project design document - adi australian doctors … · web viewthe leading causes of maternal...

Project Design Document

Western Province - Integrated rural doctor patrol project

GENERAL INFORMATION

Principal Contact & Position:

Yaman KutluPNG Country Program Manager

Local Partner Contact Position

Sister Anna Sanginawa - Diocesan Health Manager – Catholic Health Services – Diocese of Daru-Kiunga

Telephone Number(s): (+61) 2 9976 0112Fax Number: (+61) 2 9976 6992E-mail Contact: [email protected]

PROJECT DESCRIPTION

Project Brief

Project Name: Western Province - Integrated rural patrol project

Location/Region(s): North and Middle Fly Districts - Western Province, Papua New GuineaSectors (DAC-codes) Primary DAC code – 12281 – health personnel development

Secondary DAC code – 12181 – medical education/trainingImplementing Partner(s): Diocese of Kiunga-DaruPrimary Beneficiaries: 60 Rural Health Workers – 4,000 rural community membersSecondary Beneficiaries: 90,354 population catchment of CHS health centresExpected Start-up Date: 1 Jan 2016Expected Finish Date: 31 December 2017Project Evaluation Date: September 2017Project Duration: 24 monthsEstimated AUD Value:

PDD – Western Province Integrated Rural Patrol Project

mailto:[email protected]

Contents & Acronyms

Project Design Document

1. Acronyms2. Situational analysis summary3. Project rationale 4. Project description5. Target Groups/Beneficiaries6. Resources and costs7. Implementing Partners8. Monitoring and evaluation9. Assumptions and risks10. Feasibility and sustainability11. Details of consultations completed in preparation of Project Design Document12. Appendices

1 Situational analysis2 Log frame matrix3 Budget4 Activity schedule

PDD – Western Province Rural Patrol Project: of 22

1. Acronyms:

ACFID Australian Council for International DevelopmentADI Australian Doctors InternationalAVI Australian Volunteers InternationalAusAID Australian Government Aid AgencyAPNGBC Australia Papua New Guinea Business CouncilCHO Catholic Health Office is the head office of the CHSCHS Catholic Health Service CPO Child Protection OfficerCPP Child Protection PolicyDDK Diocese of Daru Kiunga – our development partnerDFAT Department of Foreign Affairs and Trade (Australian Government Dept responsible for the

Aid Budget)DOCS Department of Community ServicesDOTS Directly Observed Treatment Short courseECPNG Evangelical Church of PNGHIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syn.HMA Health Management AdvisorHO Horizon OilMDG Millennium Development GoalsM&E Monitoring and EvaluationMF Middle FlyMFDA Middle Fly District AdministrationMFH Middle Fly HealthMOU Memorandum of UnderstandingNDOH National Department of Health (PNG)NF North FlyNFDA North Fly District AdministrationNFHSDP North Fly Health Services Development Program NFH North Fly HealthNGO Non Government OrganisationNIP New Ireland ProvinceOTFRDP OkTedi Fly River Development Program PDD Project Design DocumentPNG Papua New GuineaPNGSDP PNG Sustainable Development Program POM Port MoresbyRAM Rotarians Against MalariaSDG Sustainable Development GoalsUN United NationsUNCROC UN Convention on the Rights of the ChildVBA Village Birth AttendantVHV Village Health VolunteerWHO World Health OrganisationWP Western Province


2.Situation Analysis Summary

The health sector in PNG faces significant challenges due to the de-centralisation of health services post independence. Rural areas experience high infant and maternal mortality rates, infectious diseases (including malaria, tuberculosis and HIV), and a growing incidence of non-communicable disease – diabetes, hypertension, respiratory disease, acute shortage of resources, failing infrastructure and lack of essential drugs. The challenges associated with poor physical access and infrastructure make service delivery expensive and out-of-reach to many citizens, especially rural populations. These problems are compounded by the decentralized and fragmented health care system that has led to a lack of coordination and oversight of responsibilities between national and provincial/district government agencies, hospitals, and health clinics. In more recent years JTA/Abt has been funded by the OkTedi Foundation to deliver the North Fly Health Services Development Program and the South and Middle Fly Health Services development programs. A considerable number of health stakeholders from Tabubil to Daru now coordinate their activities through these stakeholder groups.

The Montfort Catholic Mission (headquarters of the Diocese of Kiunga-Daru) operates 8 health centres and 14 health posts in the North Fly/Middle Fly area. In 2002, ADI sent the first of 22 doctors over a period of ten years to work in partnership with the DKD, providing clinical and health education services to the remote health facilities and communities. In August 2011, ADI and DKD commenced a Capacity Building Project in North Fly with the appointment of ADI’s Health Management Advisor, Leona Cayzer, to capacity build with the Catholic Health Office management and staff for 2 years. In 2016 ADI recommenced doctor led patrols at the request of Catholic Health Services and rural health staff.

For more information about Western Province see the embedded Situational Analysis:

This project has been designed based on the following ADI organisational objectives:

Objective 1: Deliver and strengthen primary health care services in rural and remote communitiesObjective 3: Increase the capacity of health workers to manage and deliver primary health services

through training and educationObjective 4: Improve access to primary health care services by rural and remote communitiesObjective 7: Advocate for improvements in the health system in our areas of operation

3. Project rationale

Papua New Guineans have low life expectancy and high infant and maternal mortality. Due to the problems of access, infant and child mortality rates are additionally double in the rural areas compared to the urban areas. PNG still has limited primary health care. There are serious public health risks and preventable diseases, such as malaria, pneumonia, perinatal conditions, tuberculosis, meningitis and diarrhoea claim many lives. Leprosy and lymphatic filariasis are also in evidence, and there is an emerging HIV/AIDS epidemic.

TB, pneumonia, malaria, obstetric and perinatal conditions and diarrhoea form the bulk of the disease burden.

Maternal and child, infectious and environmental health factors are clear areas of need. The leading causes of maternal mortality include postpartum haemorrhage, puerperal sepsis, ante-partum haemorrhage, eclampsia and anaemia. Poor access to health facilities, lack of skilled health workers in an adequately resourced facility and low uptake of family planning are key causes.


A major challenge to improving health is linked to perceptions of illness and health among the general population. There is a widespread lack of awareness regarding risk-related and health-promoting behaviour, and little involvement by local communities in health-promoting activities. Key risks include behaviour and environments that increase the risks of communicable diseases; risks of non-communicable disease, such as chewing betel nut and smoking tobacco; and the risks associated with unsafe sexual behaviour.

The non-communicable diseases epidemic in PNG is firmly established and increasing, but remains largely unrecognized in reported data. Tobacco-related and alcohol-related illnesses, diabetes and hypertension are on the increase, as are the three leading cancers (oral, hepatic and cervical), along with breast and lung cancers.

Western Province has many health challenges that are complicated by the decentralised system, poor health governance systems, failing infrastructure and understaffing in rural areas. Whilst the Provincial Government is based in Kiunga, Provincial health still operates from Daru. Alice Honjepari is Director of Rural health services. The major provider is the Government with 60% of services, ECP with 22%, Catholic Health with 10% and Company operated 8%. There are approximately 205 health facilities in WP - 5 hospitals, although Balimo has no doctor, 2 urban clinics at Daru and Kiunga, 36 health centres and 163 aid posts. Many of the health facilities are in extremely poor condition.

Medical officer visits to rural health centres are improving in partnership with NFHDS, SMFHDS and ADI although service delivery can be static with many aid posts closed or unstaffed. Challenges with communications, and adequacy of drug supply are consistent. Rural women continue to need improved antenatal care and supervision of births in a health facility by a skilled birth attendant.

4. Project Description

The Diocese of Kiunga-Daru (DKD) is led by Bishop Gilles Cote and provides a range of Catholic services for the whole of the Western Province. In Kiunga, it operates a range of health and education programs from the Montfort Catholic Mission (MCM), where Sr Anna Sanginawa is the Diocesan Health Manager. The Diocese is responsible for the operation of 8 health centres and 14 health posts. There are approximately 60 health workers across all the CHS facilities. ADI and DKD have recently updated their MOU, reconfirming their partnership and committing to capacity-building projects over a number of years.

This project meets seven of the Eight Key Result Areas identified in the Western Province Provincial Health Department’s 5 year plan to: Improve Service Delivery; Strengthen partnerships; Strengthen Health Systems; Improve Child survival; Improve maternal health; Communicable disease control in communities; and Encourage Healthy lifestyles.

The Integrated rural health patrol program includes consistent outreach treatment and training delivered to rural health facilities supported by Catholic Health Services in the Western Province. The priority for the ADI doctor is to provide in-service training to rural health workers and then supervise their treatment during static clinics at health facilities and mobile outreach clinics to villages and aidposts. Patrol where possible will be for a two week duration at CHS facilities and catchment areas. Shorter day trips will be conducted to Government run facilities closer to Kiunga in the catchment area of the Horizon Oil project.

Target Group(s)/Beneficiaries

Primary BeneficiariesIncrease the clinical capacity of 4 staff at the head office of CHS, and 60 health workers at rural Health Centres and Aid Posts through in-service training, mentoring and case-based training by volunteer doctors in the field.

Secondary Beneficiaries90,354 population catchment of CHS health centres.


The project will increase access by rural communities to a wide range of health services at 8 Health Centres, and 14 Aid Posts managed by Catholic Health Services including approx. 4,000 rural community members who will attend clinics with the ADI Dr or one of the patrol team members including, ADI Nurse, MCH Nurse, CHW – ears/eyes-disability screenings, CHW- TB and disease screenings.

2.0 Implementing Partners

The development partners:

Australian Doctors International (ADI) is a small development aid organisation based in Manly, NSW, Australia, which is working in Western Province and New Ireland Province, PNG, to reduce poverty by bringing a range of health services to the most isolated and poorly serviced communities in PNG. ADI is an accredited non-government organisation with DFAT, a member of ACFID and a signatory to the ACFID Code of Conduct.

The Diocese of Daru-Kiunga (DDK) is led by Bishop Gilles Cote and has responsibility for the whole of the Western Province. In Kiunga, it operates a range of health and education programs from the Montfort Catholic Mission (MCM) where Sr Anna Sanginawa is the Diocesan Health Manager. The Diocese is responsible for the operation of an urban clinic, 8 health centres and 14 health posts.

ADI and DDK have confirmed a Memorandum of Understanding (MoU) dated 14 December 2015, to establish the principles and broad manner in which they will cooperate on projects. It includes agreed goals, objectives, activities, outputs, obligations of both parties for all stages of the project which will run initially from January 2016 until December 2017, with an option for review and extension. ADI Program Manager, Patrick McCloskey and Sister Anna Sanginawa, Diocesan Health Manager, will facilitate this project.

In 1978 in Alma Ata, Russia, the Papua New Guinea government, along with more than 100 other governments, adopted the Primary Health Care Model and has implemented it nationwide. The model is centred on a functioning District Hospital which services a network of Health centres each of which support a network of health posts (formerly Aid posts.) There are 1200 health centres/posts in PNG many of which have closed down and more than 50% are operated by faith-based organisations.

Catholic Health Services - Western Province

The Diocese of Daru-Kiunga operates several health services located at the Montfort Catholic Mission (MCM) in Kiunga including the Kiunga urban clinic for primary health care, Callan Services – disability services, Good Samaritan – HIV Counselling and testing, Village Health Volunteer programs – funded by Sisters of Mercy (Mercy Works).

Catholic Health Service – primary health service Callan Services – disability services Good Samaritan HIV Counselling and Testing Village Health Volunteer Program (includes Village Birth Attendants - VBA)

Catholic Health Service

Head office staff is located in Kiunga at the Montfort Catholic Mission:

Catholic Health Secretary: Sr Anna Sanginawa (MW Nurse and Nun)Clinical Supervisor: Cathy Yaki RNNurse Educator Zita Sagom RNAccountant Grace Wimgka Driver, General Jean MemeopCarpenter Simon Kakuwang

There are 60 rural health workers who support the 8 health centres and 14 aid posts. This includes 8 qualified nurses and 52 community health workers who have had 18 months to 2 years health training. The level of education for the CHWs is usually to grade 10.


Health Centres Catchment Area CHS Staffing Aidposts CHS StaffingNorth Fly Health

CentresAssociated Aid Posts

Urban Clinic at Kiunga 49,258 1 x HEO2 x NO4 x CHW

Katawim 1 x CHW2 x VHV

Komokpin 2 x CHWMembok 3,695 1 x NO

4 x CHW4 x VHV

Yoot 1 x VHVKaikok 1 x VHV

Iowara & villages 6,501 2 x NO4 x CHW

Neogamban 1 x NO2 x CHW

Yodomena 1 x NO2 x CHW

Kuiu 2 x VHV1 x CHW

Matkomnai 3,598 1 x HEO2 x NO4 x CHW

Yenkenai 1 x NO2 x CHW

Kungim 4,232 2 x NO3 x CHW

Tarakbits 2,775 1 x NO5 x CHW

Golgobip 4232 2 x NO2 x CHW

Biangabip 1 NO2 x CHW

Olsobip 6,405 Bolivip 1 x NO2 x CHW

Middle and South Fly Health Centres

Associated Aid Posts

Bosset 13,890 1 x NO4 x CHW

Kuem 1 x CHWMipan 1 x NO

2 x CHWIbuwo NABamio (Lower Bamu) 1 X NO

2 x CHWBimaramio CHP 2 x CHW

Hope Centre Daru- HIV/AIDS Integrated urban Clinic

71,702 1 x NO1 x Counsellor

From August 2011 until Nov 2013, ADI and DDK delivered a Capacity Building Project in North Fly with the appointment of ADI’s Health Management Advisor, Leona Cayzer. While the major development goal of this project is “Healthier communities through access to a more efficient and effective DDK primary health care service”, it meets Seven of the Eight Key Result Areas identified in the Western Province Provincial Health Department’s 5 year plan to:

1. Improve Service Delivery2. Strengthen partnerships3. Strengthen Health Systems4. Improve Child survival5. Improve maternal health6. Communicable disease control in communities7. Healthy lifestyles8. Disease outbreak preparedness

North Fly Health Services Development Program


In 2009, OTML with JTA International (now JTA/Abt) launched the North Fly Health Services Development Program (NFHSDP) - a K20 million program aimed at developing sustainable health services in the North Fly District. The intention is to develop health services in line with PNG Minimum Standards for District Health Services, and provide and promote quality preventative and curative health programs aimed at meeting the health needs of the people. The stakeholders include OTML, Ok Tedi Development Foundation, National Department of Health, North Fly District Health, Provincial Health, Evangelical Church of PNG (ECPNG), Montfort Catholic Health Services (CHS), Local Government and JTA/Abt.

The program has been very successful and now has extended to include the CMCA Middle and South Fly Health Program (CMSFHP). The CMCA regions are only related to the Fly River communities affected by the environmental damage created by the pollution of the OK Tedi and Fly Rivers by mine operations.

The NFHSDP Implementation Coordination Committee (ICC) meets on the third Tuesday of each month. Meetings are held in either Kiunga or Rumginae and are attended by representatives from all the partners and ADI. Minutes of the previous meeting and the current agenda are usually sent out in the week preceding the ICC meetings.

In addition, five Program Activity Groups (PAGs) have been formed to deal with specific issues, including Medical Supplies/logistics/Infrastructure, TB/HIV/AIDs/STI, maternal and child health and safe motherhood, education and malaria/vector control. More information can be found in the North Fly Health Service Development Program folder on the ADI house computer.

Partner Role Relationship Status

Horizon Oil Provides logistics support for day trip patrols to Government Health facilities in the

Donor

MOU and Project Agreement Signed

Catholic Health Service (part of DKD)

Planning, management and delivery of all outreach activities to CHS facilities

Logistics including transport, vehicles, boats, fuel, food and accommodation for patrols

Coordination and communication of in-service training for all CHS staff

Implementing partner

MOU signed and Project Agreement signed

North Fly Health Services Development program – Managed by JTA/Abt

Provides technical expertise, health facility reporting, status, mobile clinic and outreach patrols and in-service to health centres and aidposts in the North Fly

ADI is a member of the combined health stakeholders group that meets quarterly in Kiunga.

All ADI/CHS patrols and activities should be communicated to NFHSDP to ensure coordination of outreach activities

CMCA Middle and South Fly Health Program (CMSFHP)- Managed by JTA/Abt

Provides technical expertise, health facility reporting, status, mobile clinic and outreach patrols and in-service to health centres and aidposts in the Central, Middle and South Fly regions

All ADI/CHS patrols and activities should be communicated to (CMSFHP) to ensure coordination of outreach activities

Kiunga – North Fly District Hospital

District Hospital for North Fly – referral hospital for ADI Drs on patrol


Anne Lanham, Western Province Program Co-ordinator at the time, went to the Montfort Catholic Mission in April, 2012 to undertake an early review of the project. She had a series of meetings with the Bishop of Kiunga-Daru, Bishop Gilles Cote, Diocesan Health Manager, Sr Anna Sangiwara, Clinical Supervisor, Cathy Yaki and ADI Health Management Advisor, Leona Cayzer. At that stage she was able to discuss the possibility of further funding being available to expand an existing Capacity Building Project through funding from Horizon Oil. Supporting the health workers in the health centres and health posts was seen as a priority, as well as providing a variety of training options for staff and employment of a project worker to put into effect a robust and detailed stock control and distribution system to manage drugs, vaccines and medical equipment for the Catholic Health System.

Essential Element Requirement for North Fly1 Effective interventions for the main causes of

morbidity and mortality (clinical, public health, health promotion for malaria, tuberculosis, HIV and AIDS and Sexually Transmitted Infections (STIs) and maternal and child health).

Interventions as described in PNG Minimum Standards for Rural Health Services1 delivered throughoutNorth Fly

2 Skilled health workers able to diagnose and treat main causes of morbidity and mortality

Development of a workforce capable of delivering essential interventions. Workforce may included Village Health Volunteers in hard to reach areas, and will require upgrading of a range of clinical skills in existing staff

3 Essential logistical elements to enable the health worker to provide the effective intervention

Ensure that all health facilities have drugs, equipment, clean water, light source, transport for referral and outreach clinics and communications in accordance with the minimum standards

4 Compliance of the patient and communities to the intervention (clinical, public health, health promotion)

Health promotion and education for communities

5 Coverage of the population Regular maternal and child health outreach patrols

3.0 PROJECT DESIGN

This project has been designed based on the following ADI organisational objectives:

Objective 1: Deliver and strengthen primary health care services in rural and remote communitiesObjective 3: Increase the capacity of health workers to manage and deliver primary health services

through training and educationObjective 4: Improve access to primary health care services by rural and remote communitiesObjective 7: Advocate for improvements in the health system in our areas of operation

The Objective of this project is: Improved health services provided by 8 Health Centres and 14 Health Posts in the North and Middle Fly District of Western Province. The three components of this project (see the three outcomes below) were designed following specific consultation with CHS, and in collaboration with another longer-term capacity building project being implemented through ADI with CHS.

3.1 Theory of Change

Management Hypothesis Intervention Hypothesis Development Hypothesis(Implementation Team) (Boundary Partners or (Wider Community or

Primary Beneficiaries) Secondary Beneficiaries)


patrick mccloskey, 20/07/16,

This needs to be agreed and a workshop needs to be conducted

3.2 Sustainable Development Goals (SDGs)

This project is targeting six Sustainable Development Goals:

1. No Poverty: ADI programs improves access to basic services and promotes healthier populations3. Good health and well being: improving access to health services, capacity building of health workers

and health education/promotion to communities4. Quality education: improved capacity building of rural health staff through case and group based

training on patrol and mixed clinical in-service training5. Gender equality: prioritization of Maternal health on patrols6. Clean water and sanitation: Infrastructure reporting on patrols and hygiene, sanitation and infection

control education through in-service and health promotions in communities, schools and villages

3.3 Outcomes:

ObjectiveHealthier communities in Western province supported by Catholic Health Services

Outcome 1Provide a patrol program that outreaches to 8 health centers and 14 aidposts and associated villages to provide supervisory support to rural health workers, providing a range of primary care treatment and training

Outcome 2Capacity build with Catholic Health Centre management to create an integrated supervisory schedule and systems for follow up support to rural health workers

Outcome 1Rural health staff well trained in management and clinical skills operating 8 Health Centres in North Fly District through quarterly training and collaboration events

Outcome 3Build the clinical capacity of health workers at health centre level through outreach on-site in-service and case based training so they can better manage in the absence of a doctor.

3.1 Planned Outputs & Activities

Outputs

Output 1.1 12 training and collaboration sessions planned and implemented by the Catholic Health Office staff and the ADI HMA, based on OIC input into most important areas for training.A commitment of $32,000 for the transport, accommodation and expenses of the Officers in Charge (OIC)s of the 8 health centres quarterly (4 x $8,000) to attend meetings and workshops in Kiunga to directly improve the operation of the health centres. OIC quarterly meetings are more than just in-service opportunities, the OIC from each health centre is part of the overall CHS management structure, so the quarterly meetings are essentially meetings of the CHS management team and discuss policy and organisational issues, as well as provide opportunity for clinical training.


16 patrols (one to each of 8 Catholic Health centres and 14 aidposts in Western province) providing in-service training and supervisory visits to 60 rural health workers

Increased access to health services, and better capacity of 60 rural health workers may contribute to improved health for 90,000 people supported by Catholic health centres in Western Province

8 health centres and 14 aid posts receiving integrated patrols over 12 months can deliver sufficient clinical services and capacity building training to rural health centres and health workers in Western Province

Output 2.1 A 48 month placement of a Health Services Support Officer (HSSO) to establish stock control systemsPayment for a Project position for a Support Worker/Logistician (approx. $16,000 plus on-costs) to work at the Catholic Health Services to develop a stock control and delivery system for the drugs, vaccines and medical equipment stored at the health office for distribution to the health centres. Salary as per other positions at the MCM would be 34,183 Kina p.a. Possibly 2 year project position.

Output 3.1 Minimum of 5 Education Specialist placements with CHS during the three years of the projectCommencing in 2013, provide funding for doctors with certain specialties ( $7,000 approx per assignment) to go to Kiunga for 4 -6 week period to undertake in-service training and on-the- job emergency obstetric care training at health centres to assess and enhance health worker practices. Other specialty areas such as Infectious Disease Management and Paediatrics may follow. The services of an obstetric specialist was particularly requested by our partners in view of the high number of delivery complications experienced in remote health centres. They want their operational practices to be observed and improved in an active work environment.


3.2 Project Log-Frame

Horizon Oil Enhanced Capacity Building Project Logframe

Objective Indicators Means of Verification including Monitoring and Evaluation

Assumptions

Improved health services provided by 9 Health Centres and 14 Health Posts in the North Fly District of Western Province

Number of improvements in effective operations, health service delivery, and staff satisfaction following clinical, administrative and managerial capacity-building of Officers in Charge (OIC) from 9 Health Centres (8 CHO and 1 govt)

Reports from health workers and community members in the form of satisfaction surveys (oral and written)

Formal evaluation after 12-18 months Heath Centre statistics

Improved knowledge of OIC and better working environment in Health Centres and Health Posts will lead to better health outcomes and increased staff commitment

Current staff will remain serving as OIC during project if accommodation and living conditions improved as promised by DKD.

Outcome 1OICs well trained in management and clinical skills operating 8 Health Centres in North Fly District through quarterly training and collaboration events

% of Health Centre staff and clinic users reporting greater satisfaction with clinic operation and services

Increased collaboration by Catholic Health Office with stakeholders within and without the Catholic Health System

Overall observable increase in clinical capacity in 14 Health Posts

Baseline on existing OIC knowledge and capacity Feedback from users on Health Centre operations Feedback from Health Centre staff Status of relationship with district and provincial health

authorities, hospitals, and North Fly Health Service Development Program

Time-based clinical observation report

Health Centres OICs have sufficient staff to enable OICs to attend quarterly meetings.

Health workers will put learning into practice.


Outputs1.1 12 training and

collaboration sessions planned and implemented by the Catholic Health Office staff and the ADI HMA, based on OIC input into most important areas for training.

Number of training and collaboration sessions implemented

Number of Health Centre teams (8 Catholic Health Office and 1 govt) operating effectively, and providing accurate monthly reports and statistics

Number of new management systems or ideas (5) OICs have established in clinic operation

% of OICs (50%) who demonstrate improved clinical and management skills

Reports provided by Catholic Health office to Catholic Health Board and ADI after each quarterly session

Reports provided to PNGSDP and Horizon Oil by ADI OIC records of rosters and daily staff attendance for

work Health Centre statistics, and detailed user data Formal evaluation Documentation of collaboration by CHO with other

Catholic Health Services (eg. HIV, Disability, Village Health Workers, etc)

Outcome 28 Health Centres and 14 Health Posts in the Catholic Primary Health system equipped with needed equipment and able to provide necessary drugs and vaccines

Number of Health Centres (8) and Health Posts (14) receiving monthly delivery of drugs and equipment from CHO to meet treatment needs of patients

Health Centre feedback on new systems for provision of drugs, vaccines and medical equipment from CHO

CHO feedback on new systems for provision of drugs, vaccines and medical equipment to Health Centres

CHO will work with HSSO to ensure that stock control system is designed collaboratively, with the goal of handing over stock control system to CHO at end of the project.

CHO has the physical capacity to deliver drugs and equipment in a timely manner.

Outputs2.1 A 48 month placement of

a Health Services Support Officer (HSSO) to establish stock control systems

Number of successful monthly deliveries to Health Centres and Health Posts during project

Number of completed stocktake and inventory reports provided during project

Documentation of Stock Control System, and quality assurance reporting

Monthly reports from HSSO Documentation of monthly orders and deliveries to

Health Centres Observation of condition of CHO storage areas and

Health Centre storage

Funding for HSSO able to be provided by DKD at the conclusion of the 48 months

PDD – Western Province Rural Patrol Project: Page 1 of 22

Outcome 3Clinical skills, practices and training of the health workers in North Fly District of Western Province improved in obstetrics, TB and paediatrics through Education Specialists providing teaching and training to health centre staff

20% increase on the level of confidence of staff of 9 Health Centres and 14 Health Posts

9 OICs (8 CHO and 1 govt) demonstrate improved knowledge

Baseline on existing Health Centre and Health Post response times, treatment capacity, and staff confidence

Satisfaction surveys (oral and written) from health services users

Formal evaluation after 12-18 months Feedback from OICs following training Feedback from DHM and ADI HMA on improvements in

clinical practice

Health workers will put learning into practice.SMOs able to work within cultural environment to provide contextualised and appropriate training and support for health worker personnel

Outputs3.1 Minimum of 5 Education

Specialist placements with CHS during the three years of the project

Number of Health Centres and Health Posts visited during placement

Number and type of presentations to OIC meetings

Number and type of formal training sessions conducted

Number of type informal training sessions conducted

Reports from Education Specialist on Health Centre and Health Post operations

Reports from Education Specialist on formal and informal training conducted

Placement summary report from Education Specialist Feedback from CHO staff, ADI HMA, and other health

workers involved in hospital and health centre visits by Education Specialist

Appropriate individuals able to be found to serve as Education Specialist with expertise in Obstetrics, TB or paediatrics.

Activities Performance outcomes Resources Responsible Timing 2013-14

Volunteer Administration Provide ongoing logistical support to WP Health Management

Advisor Source and orient Education Specialists For expatriate Education Specialists, organise and fund all

medical registration, work permit and visa requirements with PNG government

Provide ongoing logistical support to Education Specialists Design and produce reporting formats for Education

Specialists

Suitable person serving as HMA and has adequate living conditions and logistical support.

Suitable Education Specialists are selected as volunteers and have adequate living conditions and logistical support.

ADI staff timeCommunications costs (phone, internet, etc)

Program ManagerMarcel DieboldHMA

HMA in place until Dec 2013

Output 1.1 Organisational development Meeting venue HMA CompletedPDD – Western Province Rural Patrol Project: Page 2 of 22

Ensure dates set and venue booked for 2013 meetings and agendas prepared

Planning of OIC agenda based on skills checklist of health workers, and clinical and management training priorities identified by CHS senior staff

Nominate and secure Education Specialists to present at OIC meetings on specific agenda items

Conduct pre- and post- meeting surveys with participants Reports from each meeting/workshop will be produced that

include minutes of meetings, details of in-service training and results of surveys

of CHS conducted so that there is demonstrated capacity of CHS senior staff

Accommodation and mealsTransport costsStationery, specific training materialsFinancial resources from Horizon Oil LidHuman resources from Diocese of Kiunga-DaruHuman resources from Australian Doctors International

Clinical SupervisorsDiocesan Health Manager

Output 2.1 Recruit and hire HSSO Construction or organisation of storage area Design of stock control system Approval of stock control system by CHS Implementation of stock control system HSSO provides monthly activity reports to CHS HMP includes reports from HSSO in quarterly progress reports

and photos Get OIC feedback each six months on the stock management

system via questionnaires

Stock is provided to Health Centres in an efficient way to meet treatment needs

Fuel for boat or vehicleSalary for HSSOFinancial resources from Horizon Oil LidHuman resources from Diocese of Kiunga-DaruHuman resources from Australian Doctors International

HMAHSSO

Aug – Oct 2013

Output 3.1 Identify Education Specialists* to enhance the delivery of the

CHS training strategy, and write Terms of Reference for Education Specialist roles (templates provided by Program Manager)

Source Education Specialists – either from within PNG or expatriates (work with CHS Clinical Supervisor and ADI Program Manager)

SMO are selected that are best able to implement participatory, active learning for health workers that is in-line with skills that the health workers need, and complimentary to CHS overall clinical staff training program

Allowances, accommodation, etc for SMOFuel for boat/vehicle for SMOFinancial resources from Horizon Oil Lid

HMAClinical SupervisorsDiocesan Health ManagerProgram Manager

Aug – Nov 20132014


Oversee logistics of arranging in-service programs Conduct pre- and post- in-service surveys (based on New

Ireland in-service templates or other relevant templates) to capture feedback and lessons from the training to improve future CHW/NO training

* NOTE: Education Specialist can be a doctor, a nurse educator, a health management specialist, PNG expert – whatever is considered to be most effective

Human resources from Diocese of Kiunga-DaruHuman resources from Australian Doctors International

Monitoring & Evaluation1. Use earliest Supervisory Checklists completed for each HC by

CHS as baseline2. Use Skills Checklist completed for each health centre worker

as baseline (completed in mid-2013)3. HMA provide informal monthly interim report to Program

Manager (based on QPR template)4. HMA and Program Manager prepare formal quarterly report

based on QPR template5. Program Manager distributes quarterly reports6. Monitoring site visits by ADI7. Final evaluation conducted – field-based interviews, focus

groups, and comparison of most recent Supervisory Checklists in 2014 with earliest Supervisory Checklists available

Monitoring and evaluation activities are completed and demonstrate the performance of the project against the impact articulated in the logframe.

TimeADI travel costsStaff salaries

HMAProgram ManagerExternal Evaluator?

QPR:30 Sep 201331 Dec 201331 Mar 201430 June 2014

Monitoring VisitsAnnually (min)

Evaluation2014


3.3 Map of Project Location(s)

3.4 Activity Plan

See the Activity Plan for this project by double-clicking on the icon below:

4.0 CROSS-CUTTING ISSUES – SOCIAL INCLUSION

4.1 Gender And Development (GAD)ADI will seek to ensure that women and girls are not discriminated against and have equal access to the resources provided by ADI such as healthcare and health education. It will promote activities especially targeting women and girls to address their special needs. ADI is committed to educating staff and others on gender equity, and ensures that proposed activities are assessed for their impact on gender equity through its project pre-appraisal process.

ADI monitors gender equity through its monitoring and evaluation processes, including program reporting and visits. ADI programs will include consultation with all stakeholders and ensure that women and men participate in all stages of the project cycle. ADI will adopt the strategy of gender mainstreaming in the design of its programs from planning to implementation and evaluation. This is seen as a means of attaining gender equality. Where possible, ADI will collect disaggregated gender data in order to target programs more effectively. ADI will challenge all types of violence, including violence against women and girls. ADI will report and record all incidences of serious family violence

4.2 Environment & Climate Change

ADI’s environmental management activities are based on the principle of continuous improvement. Where environmental impacts cannot be avoided, ADI will make every effort to mitigate them.

Implementation of ADI Environment Policy ADI will comply with local laws and regulations ADI ensures that proposed activities are assessed for their impact on the environment through its

project pre-appraisal process. ADI monitors environmental impact through its monitoring and evaluation processes, including

program reporting and visits ADI is committed to reducing or offsetting greenhouse gas emissions ADI is committed to implementing waste minimisation initiatives throughout all activities of the

organisation ADI is committed to developing a sustainable procurement policy ADI promotes efficient transport solutions for all travel by staff and volunteers ADI follows the AusAID Environmental Risk self-assessment in assessing the potential environmental

impact of its activities If ADI undertakes any infrastructure projects that could have an impact on the natural environment,

ADI will contract appropriate experts to undertake studies and advise ADI personnel on appropriate action, including Environmental Impact Studies.

Based on the AusADI Environmental Risk self-assessment, this project is considered likely to cause minimal to no negative environmental or associated social impact.

4.3 Family PlanningFamily Planning saves lives. Early pregnancies and frequent pregnancies are associated with higher mortality rates. Both men and women need access to information and appropriate reproductive health services throughout their lives. Such information and services should be gender sensitive and allow all individuals to make informed choices about sexuality and reproduction, and to have a safe and satisfying sexual life, free of


violence and coercion. Reproductive and sexual health is a societal issue — not only the responsibility of the health sector. Therefore:

ADI builds partnerships with other public and private sectors, as well as with civil society. ADI and its partners include reproductive health and family planning information in their regular in-

service training programs. ADI staff support the PNG National Health Plan in the provision of a broad range of services including

counselling and information about sexuality, pregnancy and childbirth, contraception, abortion, infertility, reproductive tract infections and sexually transmitted diseases.

4.4 Child ProtectionADI recognises that there are a number of potential risks to children in the delivery of our programs to the vulnerable and disadvantaged. In recognising these risks, ADI proactively assesses and manages these risks to children in our programs (and in the communities where we work) to reduce the risk of harm. This is achieved by undertaking a risk management assessment for every ADI program with emphasis on the potential impact on children. Programs that involve direct work with children (e.g. health checks and education programs at schools) are considered a higher risk and will receive particular attention.

ADI employs a child abuse incident reporting sheet to document incidents that have raised concerns for staff. Incident reporting forms part of staff training, and incident reports are reviewed and addressed directly by child protection officers (CPOs), the general manager or president of the Board. ADI will at all times portray children in a respectful, appropriate and consensual way. Our guidelines on the use of children’s images are in line with the current ACFID Code of Conduct - specifically C.1.3 Portrayal of local people. ADI is committed to child safe recruitment, selection, screening, training, ongoing support and reporting practices. These practices aim to recruit the safest and most suitable people to work in our programs.

4.5 Other HIV and AIDS

PNG is a country with an HIV and AIDS infection level considered to be at epidemic levels. In response to this reality, ADI personnel will:

Ensure that appropriate hygiene and safety practices are carried out in ADI programs. Provide accurate information on the aetiology, transmission and impact of HIV in formal and informal

settings, with the aim of increasing awareness to specific target groups or the general population Provide accurate information on Mother to Child transmission of HIV, and support best practice as

advocated by National AIDS Program Promote testing to individuals or groups identified as an HIV risk category Promote healthy lifestyle options including prevention education, health maintenance, reduction of

violence against women, regular use of condoms, or being faithful to one partner Support approved government and non-government programs that aim to reduce the spread of HIV Support people living with HIV and their families to access regular services and programs Strive to ensure the right of continued access of all peoples, regardless of actual or imputed HIV or

AIDS status, to a high quality and comprehensive medical treatment Establish appropriate practices to prevent discrimination against patients and staff on the grounds of

actual or imputed AIDS or HIV infection.

Disability Disability and impairment in Asia and the Pacific are expected to increase over the coming decades as a result of population growth, ageing, lifestyle diseases (for example, diabetes), conflict, malnutrition, traffic accidents, injuries, HIV, and medical advances that preserve and prolong life. People living disabilities needs to be able to improve the quality of their lives by having access to the same opportunities for participation, contribution, decision making, and social and economic well-being as others. ADI supports the guiding principles listed in Towards a disability-inclusive Australian aid program 2009–2014:

1. Promote and enable active participation and contributions by people with disability. PDD – Western Province Rural Patrol Project: Page 1 of 22

2. Recognise and respect that people with disability hold the same rights as others.3. Respect and understand that the lived experiences and perspectives of people with disability are

diverse, and effective approaches for improving outcomes will vary in different contexts. 4. Inequality and multiple forms of discrimination may be experienced by men and women, girls and

boys who are people with disability, family members and carers.5. Children with disability face major barriers to enjoying the same rights and freedoms as their peers

and may often face greater risks of abuse. 6. The combined commitment, influence and experience of Disabled People’s Organisations,

government, civil society, faith-based and Non-Government Organisations, education and training institutions and the private sector will ensure effective development inclusive of people with disability.

5.0 SUSTAINABILITY & EXIT STRATEGY

The health sector in PNG faces several problems, including high infant and maternal mortality rates, infectious diseases (including tuberculosis and HIV), and acute shortage of resources such as essential drugs. The challenges associated with poor physical access and infrastructure make service delivery expensive and out-of-reach to many citizens, especially rural populations. These problems are compounded by a decentralized and fragmented health care system that has led to a lack of coordination and oversight of responsibilities between national and provincial/district government agencies, hospitals, and health clinics. The management of hospitals, pharmaceutical purchases, and oversight is the responsibility of the national government.

Institutional SustainabilityInstitutional Sustainability is high for this project, as CHS has been operating for many years and all ADI personnel are embedded into the CHS clinical team. CHS arranges all the logistics for health centre patrols, and CHS manages the operation of the drug warehouse. This project has been designed to extend (enhance) a four-year senior management capacity building and mentoring project that was commenced in 2011. The activities in the project were specifically identified during consultations with CHS senior staff as part of monitoring for the other capacity-building project.

Financial SustainabilityFinancial sustainability has been built into the project design, with CHS contributing some of the project costs. There is still a dependency on the Horizon Oil contribution for travel costs to OIC meetings, but CHS has built the OIC meetings into their annual plans and will budget for them in the future.

Exit StrategyThis project has three distinct outcomes. Therefore there has to be three exit strategies. For Outcome 1 the exit strategy depends on the ability of CHS to continue the quarterly OIC management meetings following the conclusion of the Horizon Oil support. The OIC quarterly meetings are more than just inservice opportunities, the OIC from each health centre is part of the overall CHS management structure, so the quarterly meetings are essentially meetings of the CHS management team and discuss policy and organisational issues, as well as provide opportunity for clinical training. Therefore CHS has committed to bringing together the OIC regularly in order to follow its newly established management structure. Outcome 2 is designed to support the construction of a new drugs and equipment warehouse for CHS. This will be funded from other sources, with construction expected to be completed by the end of 2012. The salary for the HSSO will enable this new infrastructure to be able to be used quickly. The exit strategy is for CHS to secure funding for the HSSO from its own budget of Churches Medical Council before the end of the project. Outcome 3 relates to the placement of volunteer doctors to go on patrol with CHS clinical staff. This outcome is difficult in terms of exit strategy, as it is unlikely in the near future that CHS will have its own doctor. Donors such as PNG Sustainable Development Program and North Fly Development Service are working on strategies to place more government doctors into Western Province, which will hopefully improve clinical services overall in the long term. In the shorter term, ADI volunteer doctors focus on a “treat and train” approach, and work with CHS senior staff in providing targeted clinical capacity building and skills training to the health centre staff through tracking training done over consecutive patrols.


6.0 RISK MANAGEMENT Risk Domain Risk Event Mitigation Strategy

Social Fall in ongoing commitment and capacity of CHS

ADI maintains close consultation with all key stakeholders, especially at the higher level. Collaboration is strengthened through signing of MOU and Project Agreements, and in the sharing of reports. ADI will maintain open and positive communication with CHS and DKD for all aspects of the project, and secure regular feedback for joint improvement in implementation

Technological Technological risks are low for this project

ADI committed to not introducing any new clinical equipment or process that doesn’t’ have a supply line already established by CHS

Economic Failure of CHS/DKD to make their agreed financial and in-kind contributions

CHS unable to continue salary for HSSO after project closes

CHS unable to continue to bring OIC together for quarterly meetings after project closes

ADI has formalised the financial contribution through MOU and Project Agreement. This commitment will be used in advocacy with CHS and DKD concerning payment of the financial and in-kind contributions.

CHS plans to secure ongoing funding for the HSSO from the Churches Medical Council

CHS has integrated the OIC meetings into its annual plans, and will put aside funds for these meetings after the project ends

Ecological Ecological risks are low for this project

Political Political risks are low for this project ADI was invited into Western Province by DKD in 2002, and has a long-term positive relationship with DKD.

.

7.0 MONITORING & EVALUATIOIN

Written reports will be provided every six months to Horizon Oil. A Monitoring and Evaluation plan has been written for this project. Read the M&E plan by double-clicking on the embedded icon below:

8.0 PROJECT MANAGEMENT AND COORDINATION

8.1 Role of ADI and DKD

In relation to ADI Programs in WP, ADI will fund:(a) The cost of deployment of personnel from Australia, including travel expenses between their

home base and Kiunga, living allowance and work permits;(b) Accommodation and food for Sydney office volunteers;(c) All fuel and maintenance for ADI motor vehicles; and


(d) Computers, printers, internet access, telephone / facsimile, mobile phones, stationery and consumables.

(e) Cost of transport and accommodation for OIC to quarterly meetings(f) Monthly salary of HSSO

ADI will reimburse agreed costs referred to in (b), (c), (d), (e) and (F) by deposit to the DKD current account.

DKD will provide for the purposes of ADI Programs:

(a) Accommodation at the DKD headquarters for ADI health personnel (and their partners, if applicable) engaged in those Programs;

(b) All food for such personnel;(c) Adequate security for such personnel;(d) Advice and assistance to such personnel to manage any unforeseen accident or incident; (e) By email to ADI’s office in Sydney at the end of each month, to comply with regulatory

accounting requirements applicable to ADI (including AusAID regulatory requirements), an update on the current ADI account entries in DKD’s books, together with scanned copies of all third party invoices paid by DKD on ADI’s behalf during that month.

(f) Logistics for transport and accommodation for OIC to quarterly meetings

Each Party will provide to the other on a timely basis such reports, statistics and relevant Program outcomes as may be agreed from time to time. DKD will provide active support for the Program at the highest level within DKD and facilitate, as far as possible, requests for assistance from ADI. DKD will acknowledge the Australian identity of the Program and ADI’s support for the Program and any support for the Program provided by the Australian Government, where appropriate to do so.

9.0 FINANCE & BUDGET .10Summary & Detailed Project Budget


project design document - adi australian doctors … · web viewthe leading causes of maternal...

Documents