Importance of management leadership in affecting change: Experiences from the Medical Injection Safe

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Importance of management leadership in affecting
change Experiences from the Medical Injection
Safety Project in Zambia
Martha Ndhlovu, Christopher Mazimba, Answell
Chipukuma, Matildah Zyambo, Steve Chanda,Rick
Hughes, Kuhu Maitra
APHA -November 2006
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Background

• Zambia is a landlocked country with a population
  of about 12 million people
• High burden of disease
• High prevalence of blood-borne diseases (HIV,
  Hepatitis B)
• Tremendous poverty
• 380 GNI per capita
• Weak health infrastructure and supporting
  systems
• Human resource crisis

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OBJECTIVES

• By the end of this session you should be able to
• Illustrate approaches used by the MISP to engage
  management in playing a leadership role
• Describe specific cases in which management
  leadership resulted in positive changes in
  medical practices
• Share lessons learned

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Medical Injection Safety Project Background

• 5.5 year program funded through PEPFAR
• Objective To prevent the medical transmission of
  HIV through improved infection prevention and
  injection safety practices and behaviors.

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Introduction

• Good IP practices are simple and routine, but
  they require diligence and attention to detail
  and until they become habitual, they require
  behavioral reinforcement and supportive
  supervision to implement initially.
• Because available resources are invariably
  limited, careful planning, implementing and
  monitoring activities on a regular basis, whether
  in a small clinic or busy district hospital, are
  all essential.

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Activities carried out

• MOH and MISP launched the national IP/IS
  strategic plan
• Held monthly meetings with the national IP
  working group
• Held advocacy and orientation meetings with 289
  managers and supervisors in 9 provinces and 69
  districts
• Trained 431 HCP providers in 29 districts
• Conducted commodity assessment in 36 districts.
• Procured IP/IS commodities worth 876,284
• Conducted supportive supervision and follow-up in
  17 districts

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BCC

• 24 drama groups in 18 districts (16 scale up
  and 2 pilot districts) have been assessed and
  contracted to disseminate IP/IS messages in their
  respective districts.
• Supportive supervision to monitor behavior change
  was conducted in 18 districts
• Conducted a baseline survey covering 3 districts.
• Private sector
• - Carried out a literature search,
• - Conducted a situational assessment with key
  informants
• - Developed and pre-tested a focus group (FGD)
  guide and developed a BCC plan

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• Impact and results
• 24 drama groups contracted 265 performance done
• 203 areas/HCs reached
• 28,405 community members reached

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Orientation of managers

• The main objective is to orient the top
  health care management on the injection
  safety project, help them identify their roles
  and gain their support for sustainability.
• The managers are urged to incorporate IP/IS
  issues in their action plans and budgets
• Success stories of other hospitals are shared.

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Developing successful programs

• If behavior change is going to be sustained
  management reinforcement is required. Together
  with clinic managers and IP committees, the
  administrators have a responsibility to
• Set standards for performance, mentor staff and
  regularly monitor staff performance
• Help staff at all levels to do the right things
  and use correct PPEs
• Identified deficiencies and correct them,
  dangerous practices eliminated and encourage
  staff to seek inexpensive, doable solutions.
• Provide regular feedback and be role models.

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Efforts at Kitwe central hospital

• Appointed IP/IS focal person
• Revitalized IP committee
• IP/IS guidelines produced
• Conducted sensitization workshop for HCPs Zk
  2,600,000 (us 660)
• Continued purchase IP/IS commodities and so far
  spent ZK171,430,000(43,503).
• Acquired a new incinerator

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Efforts at Livingstone General Hospital

• Appointed IP/IS focal person and sent her to MISP
  for orientation on her responsibilities.
• Formed IP/IS committee.
• Started orientation maids and so far 35 at
  K300,000 ( 76).
• Continued procurement of IP/IS commodities so far
  spent ZK 12,472,952 (3,160).
• Carry out on spots checks in hospital wards.
• Started demonstrations of IP/IS practices to
  staff and student nurses.

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Efforts at the University Teaching Hospital

• Have revitalized the IP/IS committee and
  appointed a focal point person. Lobbied for
  construction of new incinerator with funding from
  ZANARA project
• Incorporated IP/IS commodities in their budget,
  have spent ZK8,300,000 (2,101)
• Use of accountability books for record keeping
  have been strengthened
• IP/IS trained staff have been carrying out
  demonstrations in the wards.

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Ndola Central Hospital (Pilot site)

• From January to date have spent ZK35,724,090
  (8,931) on procurement of additional supplies
  and PPEs
• Have continued with staff trainings and
  orientation (gt300 HCPs and support staff)
• Management have put a monthly budget allocation
  of K3,500,000 (833) for IP/IS

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Ndola central hospital (pilot site)
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Sustained behavior after one year in 17 districts
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Results

• Provincial and District Health Management Teams
  (DHMT) have incorporated IP/IS into their routine
  supportive supervision and follow-up
• DHMTs and hospital management have developed and
  produced IP/IS guidelines (PEP, waste management)
• Appointment of IP/IS focal persons at district
  and health facility level
• Procurement of additional IP/IS commodities,
  leading to continuous availability
• Immediate supervisors have continued guiding HCPs
  in IP/IS best practices, reinforcing positive
  behavior change

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Results contd

• National IP working group strengthened and very
  active.
• MISP signed a memorandum of understanding.
• MOH and MISP developed a follow-up and
  supervisory tool.
• MOH wrote circular requesting all DHMTs to
  incorporate IP/IS activities in their yearly
  action plans and budgets.
• Formation of IP/IS committees at district and
  facility levels which actively participate in
  health planning. 36 of IP/IS committees were
  functioning actively.
• Produced a standardized procurement list

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Lessons Learned

• Importance of orientation of managers
• The role of follow-up and supportive supervisory
  visits.
• Provision of adequate supplies, information and
  skills, supervision and motivation is essential
• Training of front line health care providers
• Follow up and supportive visits
• Support of managers from central level is crucial

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Taonga chomene!