MC MOVEModels for optimizing the volume and efficiency of MC
services
By Dr Dino Rech
MC MOVE• Evolution of efficiency principles in surgery and
MC• Efficiency principles used in MC• Progress to date
– New sites and programs– Research– Ongoing evolution.
• Efficiency challenges– Balancing demand and supply/ seasonality– Counselling and communications– Part time MC providers vs specialised teams
Evolution of efficiency principles in surgery and MC…e.g.
Aravind Eye Hospital India
Orange Farm South Africa
Evolution of efficiency principles in surgery and MC
MOVEWHO pilot initiative:
Aims to maximise Surgical results and minimising time and resources needed to perform high
volumes of surgery.
Facilitates cost effective solutions to MC scale up in high volume/demand settings
Task-Shifting
- Training / certification of entire MC procedure to lower health cadres, e.g., clinical officers, nurses.
Efficiency Principles used in MC
Task-Sharing
Assign steps to lower cadres:- Surgical area clean & prep- Anaesthetic block- Final foreskin stitches- Wound dressing
Sharing supported by:- 4 beds per operator- 6 lower cadres per operator- Theatre layout for staff flow- Alcohol gel hand sanitizing- Gown change only if blood
Surgical Efficiency Techniques
Task-Shifting Task-Sharing
Techniques
- Forceps-guided- Cautery (monopolar) for haemostasis - Fewer stitches (8-12) for foreskin apposition- Collective wrap of surgical items- Pre-assembled surgical kits- Theatre layout for faster patient turnover
The Fourth Efficiency Principle
Adequate Client flow and demand for services
-Communications
-Mobilization
-Counselling and testing services
Surgical layout
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2
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4
Efficiency focused MC Kits
Surgical Methods
Surgical methods compared
Time savings to surgeon/procedure
Forceps-guided/dorsal slit 2:25
Forceps-guided/sleeve resection 7:40
Dorsal slit/sleeve resection 5:15
* Times depicted are based on time-motion observations at Orange Farm, South Africa
Results
Indicator Pre‐MOVEMOVE
(Sleeve)
MOVE (Forceps Guided)
Doctor Operating Time
25‐50 min. 10‐20 min 5‐10 min
Cubicle Turnover Time
60 min 30‐40 min 25‐30 min
# of Clients 1‐2 an hour 3‐5 an hour 5‐8 an hour
* Note Graph with initial impact and results from Tanzania.
Progress to date
• Efficiency focused( use of MOVE) implementation – South Africa – Swaziland– Zimbabwe– Tanzania– Botswana– Zambia– Kenya
• Research Efficiency or MOVE Evaluation
Aggregate Numbers – Four Pilot Sites. Tanzania
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MOVE Begins
Challenges to implementing efficient high volume services
– Balancing demand and supply / managing seasonality of demand
– Counselling and communications: How to keep up?
– Part time MC providers VS specialised teams: Pros and Cons
New Super Efficient MC Device in SA???