Strengthening Specialized Clinical Services in the Pacific
www.sscsip.org
Overview of presentation
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Background info abut SSCSiP
What SSCSiP is about
Activities in the Northern Pacific
Regionalism lens
Lessons learnt
Way forward
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
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
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
Service delivery modalities
Issues
• Offshore referrals
• In-country
through visiting
teams
• In-country though
local specialists
• 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.
Strengthening Specialized Clinical Services in the Pacific
www.sscsip.org
Example of Regionalism
Australian Government Funding
FNU as implementing agency
Project design reviewed &
endorsed by MoH, and
Pacific Island Ministers
Meeting
PICs & Development partners
coming together to discuss
identify a solution – SCS
Project
SSCSiP Project
PICs identifying a
common issue of
concern
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
GOAL
For Pacific Island Countries to achieve better planning and improved local capacity to meet secondary and tertiary
health needs in a way that is appropriately balanced against each country’s primary and preventive care priorities.
OBJECTIVE 1:
to support Pacific Island countries to plan for, access, host and
evaluate specialised clinical services.
OBJECTIVE 2:
to contribute to the development of appropriate health worker
skills and capabilities
Outcome 1.1 - visiting specialised clinical services are demanddriven and planned within each country (C)
Outcome 2.1 - Support provided for HR for SCS planning ( C )
Outcome 1.2 –visiting teams are coordinated across the Pacific and
provided in an efficient and effective manner (C +R)
Outcome 2.2 – Increased knowledge and skills of health
workers to provide and/or support quality specialised clinical
services ( C )
Outcome 1.3 - adjunct services to support specialised services are
available and generally strengthened ( R )
Outcome 2.3 – Established linkages to support health
workers’ development ( R )
Outcome 1.4 – Patient outcomes are assessed and deemed
satisfactory ( C )
Outcome 1.5 – Offshore referrals for specialist care is cost-efficient,
and consistent with agreed medical and equity guidelines ( C )
Strengthening Specialized Clinical Services in the Pacific
www.sscsip.org
Coverage
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
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)
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
SSCSiP Governance
• Secretaries/CEO of MoH and Directors of clinical services from 14 PICs
• Annual meeting
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
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
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
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)
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
Mapping of biomedical services
capacity
2. National Repair Capacity
1.Equipment
Management
Service Contracts
Policy and Procedures
MOH/Private Sector balance
MOH Engineers
Procurement
MOH Senior Biomeds
Inventory
MOH Biomeds
3. Hospital Repair Capacity
Regular Preventive
maintenance?
Safety &Function Checks?
Check Due Date marking?
MOH Trainees
Job Documentation
Minimum Equipment
Standards
Succession Planning?
Repair Facilities
Total Equipment Inventory?
Disposal of Old
Equipment
Donated Equipment
guidelines
New Technology
Assessment
Urgent Spare Parts
procurement?
Adequate Tools/Test Equipment
Equipment waiting diagnosis?
Work Recording Systems?
Total Inventory Value?
Equipment waiting spares?
Management Reports?
Equipment waiting disposal?
Equipment Identification?
Service manual availability?
Biomedical Budget allocation?
Specialised test equipment?
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
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 No
Hospitals 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
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
Country scores
80
75
Palau
FSM Pohnpei
70
FSM Chuuk
60
FSM Yap
FSM Kosrae
48
50
44
40
32
34
35
31
30
42
37
37
Fiji
33
Tonga
30
20
16
RMI Majuro
19
19
21
Samoa
Vanuatu
Solomon Islands
Kiribati
10
Nauru
0
Niue
Tuvalu
Cook Islands
Recruited a BME – work with PIC; coordinate BEMI BME; BMT training
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
Total Dr (locals + expats) per 10,000 population
35.00
No. of Local Drs per 10,000 population
30.77
Total No. of Drs (locals + expats) per 10,000 population
30.00
28.35
25.00
20.00
17.61
15.00
8.54
10.00
6.00
5.00
1.37
1.49
1.56
2.42
3.49
4.27
9.65
6.01
4.69
0.00
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
Fiji
Solomons
Vanuatu
Samoa
FSM
Kiribati
Tonga
RMI
Palau
Cooks
Tuvalu
Nauru
Tokelau
Niue
Areas of specialization for local Drs
General Surgery
Medicine
OBGYN
Paediatrics
Anaesthesia
25
17
19
13
13
4
4
4
2
5
4
2
3
1
2
5
3
4
4
4
4
3
5
2
1
2
2
1
2
1
4
2
4
2
2
0
0
0
0
0
1
1
1
1
1
2
0
2
1
1
1
0
1
1
2
0
0
0
0
0
0
0
1
0
1
0
0
0
0
1
Opthlamology
Othorpaedics
ENT
Psychiatry
Plastics
Urology
Emergency medicine
Radiology
Pathology
10
2
0
2
0
1
0
2
1
3
1
1
2
0
0
5
1
1
1
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
3
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
Niue
Tokelau
Nauru
Tuvalu
Cooks
Palau
RMI
Tonga
Kiribati
FSM
Samoa
Vanuatu
Solomons
Fiji
Total no. of specialists (locals +
expats)
General Surgery
Medicine
OBGYN
Paediatrics
Anaesthesia
26
17
20
14
15
4
4
4
3
5
6
3
6
2
3
5
3
5
6
5
7
5
8
3
4
3
3
2
3
2
4
2
4
2
2
1
2
1
1
0
1
3
1
1
1
2
1
2
1
2
2
0
2
1
2
1
0
1
0
2
0
0
1
0
1
0
0
1
0
1
Opthlamology
Othorpaedics
ENT
Psychiatry
Plastics
Urology
Emergency medicine
Radiology
Pathology
10
2
2
3
0
1
0
2
2
3
1
1
2
0
0
5
1
1
1
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
1
0
0
0
0
0
1
0
0
3
1
1
1
1
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
Reflections & the way forward
• …
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org
Strengthening
Strengthening Specialized
Specialized Clinical
Clinical Services
Services in
in the
the Pacific
Pacific
www.sscsip.org
www.sscsip.org