Outline of the Project

Project Name

Project for strengthening Management Capacity of the General Hospitals in Lusaka District

Subject

Health

Country

Republic of Zambia

Date R/D signed

10th December 2020

Term of Cooperation

May 27, 2021 to May 26, 2026

Implementing Organization

Zambia Ministry of Health (MOH), Lusaka Provincial Health Office (PHO), Lusaka District Health Office (DHO), and General hospitals (Matero, Chilenje, Chipata, Kanyama and Chawama)

Background

In Zambia, first-level hospitals play an important role among health facilities as hospitals that provide basic medical care such as simple surgeries, and general hospitals (second-level hospitals) serve as referrals for cases that cannot be handled at first-level hospitals. However, in Zambia, which has a population of approximately 17.86 million (2019), there are 99 primary-level hospitals and 34 secondary-level hospitals. The quality of service provided is an issue, especially in urban areas, including Lusaka District, due to the rapid population growth and weak functions of primary and secondary level hospitals, third-level hospitals have no choice but to handle simple surgeries that should be handled by lower level hospitals. As a result, it is no longer able to fulfill its original role as a high-level function hospital.

In order to address these issues, JICA has been working to resolve the shortage of hospitals in Lusaka District (population: approx. 2.5 million) through the implementation of the Grant Aid Project for the Improvement of Lusaka District Hospitals and the Second Lusaka District Hospital Improvement Project by upgrading the five health centers. However, the hospital management budget actually spent at each hospital is limited, and patients are forced to bear the cost of X-ray diagnosis, ultrasound diagnosis, purchase of prescription drugs (if the hospital does not have stock), etc. ing. In addition, hospitals face many challenges in managing pharmaceuticals and medical consumables, and regarding medical equipment, there are major problems with maintenance systems, such as a shortage of technicians, difficulty in procuring consumables and spare parts, and a lack of preventive maintenance. In addition, human resources in charge of management are often entrusted with hospital management without opportunities to acquire basic knowledge and management skills related to hospital operation and management. However, they have not been able to make effective use of hospitals and formulate strategic hospital operation management plans.

In addition, in the outbreak of new coronavirus disease (hereinafter referred to as ""COVID-19"") in 2019, it is said that there are many cases of COVID-19 in Zambia caused by nosocomial infections, and it is said that there are many cases of COVID-19 infection at the general hospitals. The need to strengthen infection control measures has been reaffirmed, and the Ministry of Health of Zambia has made it a priority issue.

In order to improve this situation, the Zambian government has implemented a technical cooperation project to strengthen the hospital management capacity for the 5 hospitals developed under the Grant Aid ""Lusaka District Hospital Development Project"" and ""The Second Lusaka District Hospital Development Project"".This project will strengthen the ability to improve problems based on monitoring, strengthening infection control, stock management of medicines and consumables that can be handled at the hospital level, and maintenance of facility equipment, strengthening cooperation between the five target hospitals, the Lusaka State Health Office (PHO), the Lusaka District Health Office (DHO), and Ministry of Health (MOH). The projct aims to strengthen the hospital operation management capacity to improve the quality of the hospital, thereby contributing to the strengthening of the hospital operation management capacity at the general hospitals in Lusaka.

The Overall Goal

Capacity on hospital management at First Level Hospitals and Second Level Hospitals in Lusaka Province is improved (Total number of SLH is 6 and FLH is 6)

Project Purpose

Capacity on hospital management of five target hospitals is strengthened to provide quality health care services

Output

1. Strengthening of the governance structure that makes current issues more visible, manages based on objectives, and resolves issues on their own at each target hospital.
2. Infection prevention and control measures in hospitals are strengthened at each target hospital
3. Stock management of essential medicines and medical supplies (EMMS) and appropriate management / maintenance of medical equipment is implemented at each target hospital.
4. Strengthening of coordination among the five target hospitals, LDHO, LPHO and MOH.

Project Activities

1.1.	Clarify the organizational diagram and cross-sectional committee activities within the hospital, define the roles and responsibilities that each department should carry out in accordance with the vision to be achieved, and formulate rules and regulations.
1.2.	Analyze the gap between the vision to be achieved and the current situation, and comprehensively evaluate the current situation of the hospital and identify issues.
1.3.	Identify issues to be resolved and organize annual activity plans on the Balanced Score Card with strategic objectives, key performance indicators, and targets.
1.4.	The annual activity plan based on the Balanced Score Card is to be integrated into the Medium Term Expenditure Framework (MTEF) and budget proposal is to be submitted.
1.5.	Key Performance indicators of the annual activity plan based on the Balanced Score Card are regularly monitored at the Hospital Management Committee for adjustment of the activities.
1.6.	Activities 1.1-1.5 are summarized in an annual report and hospital issues and good practices are shared with hospital staff
1.7.	Education and on-the-job training about hospital management are provided at the hospital.
2.1.	Clearly the organizational chart of infection prevention and control stakeholders (infection prevention and control committee members and link persons) and the activities of the infection prevention and control committee, and define the roles and responsibilities in infection prevention and control in the hospital, and formulate rules and regulations (as specific activities under Activity 1.1).
2.2.	Issues related to infection prevention and control are analyzed on the Balanced Score Card, the annual activity plan for infection prevention and control is formulated, and a budget proposal is submitted (as specific activities for activities 1.2, 1.3, and 1.4).
2.3.	Key Performance indicators of the annual activity plan based on the Balanced Score Card are regularly monitored at the infection prevention and control committee for adjustment of the activities (as specific activities under Activity 1.5).
2.4.	Develop and revise Standard Operating Procedures and tools for prioritized issues, and utilize these tools.
2.5.	In order to visualize healthcare-associated infections as data, feasible surgical site infection surveillance is performed, analyzed, and reported regularly to the Infection Prevention and Control Committee.
2.6.	Infection prevention control activities are reported to the Infection Prevention and Control Committee and countermeasures are discussed.
2.7.	Issues and good practices are shared within the hospital, infection prevention and control activities are promoted and recognized by hospital staff
2.8.	Trainings on infection prevention control and surveillance are conducted.
3.1.	Clearly the organizational chart of stock management of EMMS and management of medical equipment and the activities of the Pharmacy and Therapeutics Committee and Medical Equipment Commitee, and define the roles and responsibilities in stock management of EMMS and management of medical equipment and formulate rules and regulations (as specific activities under Activity 1.1).
3.2.	Issues related to stock management of EMMS and management of medical equipment are analyzed on the Balanced Score Card, the annual activity plan for stock management of EMMS and management of medical equipment is formulated, and a budget proposal is submitted (as specific activities for activities 1.2, 1.3, and 1.4).
3.3.	Key Performance indicators of the annual activity plan based on the Balanced Score Card are regularly monitored at the Pharmacy and Therapeutics Committee and Medical Equipment Committee for adjustment of the activities (as specific activities under Activity 1.5).
3.4.	In pharmaceutical stores for EMMS, stock status is visualized and monitored in a more timely and accurate manner.
3.5.	Regularly updated Medical equipment list to ensure timely and accurate status of medical equipment operations.
3.6.	Stock management of EMMS and management of medical equipment are reported to the Pharmacy and Therapeutics Committee and Medical Equipment Committee and countermeasures are discussed.
3.7.	Issues and good practices are shared within the hospital, stock management of EMMS and management of medical equipment are promoted and recognized by hospital staff
3.8.	Trainings on Stock management of EMMS and management of medical equipment are conducted.
4.1.	Clarify the roles and responsibility of LPHO, LDHO and the five target hospitals regarding hospital management
4.2.	Integration of hospital management components in existing performance assessments conducted by LPHO
4.3.	Monitoring and supportive supervision is conducted by LPHO towards the five target hospitals based on Activity 4.2
4.4.	Share and discuss issues and good practices from Activity 4.3 at the Technical Committee meeting of LPHO
4.5.	Conduct a survey and research to support good practices related to Outcomes 1, 2, and 3 and disseminate the results within the District, Province, country, and the world through LDHO, LPHO, and MOH.
4.6.	Establish standardized guidelines related to Outcomes 1, 2, and 3, led by LPHO, and provide policy recommendations to the MOH

Inputs

[Japanese Side]

• Assignment of experts:
  - 4 long-term experts; Chief Advisor,Hpspital Management, Quality Control / Infection Control, Pharmaceutical products inventory management/Medical equipment management, Project Coordinator
  - Several short-term experts
• Project operational cost
  - Training, stakeholders forum, etc.
  - Activities in the selected intervention sites
• Provision of necessary equipment for the Project operation

Inputs

[Zambia Side]

• Assignment of counterparts (C/Ps)
  - Ministry of Health
  - Target hospitals
  - Provincial Health Offices / District Health Offices
• Arrangement of the office space for the Project
• Utility cost for the Project office and the Project sites
• Personnel cost of C/Ps
• Running expenses necessary for the implementation of the project