment ........................................................................................................ 7 1-3 Project Areas and Sites ......................................................................................................... 9 1-5 Project Implementation Body ............................................................................................ 10 2. Achievement of Objectives and Outputs .............................................................................. 11 3. Project Implementation Plan and Results ............................................................................. 21 4. Inputs .................................................................................................................................... 21 4-1 Dispatch result of JICA Experts ........................................................................................ 21 4-2 Record of Training in Japan and Third Countries ........................................................... 23 4-3 Procured Materials............................................................................................................. 25 4-4 Overseas Activities Cost ..................................................................................................... 26 5. Notes of the Project Management ........................................................................................ 26 6. Changes in PDM .................................................................................................................. 27 7. Record of Joint Coordination Committee ............................................................................ 27 ANNEXES Annex 3-1: Result of Activity Implementation Plan Annex 4-2: List of Project Procured Materials Annex 6-1: PDM Ver. 1 Annex 6-2: PDM Ver. 2 Annex 6-3: PDM Ver. 3 Annex 6-4: PDM Ver. 4 Annex 7-1: Minutes of the 1st JCC Annex 7-2: Minutes of the 2nd JCC Annex 7-3: Minutes of the 3rd JCC Annex 7-4: Minutes of the 4th JCC Annex 7-5: Minutes of the 5th JCC Annex 7-6: Minutes of the 6th JCC Annex 7-7: Minutes of the 7th JCC Abbreviations AHSPR Annual Health Sector Performance Report ARV Antiretrovirals ASSIST Applying Science to Strengthen and Improve Systems BTC Belgian Technical Cooperation BUT Basic User Trainer CME Continuing Medical Education CSO Civil Society Organisation CQI Continuous Quality Improvement DANIDA Danish International Development Agency DHO District Health Officer GH General Hospital HC Health Center HMIS Health Maintenance Information System HSSIP Health Sector Strategic and Investment Plan JICA Japan International Cooperation Agency JCC Joint Coordination Committee JOCV Japan Overseas Cooperation Volunteer JRM Joint Review Mission MCH Maternal and Child Health ME Medical Equipment NGO Non-Governmental Organizations NHA National Health Assembly NO Nursing Officer PDM Project Design Matrix PHA Principal Hospital Administrator QAD Quality Assurance Department QIFSP Quality Improvement Framework and Strategic Plan QIP Quality Improvement Partner QIT Quality Improvement Team R/D Record of Discussion RRH Regional Referral Hospital SPNO Senior Principal Nursing Officer SUO Standard Unit of Output SUT Senior User Trainer TOR Terms of Reference TOT Training of Trainers TQM Total Quality Management URC University Research Co., LLC USAID United States Agency for International Development UT User Trainer/User Training WIT Work Improvement Team WS Medical Equipment Maintenance Workshop 5S Sort-Set-Shine-Standardize-Sustain 1. Outline of the Project 1-1 Introduction In 2009, the government of Uganda made a request for Japanese technical assistance with the aim of improving hospital work environments through the 5S approach, facilitating user training and the maintenance of medical equipment. In response to this request, the Japan International Cooperation Agency (JICA) dispatched a detailed planning survey team to Uganda from August to September 2010. Following the survey, the team, together with the concerned authorities in the Ugandan government, reached a basic consensus to implement the proposed project. Shortly thereafter, JICA and the Ministry of Health of the Republic of Uganda (MOH) signed the Record of Discussions (R/D) dated April 19, 2011 which contains the details of the discussions between both parties regarding the proposed project. The first project year was completed in August 2011 and the second year was completed in December 2013. The third year started in January 2014. All activities in Uganda for the year will be carried out by November 2014 and this three year project will be completed in January 2015. 1-2 Objectives and Outputs of the Project Project Overall Goal, Project Purpose and Output are as stated below. [Overall Goal] Management and utilization of health infrastructure is improved in target health facilities. [Project Purpose] Management and utilization of health infrastructure is improved in target health facilities. [Outputs] 1. 5S-CQI-TQM activities are implemented in target health facilities 2. Utilization of medical equipment is improved in target hospitals. 3. Medical equipment is maintained better by ME workshops. 1-3 Project Activities This project consists three major activities namely 5S-CQI TQM, User training, Maintenance of Medical Equipment. A series of impact assessment surveys were conducted to measure the achievement of project’s impact and objectives. The outline of each activity will be stated in following sessions. 1 1-3-1 5S-CQI-TQM 1) Outline of 5S-CQI-TQM [Output] 1. 5S-CQI-TQM activities are implemented in target health facilities [Activity] 1-1. To promote 5S-CQI-TQM activities at national level 1-2. To promote 5S-CQI-TQM activities at regional level 1-3. To promote 5S-CQI-TQM activities at facility level In order to set the best stage for health care personnel to make maximum use of their skills and knowledge, the Ministry of Health of Uganda (MoH) recommends the 5S method as the foundation for all quality improvement initiatives in the country. 5S is a sequence of activities which include: Sort- Set- Shine- Standardize- Sustain to improve the work environment and working conditions and make them as convenient as possible, and thereby improve with regards to preparedness, standardization and timeliness. The activities undertaken in the working environment can only be significantly improved when they have been continued for an adequate amount of time; namely, CQI is the only way to quality health care ・Health care quality and productivity 5S Better Quality Health Workers being diverted from Service service delivery to look for equipment, Activities -Preparedness -Standardization medicines, and medical records, and it is the Work -Timeliness Environment most frustrating form of time loss in any Improvement -Completeness -Communication health care facility. With 5S, often-needed -Safety items are stored in the most accessible location and correct adoption of the Higher work efficiency by standardization approach. Improved performance of service CQI provider ・Infrastructural maintenance Health Workers take responsibility for Figure:1-1 5S-CQI-TQM Structure keeping the workplace clean and tidy so that they can take ownership for highlighting potential problems before they have an impact on performance and preventive maintenance of all equipment and instruments. 2 ・Health and safety 5S activities have the concept of continuous improvement in health services for patients and occupational safety and health for health workers. 5S can also be a valuable marketing tool when potential customers visit. A well-organized, clean and tidy facility gives the image of a professional and well-organized service provider. 2) Issues and major activities on 5S-CQI-TQM Target Issues Major Activities and Outputs No mechanism to promote To establish the project team for 5S-CQI-TQM to Health facilities 5S-CQI-TQM activities Lack of skilled person for 5S activities To conduct training for national Lack of awareness 5S in HDP facilitators for 5S-CQI-TQM activities
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