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Towards improving quality of health care

1healthIt has been two years since the establishment of the Health Care Agency (HCA), a sector in the Ministry of Health (MOH) providing primary, secondary and tertiary care through the Seychelles Hospital and Community Health Services.

It is part of the journey of health care transformation embarked on by the government of Seychelles in 2013 to further improve Seychelles’ health services, especially the curative services.

HCA is headed by a governing board, and managed by a management team both appointed by the President.

Over the last two years, the strategy of HCA has been directed towards improving quality of care and bringing health care closer to the people by building on the health care services that existed.

It began with an assessment of the progress made and the challenges encountered during the last decade and learning for the path ahead.

Along the way, there has been steady progress and in 2015 the focus was on establishing a structure and system to deliver quality care and strengthening community health care. However, HCA remains challenged with several pressing issues, mainly surrounding funds and professionalism.

Recruitment of specialists

In line with improving quality of care to internationally accredited levels, HCA secured a donation of 2.7 million US dollars yearly for a period of four years from the government of UAE. An equivalent of one third of this amount is matched by the government of Seychelles. This programme has provided HCA with specialists from 20 years of experience; introduction of new specialties; and specialists strengthening our workforce to provide quality care. The 11 new specialists recruited from this fund include physicians in internal medicine and respiratory diseases, neurologist, orthopaedic surgeon, pathologist, psychiatrist, gastroenterologist, family medicine physician, and anaesthetist. More specialists are expected in the field of cardiology, oral and maxillofacial surgery, radiology, community medicine, and community paediatric medicine.

Private public partnership with AMSA Renal Care

HCA has embarked on a private public partnership with AMSA Renal Care (Seychelles) Pty Ltd in the management of the haemodialysis unit. AMSA Renal Care has taken over the unit since April 2014 to provide an improvement in the efficiency and quality of care at a reduced cost. The introduction of several protocols, procedures and guidelines has enabled the unit to achieve 3 ISO certifications (ISO 9001/ISO 14001& ISO 18000) within eight months of operation under AMSA. There has been multiple positive satisfaction reviews by the patients on the quality of care.

Specialised services

The Seychelles Hospital aims to further improve the quality of care by providing a more comprehensive patient centered care closer to the people. The Ear Neck Throat unit has streamlined its services by introducing two specialty clinics, has screened over 200 elderly people and provided 20 of them with hearing aids on the spot. There had been several eye camps throughout the year (Freemasons, Lions International), which have significantly reduced the backlog of cataract surgery. 417 cataract surgeries were performed by the third quarter of 2015.

2healthCataract surgical rate (CSR) is now 5,120 per million population, (up from 4,044 in 2014, (i.e. 26.6% increase).

The Mental Health Services has expanded its services to cater for the increasing number of drug addicts with the establishment of Wellness Clinic at the Green Roof for methadone maintenance, walk-in Crisis Centre and Mental Health Outpatient Clinic. The introduction of Mental Health and Addictology Services on Praslin was established to provide this service closer to the people on Praslin.

Decentralisation of methadone maintenance programme has recently been launched and will be expanded as per demand.

The backlog of orthopaedic surgery has been significantly reduced by the procurement of an increased quantity of joint replacement and spine implants in 2015. 25 total knee replacement, 15 total hip replacement and 12 spine surgeries were performed in the first three quarters of 2015. The purchase of an operating microscopy has allowed over five microscopy spine surgeries to be performed locally. These patients would have otherwise been sent overseas for treatment.

Hyperbaric oxygen therapy unit

The opening of the new hyperbaric chambers has revitalised hyperbaric oxygen therapy (HBOT) in Seychelles. HBOT services had been available since 1990s. It had been erratic due to technical and maintenance issues with the old chamber, which could accommodate only one patient in a lying down posture or two patients seated and could not cater for continuous programme for chronic cases. The treatment is individually tailored with one session lasting for up to two hours, treatment duration depends on response and to date a maximum of 91 sessions per patient are permitted. HCA is equipped with a large team of health care workers experienced in HBOT, trained since 1990s. The advantages are numerous including prevention of limb amputation, promotion of wound healing and preparation of wound beds for future skin grafts, and minimal side effects.

Oxygen production plant

The Ministry of Health has spent over R6 million to install a state-of-the-art oxygen production system at the Seychelles Hospital to provide medical oxygen to all its health facilities. The plant was commissioned in October 2015 and it is connected to Seychelles Hospital by extensive medical gas pipe network for an uninterrupted continuous regulated supply of medical oxygen. It also provides all other health care facilities oxygen via cylinders for their needs and storage.

In the past, HCA was spending approximately R8-10 million yearly for purchasing of medical oxygen in cylinders for patient treatment. There were times when this supply was interrupted and more costly oxygen cylinders were imported from overseas. The multiple advantages that this plant brings to HCA will make its acquisition as a major milestone in the development of modern medicine in Seychelles

Community health services

In the community, the Community Health Services (CHS) focuses on bringing primary health aare services closer to the people, remove congestion at the Seychelles Hospital, and make better use of existing facilities, empower the community, provide an array of primary, preventive, health promotional, curative and emergency services to the population they serve, provide specialists outpatient services in the community and recruit Family Health specialists for regional health centres.

The Expanded Programme for Immunisation (EPI) in collaboration with WHO has established a National Switch Plan to switch from the Oral Polio Vaccine (OPV) to the IPV (Inactivated Polio Vaccine); and the date has been targeted to be April 2016.

The main reason for this switch from the Tri (types 1, 2, 3) to Bivalent (types 1, 3) vaccine is based on evidence that the type 2 of the polio virus is still causing paralysis in immunised children in many parts of the world. Polio is still endemic in parts of Nigeria and Pakistan and the spread seems imminent in view of ensuing conflicts in these countries.

Partnership building in community

Participatory meetings were held with all district administrators (DA) of the 25 districts in the country. The help of all DAs in actively taking part in health outreach programmes and in mobilising the communities was solicited.

Ebola epidemic

The Ebola epidemic that has been ravaging countries of West Africa, has been a major concern for HCA. Together with the Public Health Authority, a HCA team worked in close collaboration with multisectorial teams and all key stakeholders in the country to develop a preparedness and response plan. Over R6 million have been invested in implementing the plan with involvement of other resources including conversion of the in-patient section of Anse Royale Hospital into an isolation unit. Similar development took effect on Praslin and La Digue.

Community outreach programmes

Community outreach programme activities have recorded significant increase in the number of people targeted and reached out for health promotional and educational activities. All of the district health centres took part actively and health care workers were stationed in common public places, work and occupational areas, sports activities, parish feasts and other national events which usually pull large crowds such as the regatta.

Diverse health issues were addressed and these included: non communicable diseases, cancer, diabetes, hepatitis, HIV/Aids, obesity and nutrition related illnesses.

Various screening activities are included in those outreach programmes. Screening for HIV, diabetes, high blood pressure, dental illnesses, eye testing, BMI measurement are all inclusive.

Health promoting school launch

The Health Promoting School (HPS) initiative has been established in all public schools of the country. This is a direct collaboration between Ministry of Education and Community Health services of the HCA of the Ministry of Health.

Training of Health care workers, head teachers, HPS leaders, tuck shop operators, nurses and public health officers have reinforced the concept principles.

This initiative will help bring a more closer and improved approach with the school teachers and management and school children themselves, with the aim of fostering and entrusting improved health care services to the school target groups.

A new dental caravan has been opened at the Plaisance primary school which will cater for a 1,000 plus schoolchildren in the locality. In the coming few months, the Mont Fleuri school dental clinic and the Perseverance island school dental caravan will open their doors as well. These new additions will complement the existing school dental clinics and improve on the current dental services we offer our school children.

Pharmacy

Based on monthly dispensing statistics for the first three quarters of 2015, 40,000 prescriptions were dispensed, 87% from Community Health Services (CHS) and 13% from Seychelles Hospital; a total average of R4 million worth of drugs were dispensed monthly (42% from CHS and 48% from Seychelles Hospital); 200 chemotherapy admixtures prepared; and there was an average of four items per prescription.

To minimise the quantity of medicines expired on the shelf, expiry dates in pharmacies are closely monitored and exchanged to ensure that stock are used prior to expiry dates. CMS shares on a monthly basis the list of medicines expiring within three months whereby prescribers are advised to use these medicines as their first choice of treatment.

The prices of some medicines sourced this year have decreased by 30%. More suppliers are supplying on credit therefore delivery is expedited reducing the number of stock outs in CMS and emergency orders.

The main concern is that the number of pharmacy staff has reduced by 6% compared to 2014.

Capacity building

Capacity building of our health care workers remains pivotal in the improvement in the quality of the services that we provide. 15 nurses are following diploma programme in midwifery since February 2015. Most midwives have taken refresher training in midwifery this year. 17 nurses have started an on-line advanced diploma in Child Health Paediatric in September 2015. Other training courses include: Leadership for Change Programme – 17 Nurses/Midwives; 2 nurses in BSC/MSC in nursing, leadership training of nurse managers; emergency preparedness training, neonatal resuscitation, reproductive health, school health, diabetic control and prevention, Ebola preparedness and response, HPV vaccination programme, early childhood care and development.

Way forward

The achievements and challenges during 2015 would serve as building blocks for further improvement in quality of care towards internationally accredited levels in all health care facilities and for promoting health within the community.

Source : Seychelles NATION

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