Essential Package of Hospital Service (EPHS)
Ghazni EPHS project has been implemented by Bakhtar Development Network (BDN) in Ghazni province through Ghazni Provincial Hospital to serve 127590 populations for a period of PCH project and were highest referral side for entire province and nearby provinces.
BDN offered all components of BPHS and EPHS through Ghazni Provincial Hospital. These services offered as per EPHS standards ranging from outpatient care, Emergancy services, operation and inpatients cares and referral system in there catchment area.
The general objective of this project was to enhance and improve accessibility of project coverage population to quality health care services in line with the EPHS and BPHS (MoPH) strategies and policies.
The specific objectives are:
- EPHS specified objective
- Increase access to hospital services
- Improve the quality of patient care
- Increase the efficiency of hospital operation
- BPHS Specified objective
- To improve quality of services
- Expand access of the coverage population to the primary health care service delivery system
- To focus on strategic BPHS interventions and cross cutting issue
- To plan and implement cross cutting issues like behavior change communication, capacity development, M&E
- To ensure effective management and operation of the project
The project has been implemented according to EPHS by Bakhtar Development Network (BDN) in Ghazni province through Ghazni Provincial Hospital to serve 127,955 inhabitants for a period of PCH project.
These services offered at Provincial Hospital standard type of PH, ranging from outpatient care to inpatient services at (PH) and other active partners to ensure the coordinated service delivery and referral system in there catchment area.
The hospital continued to offer essential therapeutic and preventive services to its catchment population and served as referral site for emergencies and complicated cases in support to the network of health facilities under BPHS throughout the province. The project mad extreme efforts to apply successfully proposed strategies with though there was challenges during the project life cycle.
The strategies were focused to three directions: I. Increase access to hospital services . II. Improve the quality of patient care. III. Increase the efficiency of hospital operation.
GPH provided services according to EPHS standards to a total of 65743 IPD patients and 654086 OPD patients. The patients were provided with quality services in different departments i.e. surgery, internal medicine, pediatric, MCH, laboratory, physiotherapy, X-ray, ECG, Ultrasound, nutrition and blood bank.
GPH maintains 164 technical and supportive staff out of which 38 are women. In order to build the capacity of mentioned staff training such us Mental Health, Infection Prevention, HMIS, TB and Nutrition were conducted during the project . In addition to ensure quality of health care services BDN maintained provision of regular supervision and on-the-job trainings to the health service providers.
The project managed by Project Management team including Project Manager assisted by Hospital Management bored (Hospital director, Medical director, Nursing director and admin/Finance) in monitoring, supervision. Totally 6 staff recruited in Ghazni Sub office. At central level, the PCH lead Project Director based in Kabul along with its technical were responsible for providing the required technical and managerial support by overseeing the project activities. The project activities and its scope of work were coordinated closely with all stakeholders such as; hospital community members, national and international agencies at province level, MoPH and PPHD.
Controlling mechanism was maintained thorough of project life cycle. The tools used for this purpose were: adherence to project work plan and its scope; observation and compliance to the organization policies in regard to operations services for logistic and procurement & supplies; standard operational procedures, policies and tools used in financing and approach for good pharmaceutical management and rational use of drug though strong supply management system established in the project.
Along with, monitoring and evaluation were applies through diverse dimension and tools. To improve hospital services provision, National standard hospital monitoring tool developed and applid as baseline in the hospital and its progress regularly followed in all each quarter, as per mentioned, standard in the end of project obtain 91% score.
Through the aforementioned inputs the output results shows a positive changes and improvement in the e following indicators relevant to access and quality of the provincial hospital services like:. Number of admitted patients increased from 10275 Client in 2010 to 13772 clients in 2015 , Indicators relevant to quality of patient care and the efficiency of hospital operation increase significant and show good achievements such as; Provincial hospital is properly staffed as required by EPHS and Number of health workers in Ghazni PH received NGO provided skills & knowledge transfer courses was 100% achieved. . Moreover, 13 different type of professional trainings were provided for 832 participants during the project
The summary of HMIS reflect that number of Institutional Deliveries, OPD, First ANC and PNC, IPD, , Penta3 and TT+ in pregnant women have maintained its ascending trend during the project with few fluctuations in C-section ,TB case detection, Major Surgery and CPR had descending trend in 2012 continuing with flat trend afterwards.
Though, the good achievement of the project the following challenges posed during the implementation; a) unavailability of standard building, b) shortage of specialist during some period of project, c) turnovers and d) un-availability of enough space in the hospital.
Consequently based on the significant good achievement connected to accessibility and quality of the services in the Hospital it can be concluded that, project achieved it aim through an effective and sufficient implementation. Hence, with deliberation of lessons learned and recommendation, primary health care services and hospital services as a crucial and vital approach for health promotion of country population should be sustained for the future.