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D R . A M B R O S O L I M E M O R I A L H O S P I TA L

DR. AMBROSOLI M E M O R I A L H O S P I TA L 2016-2022 STRATEGIC PLAN

Dr Ambrosoli Memorial Hospital PO Box 47 Kalongo, Agago District

c 0392177239 m kalongo.ambrosolihospital@gmail.com 2016-2022 S T R AT E G I C P L A N


2016-2022 STRATEGIC PLAN

DR. AMBROSOLI M E M O R I A L H O S P I TA L 2016-2022 STRATEGIC PLAN


I dressed your wounds, and God healed you. Ambroise ParĂŠ, the father of modern surgery


Authors: Filippo Ciantia; Andrea Carlo Lonati; Thomas Odong; Ilaria Polloni. Main Contributors: ▪▪ Strategic Goal 1 Health Care Service Delivery - Working Group: Godfrey Smart Okot (chairperson); Olanza Bosco Akecho; Amal Alice; Alex Ojera Latim; Maurice Okao; Andrew Sebulime. ▪▪ Strategic Goal 2 Institutional Development - Working Group: Filippo Ciantia (chairperson); Teddy Terry Abor; Rose Akidi; Alex Ojera Latim; Alex Obonyo; Emmanuel Otto; Ader Paska; Robinah Akutoo Tokwaro; Geodfrey Watum. ▪▪ Strategic Goal 3 Infrastructure renovation and maintenance - Working Group: Alex Obonyo (chairperson); Polly Akot; Alice Amal; Filippo Ciantia; Olua Josef; Joseph Okema; Godfrey Smart Okot; Etwop Tonny. ▪▪ Strategic Goal 4 Teaching and training services - Working Group: Carmel Abwot (chairperson); Santina Acan; Polly Akot; Paska Lalam; Maurice Okao; Quinto Owot.


2016-2022 STRATEGIC PLAN

Table of contents Table of contents A foreword to the Strategic Plan List of acronyms 1 Introduction 1.1 Dr. Ambrosoli Memorial Hospital 1.2 St. Mary’s Midwifery Training School  1.3 Key facts from Annual Analytical Report 2015-16 1.4 The Mission of Dr. Ambrosoli Memorial Hospital 2 The Journey towards the Strategic Plan 2.1 The SWOT analysis  2.2 The Stakeholders’ Meeting 2.3 The Working Groups 3 The Strategic Plan SG1 Health Care Service Delivery Strategic Objective 1.1 Strategic Objective 1.2 Strategic Objective 1.1: Activities, Tasks and Outputs Strategic Objective 1.2: Activities, Tasks and Outputs Strategic Goal 1: Time-line SG2 Institutional Development Strategic Objective 2.1 Strategic Objective 2.2 Strategic Objective 2.3 Strategic Objective 2.4 Strategic Objective 2.1: Activities, Tasks and Outputs Strategic Objective 2.2: Activities, Tasks and Outputs Strategic Objective 2.3: Activities, Tasks and Outputs

V VII IX 13 16 18 19 21 23 25 28 30 33 41 42 45 46 50 51 55 56 57 58 58 59 59 60

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DR. AMBROSOLI MEMORIAL HOSPITAL Strategic Objective 2.4: Activities, Tasks and Outputs Strategic Goal 2: Time-line SG3 Infrastructure renovation and maintenance Strategic Objective 3.1 Strategic Objective 3.2 Strategic Objective 3.3 Strategic Objective 3.1: Activities, Tasks and Outputs Strategic Objective 3.2: Activities, Tasks and Outputs Strategic Objective 3.3: Activities, Tasks and Outputs Strategic Goal 3: Time-line SG4 Teaching and Training Services Strategic Objective 4.1 Strategic Objective 4.2 Strategic Objective 4.3 Strategic Objective 4.1: Activities, Tasks and Outputs Strategic Objective 4.2: Activities, Tasks and Outputs

60 61 63 65 65 67 68 68 68 69 71 72 73 74 75

75 Strategic Objective 4.3: Activities, Tasks and Outputs 76 Strategic Goal 4: Time-line 77 8 Monitoring & Evaluation 79 9 Concluding remarks 83 References87 List of indicators 89

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A foreword to the Strategic Plan The previous strategic plan of Dr. Ambrosoli Memorial Hospital covered the period 2011–2015. Four key areas were identified: clinical services and Public Health Center (PHC), capacity building, infrastructure and sustainability. Strategic objectives and key activities were listed and guided the decisions of the management of the hospital though emergencies called for different actions. Despite achievements in infrastructure and capacity building of the staff, the provision of quality services still needs special attention. Dr. Ambrosoli Memorial Hospital is the only hospital in Agago District heading the Agago Health Sub-District. It serves as general hospital receiving patients from Agago and adjourning districts. The analysis that has been performed shows strengths, weaknesses, opportunities and threats (SWOT) of the hospital. It is clear that the hospital is a well-established institution that has been in existence for decades, serving poor and vulnerable people even in difficult circumstances. At the same time the hospital is faced with major challenges: a shift in donors’ priorities over the past years, especially concerning the support of recurrent expenditures. The lack of maintenance and proper updates, high staff turnover and dwindling motivation call for urgent actions. Considering all the above, the strategic plan acknowledges four goals: ■■ Health (including primary) care service delivery adapted to changing environment and quality demands ■■ Institutional development ■■ Infrastructure renovation and maintenance ■■ Teaching and Training Services upgraded and broaden The goals have different objectives to guide actions. In order to ensure successful implementation of the plan, key activities are yet to be identified under each strategy

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DR. AMBROSOLI MEMORIAL HOSPITAL by the end of FY 2016/17. This strategic plan has been developed to align Dr. Ambrosoli Memorial Hospital vision and to set common goals across the institution, bringing together health services delivery, institutional and human resources development, renovation and maintenance of infrastructures and upgrade of St. Mary’s Midwifery Training School. The hospital is currently faced with the challenge of fully recovering its role of general hospital, addressing new emerging needs and securing the continuation of its long established tradition of training midwives and intern doctors. These tasks are becoming more and more challenging due to lack of medical doctors, specialists and qualified health workers, institutional and organizational weaknesses and financial constraints which may undermine the sustainability of the institution in the short-medium term. The purpose of this plan is to communicate the hospital’s strategic vision and ambition for the next six years. This version of the strategic plan is a framework that enables the hospital Board of Governors and Management to take decisions guiding the preparation of annual work plans and budgets as well as monitor progresses over time. The preparations involved extensive consultations among hospital staffs at all levels. The information received during monthly management meetings, BoG meetings and consultations with the hospital’s stakeholders nationally and internationally helped to understand the strengths, weaknesses, opportunities and threats of Dr. Ambrosoli Memorial Hospital.

Dr Filippo Ciantia Chief Executive Officer

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List of acronyms ACT

Aids Care & Treatment

AIDS

Acquired Immune Deficiency Syndrome

ANC

Ante Natal Care

ART

Anti-Retroviral Therapy

BoG

Boards of Governors

BOQs

Bill of Quantities

C-section

Caesarean Section

CDC

Center for Disease Control and Prevention

CME

Continuing Medical Education

CVDs

Cardiovascular Diseases

DHIS

District Health Information System

DHMT

District Health Management Team

DSDM

Differentiate Service Delivery Mode

ECG

Electro Cardiogram

EID

Early Infant Diagnosis

eMTCT

Elimination of mother-to-child transmission of HIV

ENT

Ear, Nose & Throat

FY

Financial Year

GBV

Gender-Based Violence

GPA

Grade Point Average

HBV

Hepatitis B Virus

HCV

Hepatitis C Virus

HIV

Human Immunodeficiency Virus

HMIS

Health Management Information System

HMT

Hospital Management Team

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DR. AMBROSOLI MEMORIAL HOSPITAL HPV

Human Papilloma Virus

HR

Human Resource

HSD

Health SubDistrict

HSDP

Health Sector Development Plan

ICT

Information and Communications Technology

IPT

Intermediate Preventive Treatment for Malaria

LLUs

Lower Level Units

M&E

Monitoring and Evaluation

MHDs

Mental Health Diseases

MoH

Ministry of Health

MoU

Memorandum of Understanding

MTCT

Mother To Child Transmission of HIV

NCDs

Non-Communicable Chronic Diseases

NCHE

National Council for Higher Education

NGO

Non-Governmental Organization

OPD

Out-patient Department

OVC

Orphans and Vulnerable Children

P4P

Pay for Performance

PAC

Post Abortion Care

PCH

Public Health Centre

PM

Preventive Maintenance

PNFP

Private Not for Profit Health

RTIs

Respiratory Tract Infections

SDG

Sustainable Development Goal

SLIPTA

Stepwise Laboratory (Quality) Improvement Process Towards Accreditation

SLMTA

Strengthening Laboratory Management Toward Accreditation

SMMTS

St. Mary’s Midwifery Training School

SWOT

Strengths, Weaknesses, Opportunities, And Threats (analysis)

TB

Tuberculosis

UCMB

Uganda Catholic Medical Bureau

UMDPC

Uganda Medical and Dental Practitioners Council

UNAIDS

The Joint United Nations Programme on HIV/AIDS

UNEPI

Uganda National Expanded Program on Immunization

VCT

Voluntary Counselling and Testing

WG

Working Group

WHO

World Health Organization

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King Charles IX: “I hope well that you will take care of the king better that the poor men!” Ambroise Paré: “No Sire, it is impossible!” King Charles IX: “And why?” Ambroise Paré: “Because I take care of them as of the kings…”

A dialogue between King Charles IX and Ambroise Parè


DR. AMBROSOLI MEMORIAL HOSPITAL

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2016-2022 STRATEGIC PLAN

1 Introduction Dr. Ambrosoli Memorial Hospital is located in Kalongo Town Council (Oret Parish), within Agago County - Northern Uganda. Agago is the only county of the District which entails the entire District of Agago. It is bordered by 6 Districts: Pader to the West, Kitgum to the North, Kotido and Abim to the East, Otuke and Alebtong to the South. The majority of these neighbouring districts do not have functional hospitals and, therefore, Dr. Ambrosoli Memorial hospital serves also their population for all conditions requiring hospitalization. The landscape is mainly characterized by savannah flat fertile land with gentle slopes becoming hillier and semi-arid towards the border with Abim District in the east. Acholi is the main ethnic group with a minority of Lango ethnic group towards its southern border with Otuke District. Acholi sub-region of Northern Uganda has been affected by a 22 years long insurgency and conflict which have derailed the social and economic growth of the area. The level of literacy in the district population is still quite low and a large proportion of the inhabitants, especially women, do not speak or write English. The spoken language is Acholi, with Lango being the other minority ethnic group in the southern areas of the district bordering Otuke and Aleptong districts. According to National Population and Housing Census 2014, Kalongo Town Council currently has a total estimated population of 11,077, with 87.27% of Agago District’s

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DR. AMBROSOLI MEMORIAL HOSPITAL population (that amounts to 230,908) is living in rural areas and just 12.73% in urban areas with a population density of 65 people per km2. The main economic activity is agriculture focus on subsistence farming in the framework of self-employment adsorbing about 90% of available labour force. The main crops grown in the region are millet, sorghum, maize, beans, ground-nuts, simsim, cassava, and sweet potatoes, produced mainly for local consumption. Other crops include cotton, rice, soya beans and sunflower produced mainly as cash crops, but in limited quantities. Most homesteads in the area rear cattle, goats, sheep, poultry and pigs as additional source of income. There are no industries in the district and commercial activities are very limited.

Figure 1. The Bwola, a typical Acholi dance with ostrich plumes decorations.

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Agago District is one of the poorest areas of the country and a large proportion of the population is living in a condition of poverty. According to the Poverty Status Report – November 2014, 35.2% of the population in the mid North Region where Agago District is located, lives below the national poverty line (less than 1 $ per day) - against a national average poverty rate of 19.7% -, and 41.4 % are insecure, though not poor. Any unexpected event (e.g. bad harvest, sickness or death of one member of the family) can change the status of insecure non-poor people to poor. In fact, global warming has not spared the region: rains are erratic with an adverse effect on the agricultural output and nutritional status and overall well-being. While the monthly consumption per adult equivalent in


2016-2022 STRATEGIC PLAN

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Figure 2. Map of Uganda and Agago district boundaries.

Agago District is between 60,000 UGX and 80,000 UGX, in Kampala is more than 200,000 UGX. The poverty north-south gap in Uganda is still relevant. The District is still lacking a good road network. There are no tarmac roads and most are in poor

maintenance conditions, occasionally disrupting routine field activities (transfer of patients for emergency care, immunisation campaigns, supervision of LLUs, home visiting) and adding extra costs to all transport activities.

INTRODUCTION | 15


DR. AMBROSOLI MEMORIAL HOSPITAL Telephone and internet connections are available but erratic and not fully reliable. Availability of power supply, although not constant and regular, has been nevertheless improving in the last years, at least in the major urban centres. Therefore, in

the hospital electricity is provided 24 hours per day, mainly thanks to general electricity supply, with generators for backup.

Figure 3. Dr. Ambrosoli Memorial Hospital OPD entrance

1.1 Dr. Ambrosoli Memorial Hospital In 1944 the Comboni Missionary Sisters arrived in Kalongo bringing the first organized healthcare and starting a small dispensary in a grass hut. This grass hut rapidly developed into maternity and medical units, and with the arrival of Father Dr. Giuseppe Ambrosoli in 1956 a hospital was established. The Hospital is a Private Not For Profit Health provider, it registers annually with the Medical and

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Dental Practitioners Council and is approved to operate under section 121 (1) of the Public Health Ordinance since the 20th of June 1957. The hospital is member of the network of Catholic health facilities under the coordination of the UCMB (Uganda Catholic Medical Bureau), undergoing annual accreditation process and enjoying support of representation at national level as well as technical and other support.


2016-2022 STRATEGIC PLAN The legal and registered owner of the hospital is the Catholic Diocese of Gulu. Dr. Ambrosoli Memorial Hospital is heading the Agago Health Sub-District which is actually covering the whole district. It serves as general hospital receiving patients from Agago and adjourning districts. The Hospital has gradually gained a high reputation in the fields of maternal and surgical services so that it is also receiving intern doctors for the disciplines of Surgery and Obstetrics & Gynaecology. Dr. Ambrosoli Memorial Hospital is a general rural hospital with 267 bed capacity distributed through 5 wards: Medical, Surgical, TB, Maternity and

Paediatrics (see Table I for details). In the FY 2015-2016 it provided services to 28,883 outpatients and 22,274 inpatients. Out of the 9,719 deliveries in Agago District, 35.7% (3,465) were in the hospital with a total of 315 caesarean sections. A comprehensive HIV/AIDS programme is also run with 2,952 patients involved. Moreover, Dr. Ambrosoli Memorial Hospital is the laboratory hub and head of the Agago Health SubDistrict. In this capacity, it supervises a total of 40 Lower Level Units (LLUs).

Figure 4. Savannah in the area outside Kalongo.

INTRODUCTION | 17


DR. AMBROSOLI MEMORIAL HOSPITAL

1.2 St. Mary’s Midwifery Training School St. Mary’s Midwifery Training School (SMMTS), more commonly known as Kalongo Midwifery School, has a long and storied history. The School was founded by Dr. Giuseppe Ambrosoli in 1959 in order to face and resolve enormous mortality rates in maternity and childbirth. He was guided by the intuition that Africa could be saved by the great capacity of African women, true to the Comboni ideal “Save Africa with Africans”. St. Mary’s Midwifery Training School is acknowledged as one of the best School of Midwifery in Uganda in 2011. So far it qualified a total of 1,053 Certificate Enrolled Midwives, 219 Registered Diploma Midwives, and 40 Enrolled Comprehensive Nurses for a total of 1,312 qualified health personnel. These graduates are working throughout Uganda, focusing on prevention and treatment in mother and child care. St. Mary’s is fully accredited by the Ministry of Education and Sports and Uganda Catholic Medical Bureau (UCMB) and approved by the

National Council for Higher Education (NCHE). St. Mary’s Midwifery Training School, reflecting the mission of Ambrosoli Memorial Hospital, aims to educate highly competent midwifery leaders with a strong sense of moral responsibility and the social values demanded by the challenges of the world today and local communities. The Catholic identity of the school, grounds students in the Joy of Service and develops the Gifts of Caring, Kindness, Compassion and Respect. This provides students not only with excellent learning experiences but the opportunity to develop healthy psychosocial behaviours within traditional culture; all contributing to a rich and diverse experience that prepares students to competently and confidently assume the role of a professional midwife. The faculty prepares professional midwives for evidence-based practice at the basic and advanced levels that reflect the values and standards of the profession.

Figure 5. Sister Carmel Abwot during a lecture in the St. Mary’s Midwifery School (photo credit Jessica Pepper-Peterson Photography).

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2016-2022 STRATEGIC PLAN

1.3 Key facts from Annual Analytical Report 2015-16 In Financial Year 2015-2016 Dr. Ambrosoli Memorial Hospital admitted a total of 22,274 patients with an increase of 74% from FY 20142015 (12,799). This increment is due mainly to the Malaria epidemic affecting Northern Uganda after the suspension of the Indoor Residual Spray campaign. This increase was observed in all the wards: in particular the Medical ward’s admissions increased by 50.4%, the Surgical ward by 4.4%, the Paediatric ward by 186% (it had almost three times the patients of previous year), the Maternity ward by 27.9% and the TB ward by 21.1%. The Out Patient Department (OPD) has expanded the working hours because of the increased attendance (+13.2%, from 25,526 to 28,883). These results allowed the hospital to rank third in the League Table amongst general hospitals (Annual Health Sector Performance Report 2015-16 by MoH). The BoG comprises 14 members and the HMT comprises 6 members; a total of 5 staffs are currently being facilitated for further studies. Income decreased by 4.5% in the hospital, increased by 2.38% in the school and increased by 0.36% in the HSD; expenditure exceeded Income for the first time in five years by UGX 479,871,430/=. In relation to morbidity, in the FY 2015-2016, due to the persistent epidemic, Malaria is the major cause in HSD with 208,384 cases (39.7% of the total), followed by Respiratory Tract Infections (RTIs) also considerably high at 25.4%. The other morbidity causes have a percentage lower than 4.4% (diarrhoeal diseases). 21.4% of deaths recorded were attributable to Malaria, confirming the seriousness of the epidemic. Anaemia follows with 6.1% showing the impact of Malaria and poor nutrition. The lack of blood supply, one of the main

challenges for the whole country and especially for remote areas, determined: several situations of lack of blood for needing patients. Cardiovascular diseases are the 5th cause of death registered, with a growing impact on population: probably, we are facing an epidemiological transition in the district due to the aging of the population and the changing in lifestyle. NCDs, including Diabetes and Chronic Hepatitis B, are most likely grossly under-reported and, therefore, the dimension of their role and impact may be largely underestimated. Obstetrics & Gynaecology Services Antenatal, Delivery & Postnatal care, Prevention of MTCT of HIV, Emergency Obstetric and Neonatal care, General and Specialized Obstetric and Gynaecology Surgery General Surgical Services Trauma and Emergency Care, Surgical Clinic, Minor Orthopaedic services, Burns care, Anaesthesia, General surgical operations Internal Medical Care HIV Care and Treatment, General and private Out-patient (OPD), Clinic Emergency medical care, Electro Cardiogram (ECG), Medical Admissions and care, TB Detection and treatment, Communicable and Non-Communicable Diseases care and prevention Paediatrics & Child Health Young child clinic, Malnutrition, Therapeutic feeding, Neonatal Special Care Unit, Paediatric admissions and care, Immunization and health promotion Community Health Health promotion outreaches, Immunization, Health education, Primary Health Care Health Training Midwifery training, Internship for Medical Doctors and others like Clinical Officers, Pharmacy, Nurses, Midwives and laboratory students (guidance is usually provided by a senior staff in the discipline.) Table I.

Services offered by Dr. Ambrosoli Memorial Hospital

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DR. AMBROSOLI MEMORIAL HOSPITAL

God is love, and I am his servant for the suffering people Father Dr. Giuseppe Ambrosoli

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1.4 The Mission of Dr. Ambrosoli Memorial Hospital Dr. Ambrosoli Memorial Hospital is a private not for profit general hospital and training school serving Agago and neighbouring districts, offering quality care and ensuring access to the poor and vulnerable people. The Hospital embodies the spirit of his founder,

Father Dr. Giuseppe Ambrosoli, and the motto “Serve with love and humility”, which guides the life of the hospital and its staff in the journey to provide health to the people. The mission of Dr. Ambrosoli Memorial Hospital is illustrated below.

Serve with Love and Humility the motto of Dr. Ambrosoli Memorial Hospital

1 2 3 4 5 6 7

The Mission of Kalongo Hospital is based on the imitation of Christ and His deeds, to promote life to the full and to heal. The hospital is committed to a holistic, integrated and sustainable action on health, which includes treatment, prevention, health promotion, and training of health workers. The hospital training programmes will aim at the development of well-trained, responsible professionals with high moral standards. The hospital wants to promote access to health care for the weakest and vulnerable social groups, like women, children, the financially destitute, and the chronically ill. To this purpose the hospital is a non- profit making institution of the Church. Since the person is at the centre of all activities of the hospital, a basic attitude of respect for the human dignity will be the guidance for all actions, regardless of ethnic origin, social status, gender, and religious or political affiliation. Any form of discrimination will be avoided. The principle of subsidiarity will therefore be applied with equity in all relationships within the hospital network. Justice, universality and equality will mark the work of all the officers and staff members of Kalongo Hospital. Their work will be done in a professional way and abiding by the catholic ethical code. Human life being sacred, the basic attitude of all personnel will be the healing of the person with total respect for life.

INTRODUCTION | 21


DR. AMBROSOLI MEMORIAL HOSPITAL

22  |  THE JOURNEY TOWARDS THE STRATEGIC PLAN


2016-2022 STRATEGIC PLAN

2 The Journey towards the Strategic Plan Dr. Ambrosoli Memorial Hospital stands on the shoulders of its founder and leader, Father Dr. Giovanni Ambrosoli. His vision, courage and passion grew this Hospital and its midwifery school into one of most highly respected medical facilities of the country. The hospital is now facing new challenges and difficulties, including a shift in donors’ priorities over the past years, especially concerning the support of recurrent expenditures; an increasing epidemiological transition towards non-communicable and chronic diseases which coexist with communicable diseases; the lack of maintenance and proper updates of facilities and equipment; high staff turnover with dwindling motivation. This struggles call for urgent actions, and therefore we have identified many challenges to be faced in the coming years and outlined the steps to turn those challenges into opportunities - to improve efficiency, to improve economic sustainability and access to health care serving poor and vulnerable people in difficult circumstances. The Dr. Ambrosoli Memorial Hospital Strategic Plan sets the objectives we hope to achieve between now and 2022. The strategic planning process was guided by commitment to innovation and engagement of stakeholders: to achieve these principles, a step-by-step process was designed infusing broad engagement, meaningful dialogue and challenging discussion every step along the way. The process (see Figure 6) started at the beginning of 2016 involved different key figures and stakeholders from the hospital, through extensive consultations among the staffs at all levels, and from the town of Kalongo and the Agago district.

THE JOURNEY TOWARDS THE STRATEGIC PLAN  |  23


DR. AMBROSOLI MEMORIAL HOSPITAL

SETTING UP THE ORGANIZATION’S DIRECTION

FORMULATING THE ORGANIZATION’S BROAD POLICY

ASSESSING THE EXTERNAL AND INTERNAL ENVIRONMENT

IDENTIFYING KEY ISSUES AND DEVELOPING STRATEGIES TO DEAL WITH THEM

PAYING ATTENTION TO THE NEEDS OF THE STAKEHOLDERS

PLANNING, REVIEWING AND ADOPTING PROCEDURES

IMPLEMENTING THE PLAN

MAKING FUNDAMENTAL DECISIONS AND TAKING ACTIONS ACCORDINGLY Figure 6. The step-by-step process of the Strategic Plan

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As part of the development of strategies and plans to enable the hospital to achieve its objectives, we have used a systematic process started with a SWOT analysis (strengths, weaknesses, opportunities, and threats), a structured planning method for the analysis of the hospital and environmental factors. The environmental scanning and the assessment of the present situation led to the identification of four strategic goals. Through a participatory design approach, involving stakeholders (e.g. employees, partners, citizens), the hospital issues have been defined and the new strategies developed. Each of the four Strategic Goals underwent a process of analysis conducted by Working Groups that included staff, experts, and stakeholders, defining their objectives and projecting activities and task for strategy implementation, including planning and indicators for monitoring and evaluation of the process. The process was guided by an expert who defined the strategy, the time-line and the planning tools of the Strategic Goals.


2016-2022 STRATEGIC PLAN

Figure 7. The old Dr. Ambrosoli Memorial Hospital Laboratory (photo credit Jessica Pepper-Peterson Photography)

2.1 The SWOT analysis The SWOT analysis has been an important moment in the journey towards the Strategic Plan, which made to possible to examine Dr. Ambrosoli Memorial Hospital’s strengths and weaknesses, to determine its opportunities for growth and improvement and the threats the external environment present. SWOT analysis is an acronym for strengths, weaknesses, opportunities, and threats and is a structured planning method for the development of strategies and plans to achieve objectives: ■■ Internal factors, the strengths (characteristics that give it an advantage over others) and weaknesses (characteristics that place the project at a disadvantage relative to others) internal to the organization. ■■ External factors, the opportunities (elements in the environment that the project could

exploit to its advantage) and threats (elements in the environment that could cause trouble for the project) presented by the environment external to the organization. This analysis promotes a better understanding of barriers to change, innovation and the transfer of knowledge to practice, improved outcomes and more efficient allocation of health care resources. The SWOT analysis (Table II) shows that the hospital is a well-established institution. It has been in existence for decades, serving the people under often harsh and difficult circumstances and it has been a safe haven for many people seeking cure, care and sometimes just shelter. His storied history and background, and the faithfulness to the mission of the hospital, represent an advantage in the achievement of the objectives of this planning.

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DR. AMBROSOLI MEMORIAL HOSPITAL

S

STRENGTHS

Clear vision, mission and values

W

High dependency on financial subsidies

Historical background

Insufficient number of staff and lack of specialists

International partnership and networking

Lack of capacity building in long period

Well defined organizational structure

Inadequate maintenance of equipment and aged infrastructure

Accredited by MOH and UCMB Heading Agago Health Sub District (HSD) and member of the District Health Management Team (DHMT) Training hospital for midwives and interns Accessible by poor and vulnerable people

Process of participatory management style started Recognized as one of major stakeholders in the UCMB network and MOH Supported by Government & local institution One of most valued Midwifery’s school of Uganda Known and recognized internationally

Lack of structured policies and procedures Lack of staff time discipline Poor internet system and out of date IT infrastructure Limited data elaboration and reconciliation

High dependency on financial subsidies High staff attrition Increased number of non-communicable disease (epidemiological transition) Changes of International Organization and Donor strategies Sustainability rate very low

Recognized Laboratory hub for Pader and Agago District

External environment still underdeveloped (e.g. lack of road, social amenities, poor education system)

Existing staff training and development policy guideline draft

Increase of user fees can have a utilization rebound

O

Table II.

WEAKNESSES

OPPORTUNITIES

SWOT analysis of Dr. Ambrosoli Memorial Hospital

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THREATS

T


2016-2022 STRATEGIC PLAN At the same time, the hospital is faced with major challenges. A shift in donor’s priorities over the past few years, especially where it comes to recurrent expenditure support, is threatening the very low financial sustainability of the hospital. During the last financial years, in fact, the hospital has faced the rising of costs on the one hand, and the likelihood of declining funds from sponsors and donors, both national and international, on the other hand. The environment is also changing: we are facing an epidemiological transition due to the increase number of non-communicable chronic diseases (NCDs), with higher costs in health expenditure for treatments that often are lifetime. The results of this SWOT analysis all call for urgent actions, and therefore were identified four Strategic

Goals, representing ambitious ethical, practical and economic commitments: ■■ Health care service delivery ■■ Institutional development. ■■ Infrastructure renovation and maintenance. ■■ Teaching and Training Services. Each of the four Strategic Goals was consequently structured into several Strategic Objectives that the hospital aims to achieve in the following six years, covering the issues and the concerns highlighted in this analysis and during the needs assessment of Dr. Ambrosoli Memorial Hospital.

Figure 8. The inauguration of the new Dr. Ambrosoli Memorial Hospital Laboratory.

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DR. AMBROSOLI MEMORIAL HOSPITAL

2.2 The Stakeholders’ Meeting The Stakeholders’ Meeting is the assembly of all parties, authorities, organizations, people, institutions, interested in the life and services of Dr. Ambrosoli Memorial Hospital. The meeting took place in November 2016 with the theme “Sustainability of services delivery in Dr. Ambrosoli Memorial Hospital, Kalongo”, and was an opportunity to address the main issues that are concerning the sustainability of the hospital and to present the results of the SWOT analysis, the four Strategic Goals and the Strategic Objectives. The meeting has offered an occasion for accounting to the stakeholders (both programmatically and financially) of what the hospital is for and what it does, to get the true understanding of the situation of the hospital, including its challenges instead of having illusions and misinformation. Participants has been helped to understand in a clear way what the hospital does, the limitations and challenges it faces, while, on the other hand,

1 2 3 4 5

the hospital had the chance to discuss and clarify its expectations from the stakeholders. The dialogue has helped to gradually harmonize expectations (of stakeholders) from the hospital and (of the hospital) from the stakeholders and to forge together a common way forward. The hospital had the chance to get closer to its environment and to understand it better, knowing what other beneficial opportunities exist among the partners and stakeholders. The stakeholders’ meeting helped in understanding and working relationship with the community, the political leadership, the local government, the donors, the NGO’s community (national and international) and with Ministry of Health and other government ministries and departments, gradually reducing the “us and them” separation between the hospital and the community. The rationale of the Stakeholders’ Meeting stems from the purpose and the benefits. PNFP Health Providers (as all public health providers) have the

Ensure commitment of all the hospital employees to the institution’s mission. Diversify the hospital’s funding sources – including widening the donor base. Work towards ensuring retention of staff. Internal communication among the supervisee & supervisor management to be improved. Prudent revision of the new fees policy engaging the community

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2016-2022 STRATEGIC PLAN

Figure 9. Father Dr. Giuseppe Ambrosoli visiting a patient in Kalongo Hospital.

responsibility to account not only to the official owners of the hospital (the Archdiocese of Gulu) and to the Ministry of Health and other authorities, but also to report to the beneficiaries of the hospital, the real owners of the hospital. The participants were also invited to cooperate with the hospital during the Strategic Plan process, and, thanks to a constructive and sincere participation, six main recommendations have emerged (see opposite page). Stakeholders have conceived these recommendations with the ultimate desire to bring the hospital to “fly high as in the times of Father Dr. Ambrosoli”.

The results from the SWOT analysis, the four strategic goals and their strategic objectives, and the recommendations from the Stakeholders’ meeting, turn out to be the most important instruments the hospital and the Working Groups had for the development of the Strategic Plan.

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DR. AMBROSOLI MEMORIAL HOSPITAL

2.3 The Working Groups The final step in the journey towards the strategic plan was the definition of activities and tasks to implement to achieve the Strategic Goals, together with the expected outcomes and outputs and the indicators to monitor the accomplishments and the progress of the realization of the plan. Each of the four Strategic Goals, along with their respective Strategic Objectives, has been assigned to a dedicated Working Group: they were composed by subject experts and stakeholders, both from the hospital and other institutions, who worked together to achieve the definition of each Strategic Objective. The tasks of the Working Groups were: ■■ Making and reviewing the objectives, activities, measures, and tactics identified to implement the plan. ■■ Providing advice on strategic priorities.

■■ Developing strategies for assessing progress of the implementation of the plan. Each group was provided with Planning Tools for: ■■ Activities, outcome and outputs, and indicators definition. ■■ Time-line and milestones delineation. ■■ Monitoring and evaluation. The meetings were facilitated by two consultants from University of Milan, serving the needs of the groups with the purpose of exchanging ideas and information and making decisions on the Strategic Plan. Through a participated process of information sharing, group discussions and debates, considering the materials from the SWOT analysis and the Stakeholders’ meeting, each group arrived at the definition of the activities, outcome and outputs, and indicators using the Planning Tools.

Figure 10. A little patient of Dr. Ambrosoli Memorial Hospital is weighed by a nurse (photo credit Jessica Pepper-Peterson Photography).

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Serve with love and humility Dr. Ambrosoli Memorial Hospital

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Jessica Pepper-Peterson Photography

2016-2022 STRATEGIC PLAN


DR. AMBROSOLI MEMORIAL HOSPITAL

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2016-2022 STRATEGIC PLAN

3 The Strategic Plan Dr. Ambrosoli Memorial Hospital has a long and proud tradition of providing high quality care to the people of Agago district and the surrounding areas. Today, the hospital is one of Uganda’s most highly respected medical units: the last financial year’s results and achievements propelled Dr. Ambrosoli Memorial Hospital to rank third in the League Table amongst general hospitals (Annual Health Sector Performance Report 2015-16 by Uganda Ministry of Health). This Strategic Plan, focused on the period 2016-2022, reflects the need to continue providing high quality and effective care services, playing a vital role in the District, setting out the key goals and objectives for the hospital over the next six years. The plan is ambitious and far-reaching, but it has one simple goal: to bring the power of hope, care and cures to as many people as possible, ensuring access to the most poor and vulnerable. As part of the development of this strategic plan, the hospital undertook an analysis of the strengths, opportunities and challenges, together with a needs assessment trough a participatory approach, involving stakeholders, employee and institutions, both national and international (see Chapter 2 for details). This struggles call for urgent actions, and therefore we have identified many challenges to be faced in the coming years and outlined the steps to turn those challenges into opportunities - to improve efficiency, to improve economic sustainability and to improve access to health care serving poor and vulnerable people even in difficult circumstances.

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DR. AMBROSOLI MEMORIAL HOSPITAL

Figure 11. The entrance of Dr. Ambrosoli Memorial Hospital new Theatre (photo credit Jessica Pepper-Peterson Photography).

We have identified four strategic goals, representing ambitious ethical, practical and economic commitments: 1. Health care service delivery adapted to changing environment and quality demands 2. Institutional development 3. Infrastructure renovation and maintenance 4. Teaching and Training Services upgraded and broaden The four goals integrate different dimensions (economic, social and environmental) around the themes of health, infrastructure, partnership and education remaining deeply interconnected. They seek to prioritize the commitment of serving poor and vulnerable people, even in difficult circumstances, while also focusing on quality, efficiency and efficacy of the delivered services, and

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the empowerment of the staff and their faithfulness to our mission. Health care service delivery. The hospital aims at delivering health services with special preference for the poor and most vulnerable and disadvantaged people. The focus will be to ensure that all patients receive effective and efficient assessment, diagnosis, admission, treatment, discharge and preventative care to achieve the best possible outcomes for the individual. The institution will strive to ensure an evidence based care, developing strategies to provide the best care possible facing new challenges, like epidemiological transition, the increase incidence of NCDs and of viral chronic diseases, meeting the challenges and opportunities of the rapidly changing world of healthcare. Recognizing that value for money is fundamental, the hospital is committed to plan and deliver services in a cost-effective manner


2016-2022 STRATEGIC PLAN with clear accountability to stakeholders. Institutional development. Health workers are the main asset of the hospital and the fundamental resource for service provision. The hospital is committed to offer adequate opportunities for personal and career development. The organization is changing from being predominantly run according to a top – down hierarchy to a participatory management style. As a result, work satisfaction will increase. Procedures and protocols will be developed to attain efficiency and effectiveness. Dr. Ambrosoli Memorial Hospital will move forward and reach goals as a unified organization, with seamless collaboration between and among the hospital, the St. Mary’s Midwifery School, the foundation and the nearby institutions. This spirit of unity and cooperation gave rise to the new

strategic plan that reflects the ideas and opinions of the entire community. Infrastructure renovation and maintenance. The existing infrastructures do not correspond to actual standards for quality and safety. Staff quarters, children, surgical and medical wards need urgent renovations. The solid and liquid waste disposal system is to be expanded to the whole hospital complex. Such infrastructure renovation, maintenance and expansion need an important capital investment. Teaching and Training Services. St. Mary’s Midwifery Training School has been recognised nationally for its standard of professionalism. To maintain this reputation and to upgrade and broaden its courses, the school needs to build a new computer laboratory and to enlarge the existing skill

Figure 12. A moment in the Maternity ward (photo credit Jessica Pepper-Peterson Photography).

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DR. AMBROSOLI MEMORIAL HOSPITAL

SG1

HEALTH CARE SERVICE DELIVERY

1.1

STRATEGIC OBJECTIVE 1.1 To deliver quality health services while being aware of and considering the needs of the less privileged and vulnerable social groups including women, children and the chronically ill.

1.2

STRATEGIC OBJECTIVE 1.2 To create a network with nearby hospitals (e.g. St. Mary’s Hospital Lacor Gulu and St. Joseph’s Hospital Kitgum), providing better and broader care.

SG2 INSTITUTIONAL DEVELOPMENT 2.1

STRATEGIC OBJECTIVE 2.1 To increase Dr. Ambrosoli Memorial Hospital financial sustainability, improving efficiency and providing high quality and cost-effective care.

2.2

STRATEGIC OBJECTIVE 2.2 To sustain capacity building & human resource management through the gradual spread of the principles of participatory management style and a career development path.

2.3

STRATEGIC OBJECTIVE 2.3 To introduce a result based financial administration.

2.4

STRATEGIC OBJECTIVE 2.4 To ensure constant high patient satisfaction

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2016-2022 STRATEGIC PLAN

INFRASTRUCTURE RENOVATION & MAINTENANCE

SG3

STRATEGIC OBJECTIVE 3.1 To develop a maintenance master plan to ensure that the hospital is able to continue delivering services.

3.1

STRATEGIC OBJECTIVE 3.2 To develop a master plan and implement a clear action plan with priorities and milestones.

3.2

STRATEGIC OBJECTIVE 3.3 To ensure funding for additional capital investments.

3.3

TEACHING AND TRAINING SERVICES

SG4

STRATEGIC OBJECTIVE 4.1 To expand the teaching capacity of St. Mary’s Midwifery Training School.

4.1

STRATEGIC OBJECTIVE 4.2 To ameliorate and upgrade the St. Mary’s Midwifery Training School to prepare the School for the Strategic Objective 4.3.

4.2

STRATEGIC OBJECTIVE 4.3 Creation of the Bachelor’s Degree course in Midwifery at St. Mary’s Midwifery Training School.

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DR. AMBROSOLI MEMORIAL HOSPITAL laboratory. The school’s staff needs further training in order to ensure quality teaching to raise the level of the school from Diploma to Midwifery Degree. The four strategic goals are supported by the following four organizational strategic enablers: ■■ Quality: Ensure a culture of continuous quality improvement and risk management ■■ Efficiency: Deliver care and service in a costeffective manner ■■ Human Resources: Ensure recruitment and retention of qualified hospital staff through career and training promotion ■■ Physical Environment: Provide appropriate facilities to deliver care and services and to decently accommodate staff The conditio sine qua non to accomplish the Strategic Plan is represented by the financial sustainability of the hospital. Indeed, to achieve the goals and the

objectives set out in this Strategic Plan, sufficient resources are necessary to carry out the work identified. Now, the hospital’s primary source of income are yet the donors, mainly Dr. Ambrosoli Foundation, Comboni Missionaries and UCMB/ CDC, who represents more than 70% of the income of the hospital. The remaining part of the income is represented by a sure and constant support from the Ministry of Health and the Government of Uganda (13% of the income in the former financial year 2015-16), and from the patients of the hospital (14% in the last financial year). It is necessary to sustain the current levels of support and to identify new sources of funding. The management of the health expenditure, increasing efficiency and costeffectiveness of the care, while identifying new sources of funding (e.g. through the creation of projects, national and international fundraising

Figure 13. Dr. Godfrey Smart Okot in the Surgical Ward (photo credit Jessica Pepper-Peterson Photography).

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2016-2022 STRATEGIC PLAN

Figure 14. The OPD (photo credit Jessica Pepper-Peterson Photography).

activities, merchandising), represent both a challenge and a requirement to achieve financial sustainability. Furthermore, the implementation also calls for a plan with clearly defined monitoring and evaluation systems. It will be essential to continuously monitor and measure the progresses in order to stay on track. The strategic plan is intended to cover a 6 years period, which will be translated into annual plans of

action before the end of every financial year. Thus, the implementation of the plan will be evaluated annually and a midterm review shall be undertaken 3 years after launching, putting in place, if needed, corrective measures or new thinking and action to address new challenges. Goals are clear. Teams are aligned. Thanks for your support, dedication and optimism.

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DR. AMBROSOLI MEMORIAL HOSPITAL

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2016-2022 STRATEGIC PLAN

SG1 Health Care Service Delivery Since his foundation, Dr. Ambrosoli Memorial Hospital provides the people of Agago District and the surrounding areas with high-quality health care services, working with professionalism and dedication to provide the very best care possible with available resources and putting the patients at the centre of its work. A major attention is devoted to the poor and most vulnerable and disadvantaged people, being faithful to our mission and the recommendations from the Ugandan Ministry of Health “Health Sector Development Plan (HSDP) 2015/16 - 2019/20”. The social background and health context in which the hospital is located have changed over the years and continue to transform. Even if the area, devastated by years of war, is still rural and poor and far from the major centres of the country, at the same time it is influenced by socio-demographic changes taking place across Uganda. The Hospital requires care models focusing on the social determinants of health and driven by strong networks between the health and social sectors. The demographic and epidemiological transition (the replacement of infectious diseases by chronic diseases over time due to expanded public health and sanitation) which is under way in most low-income countries, is leading to very significant changes in the pattern of diseases, especially in sub-Saharan Africa. Here, the double burden of diseases (the fact that both infectious diseases and NCDs tend to coexist) is causing a rise in health problems. The hospital is facing this new challenge, dealing with a rise of NCDs (e.g. cardiovascular diseases, diabetes, and hypertension) which coexist with infectious diseases. The future

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DR. AMBROSOLI MEMORIAL HOSPITAL challenges relate to coping with the double burden of diseases, implementing effective measures and upgrading Dr. Ambrosoli Memorial Hospital to contain and manage the rise in NCDs. To identify areas for improvement and implement changes to ensure high-quality service, responding the needs of the people and communities, retaining our loyal donors and attracting new support while maintaining sustainability over time, we have developed two important strategic objectives: ■■ Strategic Objective 1.1: to deliver quality health services while being aware of and considering the needs of the less privileged and vulnerable social groups including women, children and the chronically ill. ■■ Strategic Objective 1.2: to create a network with nearby hospitals (e.g. St. Mary’s Hospital Lacor Gulu and St. Joseph’s Hospital Kitgum), providing better and broader care. Strategic Objective 1.1 is focusing on expanding the package of health services and strengthening the existing, like Surgery, HIV/AIDS care, Maternal, new-born care and nutrition, and the outpatient

department, to increase coverage and utilization, improving quality and efficiency while optimizing resources. Strategic Objective 1.2 aims to lay the foundation for a scientific and practical exchange, as well as future cooperative projects, with Hospitals in the North of Uganda, strengthening the existing cooperation trough the establishment of networks. With this strategic objective, we have the ambition of providing specialist health services (such as dentistry, psychiatry, orthopaedics) that are not financially sustainable for our hospital alone. Dr. Ambrosoli Memorial Hospital must face these challenges and ensure that the Hospital benefits as many individuals as possible through the provision of an adequate, efficient, and effective health care system, balancing the financial and technical implications to the Hospital while being useful for the community. Next paragraphs describe how Dr. Ambrosoli Memorial Hospital aims to achieve Strategic Goal 1 and his objectives, together with a detailed definition of activities, tasks, outcome and indicators, and time-line at the end of the chapter.

Strategic Objective 1.1 To deliver quality health services while being aware of and considering the needs of the less privileged and vulnerable social groups including women, children and the chronically ill. The first Strategic Objective embraces several tasks, covering the different areas of the life of Dr. Ambrosoli Memorial Hospital. Therefore, the activities have been subdivided and grouped under three thematic areas – Medical and Surgical Care, Public Health Interventions, and Services – managed by a project coordinator to simplify

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the implementation of the plan. All the planned activities aim to fulfil standards and requirements of national and international guidelines and recommendations. The Medical and Surgical Care Area includes services and vital for the continuous operation of the health facility such as medical ward, out-patient


2016-2022 STRATEGIC PLAN department and the surgery ward. The following activities from the Medical and Surgical Care Area deserve particular mention: Activity 1.1.2 HIV/AIDS Care. HIV infection is still a major cause of illness in both adults and children requiring expensive interventions such as provision of anti-retro-viral therapy and expensive tests. In our hospital HIV/AIDS services are managed under the umbrella of the ACT Program (Aids Care & Treatment) funded by CDC through the Uganda Episcopal Conference and UCMB. These services were initiated in November 2005 and are substantially integrated into the hospital services. The Programme provides comprehensive HIV/

AIDS care, including Anti Retro-Viral Therapy, Prophylaxis for and Treatment of Opportunistic Infections, Case Management of co-infections (HIV/HBV, HIV/TB), Counselling and Testing, VCT, eMTCT, OVC, GBV related services and a Community Programme. We will continue to re-affirm our commitment in HIV/AIDS care, by consolidating the successes so far achieved, we will continue on the path of early diagnosis and HIV/AIDS patient’s management, improving our services on important themes such as eMTCT, EID and co-infections while reducing incidence, HIV related complications and mortality overtime.

Figure 15. Outside the Maternity ward (photo credit Jessica Pepper-Peterson Photography).

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DR. AMBROSOLI MEMORIAL HOSPITAL Activity 1.1.3 Maternal, new-born care and nutrition Services. Maternal, new-born and child health, including nutrition, are the major focus of the Government of Uganda, as well as being one of the targets of the Millennium Development Goals. Strengthening integration between St. Mary’s Midwifery Training School and Dr. Ambrosoli Memorial Hospital to provide better and more efficient maternal and new-born care services will be a fundamental challenge. Activity 1.1.5 Palliative Care. The World Health Organization (WHO) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”. We are committed in the implementation of a Palliative Care Service and aim for its continual improvement through regular reviews and establishing objectives and targets, in line with the mission of the hospital. The Public Health Interventions Area includes activities of primary prevention and health promotion, aimed to implement evidence-based interventions and to empower communities, people and employees building up health-consciousness and awareness of prevention. Activities on immunizations, family planning and health educations, in line with indications from Ugandan Ministry of Health, will be implemented for this purpose. The following activities are focused on the challenges Dr. Ambrosoli Memorial Hospital will have to face in the next years, such as epidemiological transition and emerging diseases, mental health issues and immunization programs.

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Activity 1.1.7 Emerging diseases (communicable and non-communicable), co-morbidity and epidemiological transition. Uganda’s burden of disease is dominated by communicable diseases, which account for over 50% of morbidity and mortality. Malaria, HIV/AIDS, TB, and respiratory, diarrhoeal and vaccine preventable diseases are still the leading causes of illness and death. Even if communicable diseases still represent the most common causes of admission in Dr. Ambrosoli Memorial Hospital, there is growing concern on non-communicable diseases (NCDs), such as cardiovascular diseases and diabetes, together with chronic viral diseases (e.g. HPV, HBV and HCV) and co-morbidities (e.g. tuberculosis and diabetes, hypertension and diabetes, HIV and tuberculosis…), particularly for the increased lifeexpectancy of HIV people receiving ART. Activity 1.1.11 Mental Health and substance abuse service. The main purpose is to provide high quality, evidence-based, accessible and equitable mental, neurological and substance abuse services, delivered at all levels of care. In this framework, Dr. Ambrosoli Memorial Hospital is committed to cooperate with nearby hospitals to provide an adequate Mental Health Service, improving the management and the therapeutic treatment of the mentally ill patients. The last thematic area is dedicated to the Hospital Services, both medical and technical (e.g. ICT, supply management system), which are essential to the smooth running of the Hospital especially helping to achieve our goals and to provide the best high-quality care. Moreover, the Strategic Objective 1.1 includes fundamental and cross-cutting tasks, such as continuing medical education and continuing professional development, and the revision and distribution of clinical guidelines and pathways.


2016-2022 STRATEGIC PLAN

Figure 16. A patient underwent surgery in the new Theatre (photo credit Jessica Pepper-Peterson Photography).

Strategic Objective 1.2 To create a network with nearby hospitals (e.g. St. Mary’s Hospital Lacor Gulu and St. Joseph’s Hospital Kitgum), providing better and broader care. Dr. Ambrosoli Memorial Hospital’s catchment area includes one of the most socially and economically disadvantaged communities in Uganda. With this Strategic Objective, we aim to create a model of integrated care, working with other hospitals and health-care providers, designing a comprehensive, integrated health-care system that is high-quality, accountable and accessible to the community and covers
the entire continuum of care from primary to specialty care. Strengthening the existing cooperation through the establishment of a network with St. Mary’s Hospital Lacor in

Gulu and St. Joseph’s Hospital in Kitgum, could be a successful strategy for financial and technical sustainability, through cost sharing (arrangement under which costs of a project are shared by the involved hospitals) and services sharing. We are keen to continue the legacy of Father Dr. Giuseppe Ambrosoli, and to play our part in the provision of high-quality healthcare to the people of Kalongo and the surrounding areas: networking and cooperation could be an answer to the financial, structural and recruitment difficulties the hospital is facing.

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DR. AMBROSOLI MEMORIAL HOSPITAL

Strategic Objective 1.1: Activities, Tasks and Outputs ACTIVITIES 1.1.1 In-patients (all wards)

TASKS Improvement in in-patients’ services and admission and discharge Medical education on clinical case management: ▪▪ Clinical audit ▪▪ Rounds and grand rounds ▪▪ Clinician Meeting ▪▪ Continuing Medical Education (CME) Strengthen the use (through improving their accessibility and implementation) of up-to-date clinical pathways and medical guidelines; creation of a booklet for health professionals with clinical pathways

OUTPUTS Outputs: ▪▪ Number of staff trained and re-orientated each year ▪▪ Clinical pathways and medical guidelines Indicators: ▪▪ % of staff trained and re-orientated each year (at least 20-25% per year) ▪▪ Indicators from annual analytical report (e.g. admissions, deaths, deliveries…)

Implement Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and develop a dedicated data management software for in-patient department. 1.1.2 HIV/AIDS Care

Hold HIV testing initiatives and service Provision of ART and treatment of opportunistic infections in HIV+ patients Option for provision of home-based care (DSDM) Follow-up of HIV positive clients on treatment Establishing and strengthening Adolescence Friendly Services

MEDICAL AND SURGICAL CARE

Adoption of UNAIDS’ 90-90-90 global target, by year 2020: ▪▪ 90% of all people with HIV should know their status ▪▪ 90% of HIV+ should be linked to ARV (anti-retroviral) ▪▪ 90% of HIV+ on ART for at least 6 months should have suppressed viral load

Strengthen eMTCT (elimination of mother to child transmission of HIV) and EID (early infant diagnosis) services

Outputs: ▪▪ Regular monitoring of people who access HIV/AIDS care service from Dr. Ambrosoli Memorial Hospital (Kalongo) ▪▪ Number of HIV+ clients enrolled in DSDM ▪▪ Establish an Adolescence Friendly Service Indicators: ▪▪ % of HIV+ clients enrolled in DSDM (target by 2022: 50%) ▪▪ HIV incidence (SDG target: reduce the annual number newly infected with HIV by 90%) ▪▪ % of people living with HIV receiving ART ▪▪ HIV/AIDS-related mortality rate (SDG target: reduce the annual number of people dying from AIDS-related causes by 80%) ▪▪ % of people with HIV knowing their status (UNAIDS target: 90%) ▪▪ % of people living with HIV receiving ART (UNAIDS target: 90%) ▪▪ % of HIV+ people on ART (for 6 months) with suppressed viral load (UNAIDS target: 90%) Outputs: ▪▪ All mothers tested for HIV during pregnancy (ANC) or delivery ▪▪ All exposed infants tested for HIV Indicators: ▪▪ % of mothers tested for HIV during pregnancy (ANC) or delivery ▪▪ % of HIV-positive newborns from HIV-positive mothers ▪▪ % of exposed infants tested for HIV

Strengthen the use (through improving their accessibility and implementation) of up-to-date clinical pathways and medical guidelines on HIV/TB patients care Enhancing ART coverage among HIV-positive TB cases

Outputs: ▪▪ Implementation of HIV/TB clinical pathways for patient care in line with national guidelines ▪▪ All HIV-positive TB cases treated with ART Indicators: ▪▪ % of HIV+/TB cases starting ART within 2 months

Health education programs on population, e.g. radio advertisements on HIV control and prevention (both primary and secondary), information, education and community group counselling sessions; community mobilization Implement Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and develop a dedicated data management software for HIV/AIDS care service. 1.1.3 Maternal, new-born care and nutrition Services

Strengthen the integration between St. Mary’s Midwifery Training School and Dr. Ambrosoli Memorial Hospital to provide better and more efficient maternal and newborn care services: ▪▪ Participation of the tutors in ward activities (e.g. bed-side clinical training) ▪▪ Increase the number of clinical trainers and mentors

Outputs: ▪▪ Numbers of clinical trainers and mentors ▪▪ Bed-side clinical session being conducted ▪▪ Creation of at least one project each year with St. Mary’s Midwifery Training School

Improvement in Goal Oriented Ante-Natal Care (ANC) Services

Outputs: ▪▪ Decrease the number of pregnant who do not attend ANC servicea ▪▪ Number of pregnant women attending ANC service at least oncea ▪▪ Number of pregnant women attending ANC service 4 times (or more)a ▪▪ Number of pregnant women who received Intermittent Preventive Treatment in pregnancy (IPTp) for Malaria during ANC visit

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2016-2022 STRATEGIC PLAN ACTIVITIES (continue)

TASKS

OUTPUTS Indicators: ▪▪ % of pregnant women who did not attend ANC serviceb ▪▪ % of pregnant women who attended ANC service at least onceb ▪▪ % of pregnant women who attended ANC service 4 times (or more)b ▪▪ % of pregnant women who received Intermediate Preventive Treatment for Malaria (IPT) during ANC visitb

(continue)

a. Monitor this output during the delivery (e.g. through an interview), indicating if the ANC service was provided by Dr. Ambrosoli Memorial Hospital or an external service b. Monitor this indicator using outputs (divided in internal and external ANC visits) as a numerator and total number of deliveries in Dr. Ambrosoli Memorial Hospital as denominator

Outputs: ▪▪ Number of births occurred in the Hospital ▪▪ Number of births delivered by C-section ▪▪ Reduction in number of post C-section infections ▪▪ Reduction in number of puerperal fever/sepsis ▪▪ Reduction in number of post-partum deaths

Improvement in Maternity services: ▪▪ Mother-friendly obstetric services ▪▪ Post abortion care (PAC): emergency care and contraceptive counselling (see. 1.1.8. Family Planning Service)

MEDICAL AND SURGICAL CARE

Indicators: ▪▪ % of births in the Hospital over the total birth in the district ▪▪ % of births delivered by C-section ▪▪ % of puerperal fever/sepsis ▪▪ % of post C-section infections ▪▪ Maternal mortality ratio: 50% reduction by 2022 (2015-2016: 116 per 100,000 live births, SDG target: less than 70 deaths per 100,000 live births) ▪▪ Number of women who received PAC Outputs: ▪▪ Number of newborns who received post-natal care within 48 hours ▪▪ Reduction in number of neonatal asphyxia ▪▪ Reduction in number of neonatal deaths ▪▪ Reduction in number of stillbirth

Improvement in Post-Natal Care services: ▪▪ Improve quality of care during the first day and week of life ▪▪ Reach every woman and every newborn to reduce inequities (health education and community mobilization programs) ▪▪ Empower parents, families and communities ▪▪ Count every newborn (stillbirth/live birth) Improvement in services provided by Neonatal Special Care unit: ▪▪ Acquisition of more skilled human resources ▪▪ Acquisition of new equipment (e.g. incubators, cPAP) ▪▪ Health education programs on health professionals (e.g. professional updating courses, training/re-orientation of the staff, training on-the-job)

Indicators: ▪▪ % of newborns of received post-natal care within 48 hours ▪▪ % of neonatal asphyxia ▪▪ Neonatal mortality ratio: 20% reduction by 2022 (2015-2016 9.9 per 1000 live births, target SDGs: less than 12 per 1000 live births) ▪▪ Stillbirth rate: 20% reduction by 2022 (2015-2016 13.27 per 1000 live births, target: 12 deaths per 1000 total births)

Implement Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and develop a dedicated data management software for maternal and newborn care services. 1.1.4 Out-Patients Department (OPD)

Outputs: ▪▪ Number of staff trained and re-orientated each year ▪▪ Improvement in Patient satisfaction levels (Humanity of care and Organization of the care/waiting) ▪▪ Institution of a registration counter with triage activity

Implementing triage activity (process of determining the priority of patients’ treatments based on the severity of their condition) Creation of a 24/7 emergency point with observation room to stabilize patients before admission in the Hospital Creation of dedicated pathways for private patients (e.g. dedicated registration and admission office)

Indicators: ▪▪ % of staff trained and re-orientated each year (at least 20-25% per year) ▪▪ % of patient satisfaction levels (see SO 2.4)

Training/re-orientation of staff: ▪▪ Training on-the-job (e.g. for triage activity) ▪▪ Professional updating courses ▪▪ Improvement in healthcare employees’ communication (e.g. medical officer-to-clinical officer) Acquisition of more skilled human resources Additional equipment & supplies and Medical Equipment maintenance Implement Specialty Care Clinic in OPD (see 1.1.11 for Mental Health and 1.1.7 for Diabetes, CVDs and HPV) Implement Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and develop a dedicated data management software for OPD

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DR. AMBROSOLI MEMORIAL HOSPITAL ACTIVITIES

TASKS

1.1.5 Palliative Care as an integral component of care

Work collaboratively with ward/department teams to review and build on existing palliative care initiatives Develop a system of support for staff who completed the series of palliative care education days to enable them to encourage and promote the delivery of palliative care and provide the potential for care that is more cost effective Create baseline palliative care information and skills for all levels of staff with implementation initiatives Create a culture of supervision in practice to support the delivery of palliative care

MEDICAL AND SURGICAL CARE

Acquire health professionals/materials and equipment to enable these tasks

OUTPUTS Outputs: ▪▪ Baseline knowledge of palliative care for all healthcare professionals ▪▪ Creation of groups in each ward/department with more in-depth knowledge of palliative care ▪▪ Creation of an annual questionnaire on palliative care for staff, family and patients Indicators: ▪▪ % of patient satisfaction levels on palliative care ▪▪ % of family satisfaction levels on palliative care ▪▪ % of staff satisfaction levels on palliative care

Evaluation and review of these tasks at regular intervals 1.1.6 Surgery Department

Enhance collaboration with hospitals (both national and international) to provide advanced Surgery Care (e.g. intensive care, orthopaedic surgeon) Strengthen cooperation with OPD emergency service (see Activity 1.1.4) Organize regular Surgical camps and strengthen collaboration with Association of Surgeons of Uganda (ASOU) Implement WHO Guidelines for Safe Surgery (WHO Surgical Safety Checklist) Medical education on clinical case management: ▪▪ Clinical audit ▪▪ Rounds and grand rounds ▪▪ Clinician Meeting ▪▪ Continuing Medical Education (CME) Strengthen the use (through improving their accessibility and implementation) of up-to-date clinical pathways and medical guidelines; creation of a booklet for health professionals with clinical pathways

Outputs: ▪▪ Memorandum of Understanding (MoU) with other facilities ▪▪ Collaboration with other facilities ▪▪ Number of visiting surgeons ▪▪ Number of staff trained and re-orientated each year ▪▪ Clinical pathways and medical guidelines updated ▪▪ WHO Surgical Safety Checklist Indicators: ▪▪ % of transferred patient to other facilities ▪▪ % of staff trained and re-orientated each year (at least 20-25% per year) ▪▪ % of deaths on surgical patients ▪▪ % of surgery-related infections ▪▪ % of surgical wound infection ▪▪ % of properly filled WHO Surgical Safety Checklist over the number of surgical procedures performed ▪▪ Indicators from annual analytical report (e.g. admissions, deaths, deliveries…)

Health education programs on health professionals (e.g. surgeon and anaesthesiologist): ▪▪ Professional updating courses ▪▪ Training/re-orientation of the staff ▪▪ Training on-the-job ▪▪ Improvement in healthcare employees’ communication (e.g. medical officer-to-clinical officer)

PUBLIC HEALTH INTERVENTIONS

Implement Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and develop a dedicated data management software for Surgery Department ACTIVITIES

TASKS

OUTPUTS

1.1.7 Emerging diseases (communicable and non-communicable), co-morbidity and epidemiological transition

Strengthen the use (through improving their accessibility and application) of up-to-date clinical pathways and medical guidelines and realize services for the following health challenges: ▪▪ Cardiovascular diseases (hypertension, heart failure) ▪▪ Diabetes and nutrition (type I and II, nutritional counselling/epidemiological transition) ▪▪ Chronic viral diseases (e.g. HBV, HCV and HPV) ▪▪ Co-morbidity (e.g. diabetes & TB, HIV & TB, HIV & HBV, HIV & HPV…) ▪▪ Cervical cancer and HPV screening program

Outputs: ▪▪ Strengthen OPD services for Diabetes, CVDs and HPV ▪▪ Update clinical pathways and medical guidelines on the following topics: Diabetes, CVDs, HPV, chronic viral diseases (e.g. MTCT of HBV, HBV care and HCV) considering growing comorbidity issues ▪▪ All mothers tested for HBV during pregnancy (ANC) or delivery each year ▪▪ All newborns from HBV-positive mothers vaccinated from HBV at birth ▪▪ Cervical Cancer screening on sexually active women

Strengthen hospital’s resilience facing new challenges (e.g. epidemiological transition, nutrition) Training/re-orientation of staff (professional update) Health education programs on population, e.g. radio advertisements on nutrition, CVDs prevention, viral diseases prevention (both primary and secondary), information, education and community group counselling sessions; community mobilization, e.g. for screening programs on viral diseases Implement Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and develop a dedicated data management software

48  |  SG1: HEALTH CARE SERVICE DELIVERY

Indicators: ▪▪ % of staff trained and re-orientated each year (at least 20-25% per year) ▪▪ % of mothers tested for HBV during pregnancy (ANC) or delivery ▪▪ % of newborns from HBV-positive mothers vaccinated from HBV at birth [target SDGs 95% decline in new cases of chronic HBV infection between 2010 and 2030]


2016-2022 STRATEGIC PLAN ACTIVITIES 1.1.8 Family Planning Service

TASKS

OUTPUTS

Training/re-orientation of service providers on modern natural Family Planning methods Procurement of CycleBeads® for SDM Hold FP clinics Health education programs on population, e.g. radio advertisements on family planning, information, education and community group counselling sessions; community mobilization.

Outputs: ▪▪ Number of couples using modern natural Family Planning methods, i.e. Lactation Amenorrhea Method (LAM), Standard Days Method® (SDM), TwoDay Method® (TDM) Indicators: ▪▪ % of women currently using modern natural Family Planning methods (i.e. LAM, TDM, SDM)

Implement Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and develop a dedicated data management software

PUBLIC HEALTH INTERVENTIONS

1.1.9 Health Education, communication strategies and professional update

Health education programs on population (see activities for SO 1.1): ▪▪ Radio advertisements ▪▪ Diseases prevention ▪▪ Information ▪▪ Community group counselling sessions

Indicators: ▪▪ Indicators from annual analytical report (e.g. admissions, deaths, deliveries…) Health education programs on health professionals (see activities for SO 1.1): ▪▪ Professional updating courses ▪▪ Training/re-orientation of the staff ▪▪ Training on-the-job ▪▪ Continuing Medical Education (CME) Creation of a research-dedicated area with medical library, computers and internet access

1.1.10 Immunization

Outputs: ▪▪ Creation of health education programs on populations (at least 1 per year) ▪▪ Community mobilization and community group counselling sessions

Outputs: ▪▪ Creation of health education programs on health professional (at least 4 per year) Indicators: ▪▪ % of staff trained and re-orientated each year (at least 20-25% per year) Outputs: ▪▪ At least 95% of infants fully immunized for diseases included in the UNEPI (expanded immunization program) by the end of FY 2021-2022

Harmonization of Hospital and District activities, bringing efforts together in enhancing immunization coverage Supply/distribution of vaccines Cold-chain maintenance

Indicators: ▪▪ Immunization coverage per disease (according to immunization schedule provided by UNEPI see references)

Transportation of vaccinators to outreaches Creation of a program for community vaccinators & community mobilizers Implement Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and develop a dedicated data management software Health education programs on population (e.g. radio advertisements on the topic) and community mobilization 1.1.11 Mental Health and substance abuse service

Outputs: ▪▪ Collaborations with other facilities ▪▪ Number of admission for mental health diseases

Collaborations with nearby hospitals to provide an adequate Mental Health Service in OPD (e.g. acquisition of shared psychiatrist or registered psychiatric nurse) Mental health patients’ hospitalization process, improving their management and their admission to the medical ward Adequate supply of essential psychiatric drugs (see activity 1.1.15). Health education programs on population, e.g. radio advertisements on mental diseases, alcohol abuse and harmful use of alcohol; information; education; community group counselling sessions and community mobilization

Indicators: ▪▪ Number of attendances for mental health diseases in OPD ▪▪ % of hospitalized patients for mental health diseases (over OPD admission for the same issues) ▪▪ % of patients’ admission for alcohol abuse

Implement Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and develop a dedicated data management software for Mental Health Service

SERVICES

ACTIVITIES 1.1.12 Information and Communication Technology (ICT) department (see SG3)

TASKS Development of a strong Wi-Fi connection within the facilities of the hospital Development of an information technology department Creation of a hospital register with dedicated data management software

OUTPUTS Outputs: ▪▪ Functioning of Wi-Fi connection ▪▪ Data management software Indicators: ▪▪ % of staff trained and re-orientated (at least 20-25% per year)

Training/re-orientation of staff (professional update)

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DR. AMBROSOLI MEMORIAL HOSPITAL ACTIVITIES

TASKS

1.1.13 Depart- Department of diagnostic imaging expansion: ment of Diag- ▪▪ On-site development: additional equipment and supplies e.g. nostic Imaging Portable X-ray, Digital Radiography equipment; improvement in quality and variety of tests offered e.g. contrast radiography, (Radiology and Medical digital radiography, bedside ultrasound Imaging) ▪▪ Off-site development: build up agreements among hospitals, both national and international for e.g. off-site teleradiology Training/re-orientation of staff: ▪▪ Training on-the-job programs e.g. for bedside ultrasound ▪▪ Professional updating courses e.g. ultrasound, digital radiography Acquisition of more skilled human resources

OUTPUTS Outputs: ▪▪ Number of staff trained and re-orientated each year ▪▪ Number of investigation increased (e.g. contrast radiography, digital radiography, bedside ultrasound) ▪▪ Number of agreements with other institutions Indicators: ▪▪ % of staff trained and re-orientated each year (at least 20-25% per year) ▪▪ % of new investigation performed over the total number of investigations

SERVICES

Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and data management software 1.1.14 Labo- Laboratory Testing Services expansion (clinical pathology – clinical miratory Testing crobiology, clinical chemistry and haematology; anatomic pathology): Service ▪▪ On-site development: amelioration of quality and variety of tests ▪▪ Off-site development: build up agreements among hospitals, national or international, for external testing or Telemedicine Services Procurement of additional laboratory equipment and supplies Training/re-orientation of laboratory staff on use of new equipment Apply for accreditation of the hospital laboratory Clinical Documentation improvement (e.g. proper filling of sheets and registers by health professionals) and data management software

Outputs: ▪▪ Number of laboratory tests introduced to meet the recommended standard for a general hospital ▪▪ WHO Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) in the African Region Checklist (see references) ▪▪ SLIPTA audit on laboratory quality management ▪▪ Accreditation of Dr. Ambrosoli Memorial Hospital Laboratory Service ▪▪ Number of agreements with other Facilities

Indicators: Professional updating courses for the correct use of laboratory testing ▪▪ % SLIPTA score on on-site audit following their tiers of recognition (target: reach 5 stars rating in 2021-2022) and the implementation of clinical pathways and medical guidelines 1.1.15 Medical Products and Hospital supply closet (Optimizing Healthcare Supply Management)

Creation of an electronic database and register for drugs and sundries (dedicated inventory management software may be needed) Estimating quantities of drugs and sundries required Continuous monitoring of drugs and sundries consumption Ordering drugs and sundries Health education programs on population (e.g. radio advertisements on drug use, injection vs oral medication) & staff (correct use of drugs)

Outputs: ▪▪ Electronic database and register created. ▪▪ Essential drugs and medical products always in stock Indicators: ▪▪ % stock-out of 10 tracer indicator drugs per month (essential drugs which run out more frequently e.g. malaria treatment or antibiotics)

Training/re-orientation of staff (professional update)

Strategic Objective 1.2: Activities, Tasks and Outputs ACTIVITIES 1.2.1 Mental Health and substance abuse service

TASKS Build up strong working collaboration relationships with sister hospitals to provide an adequate Mental Health Service Acquisition of shared psychiatrist or registered psychiatric nurse Definition of a shared work schedule among the hospitals Implementation of Mental Health Service in OPD (at least 1 day/week)

1.2.2 Out-Patients Build up strong working collaboration relationships with sister hospiDepartment (OPD) tals to provide an adequate specialty care Acquisition of shared specialists (e.g. ENT, ophthalmologist, dentist) Definition of a shared work schedule among the hospitals

OUTPUTS Outputs: ▪▪ Collaborations with other facilities Indicators: ▪▪ Number of attendances for mental health diseases (MHDs) in OPD ▪▪ % of hospitalized patients for MHDs (on OPD MHD attendance) Outputs: ▪▪ Agreements with other facilities Indicators: ▪▪ Number of admission for dental, eye or ENT diseases in OPD

Implement a Specialty Care Clinic in OPD (at least 1 day per week) or organize Specialty Care camps (e.g. 1 week twice a year) 1.2.3 Surgery Department

Build up strong working collaboration relationships with sister hospitals to provide advanced Surgery Care (e.g. intensive care, orthopaedic surgical care…) Definition of inter-facility patient transfer pathway

1.2.4 Services (Laboratory Testing Service and Department of Diagnostic Imaging)

Build up strong working collaboration relationships with hospitals to provide advanced laboratory service and diagnostic imaging service Laboratory testing service: external specimen testing (creation of a price list for single exam); pathology telemedicine service Department of diagnostic imaging: off-site tele-radiology, acquisition of shared equipment

50  |  SG1: HEALTH CARE SERVICE DELIVERY

Outputs: ▪▪ Agreements with other facilities creating clinical pathways Indicators: ▪▪ % of transferred patient to other facilities Outputs: ▪▪ Agreements with other facilities ▪▪ Production of a price list for external laboratory testing ▪▪ Creation of a telemedicine service (for pathology and radiology)


2016-2022 STRATEGIC PLAN

Strategic Goal 1: Time-line SO 1.1: To deliver quality health services while considering the needs of the less privileged and vulnerable social groups including women, children and the chronically ill.

ACTIVITIES 1.1.1. In-patient Department (all wards)

TASKS

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

In-patients’ admission and discharge Medical education and clinical pathways Health education on health professionals Clinical Documentation improvement

1.1.2. HIV/AIDS Care Hold HIV testing services ART & treatment of infections (OIs) Home-based care (DSDM) Follow-up of HIV+ clients on ARV Adolescence Friendly Services UNAIDS’ 90-90-90 global target Strengthen eMTCT and EID Clinical pathways on HIV/TB care Enhancing ART coverage on HIV/TB Health education on population Clinical Documentation improvement 1.1.3. Maternal, new-born care and nutrition Services

Integration with St. Mary’s MTS Goal Oriented Ante-Natal Care (ANC) Maternity services & Post abortion care Post-Natal Care Neonatal Special Care unit Clinical Documentation improvement

1.1.4. Out-Patient Department (OPD)

Triage activity Emergency point & observation room Pathways for private patients Training/re-orientation of staff Acquisition of human resources New medical equipment & maintenance Specialty Care Clinic in OPD Clinical Documentation improvement

1.1.5. Palliative Care

Review existing palliative care initiatives Palliative care education days Baseline palliative care skills for all staff

SG1: HEALTH CARE SERVICE DELIVERY  |  51


DR. AMBROSOLI MEMORIAL HOSPITAL (continue)

Culture of supervision Acquire health professionals/equipment Evaluation and review

1.1.6. Surgery Department

Collaboration for advanced Surgery Care Cooperation with OPD and Emergency Surgical camps WHO Guidelines for Safe Surgery Medical education and clinical pathways Health education on health professionals Clinical Documentation improvement

1.1.7. Emerging diseases, Update clinical pathways comorbidity, epidemiological transition Hospital’s resilience on new challenges Training/re-orientation of staff Health education on population Clinical Documentation improvement 1.1.8. Family Planning Service

Professional update on Family Planning CycleBeads® for SDM FP clinics Health education on population Clinical Documentation improvement

1.1.9. Health Education on HP Health education on population and population Health education on health professionals Research-dedicated area 1.1.10. Immunization

Hospital and District network Supply/distribution of vaccines Cold-chain maintenance Mobilize vaccinators to outreaches Vaccinators & community mobilizers Clinical Documentation improvement Health education on population

1.1.11. Mental Health and Substance Abuse Service

MHS in OPD (networking with hospitals) Mental health patients’ hospitalization Essential psychiatric drugs Health education on population Clinical Documentation improvement

52  |  SG1: HEALTH CARE SERVICE DELIVERY


2016-2022 STRATEGIC PLAN 1.1.12. Information and Communication Technology (ICT)

Wi-Fi connection Information technology department Data management software Training/re-orientation of staff

1.1.13. Department of Diagnos- Diagnostic imaging expansion tic Imaging Training/re-orientation of staff Acquisition of human resources Clinical Documentation improvement 1.1.14. Laboratory Testing Service

Laboratory Testing Services expansion Laboratory equipment & supplies Training/re-orientation of staff Accreditation of the laboratory Clinical Documentation improvement Professional update, clinical pathways

1.1.15. Medical Products and Hospital supply closet

Inventory management software Estimating drugs&sundries required Monitoring drugs&sundries consumption Ordering drugs&sundries Health education on population Training/re-orientation of staff

SO 1.2: To create a network with nearby hospitals (e.g. St. Mary’s Hospital Lacor Gulu and St. Joseph’s Hospital Kitgum), providing better and broader care. ACTIVITIES 1.2.1. Mental Health and substance abuse service

TASKS

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

Collaboration with sister hospitals Shared psychiatrist/psychiatric nurse Shared work schedule Mental Health Service in OPD

1.2.2. Out-Patients Department (OPD)

Collaboration with sister hospitals Acquisition of shared specialists Shared work schedule Specialty Care Clinic in OPD

1.2.3. Surgery Department

Collaboration with sister hospitals Inter-facility patient transfer pathway

1.2.4. Services

Collaboration with sister hospitals Laboratory testing service Department of diagnostic imaging

SG1: HEALTH CARE SERVICE DELIVERY  |  53


DR. AMBROSOLI MEMORIAL HOSPITAL

54  |  SG2: INSTITUTIONAL DEVELOPMENT


2016-2022 STRATEGIC PLAN

SG2 Institutional Development For several decades, Dr. Ambrosoli Memorial Hospital served the people of Kalongo and the surrounding districts providing a high-quality health care. Now, the hospital is addressing pervasive financial and management challenges that undermine its efforts to attain a good level service. The SWOT analysis showed weaknesses, like high dependency on financial subsidies, insufficient number of staff and lack of specialists, lack of structured policies and procedures, lack of staff time discipline, poor internet system, out of date infrastructures and limited data elaboration and reconciliation. Over time, these weaknesses and shortcomings could threaten the effectiveness in delivering health to the people. Therefore, we have identified four Strategic Objectives aimed at strengthening the hospital’s core management processes that can solve weaknesses and ultimately support the effective implementation of the four Strategic Goals over the next six years: ■■ Strategic Objective 2.1: to increase Dr. Ambrosoli Memorial Hospital financial sustainability, improving efficiency while providing high quality and costeffective care. ■■ Strategic Objective 2.2: to sustain capacity building and human resource management through the gradual spread of the principles of participatory management style and a career development path. ■■ Strategic Objective 2.3: to introduce a result based financial administration. ■■ Strategic Objective 2.4: to ensure constant high patient satisfaction.

SG2: INSTITUTIONAL DEVELOPMENT  |  55


DR. AMBROSOLI MEMORIAL HOSPITAL Next paragraphs describe how Dr. Ambrosoli Memorial Hospital aims to achieve Strategic Goal 2 and his objectives, together with a detailed definition

of activities, tasks, outcome and indicators, and time-line at the end of the chapter.

Strategic Objective 2.1 To increase Dr. Ambrosoli Memorial Hospital financial sustainability, improving efficiency while providing high-quality and cost-effective care. The main hospital’s challenge is to achieve financial sustainability and thereby assure the implementation of the Strategic Plan. It is crucial to sustain the current levels of support and to identify new sources of funding, considering the current decline in aid from traditional sponsors and donors. The current funding for health services is still inadequate compared to the needs. This inevitably affects the performance and the stability of the hospital. This Strategic Objective is therefore focusing on the implementation of an appropriate integrated model that can guarantee financial sustainability over time and promote a constant development of the hospital. Alongside the following actions, strengthening the existing cooperation with nearby hospital (see Strategic Objective 1.2 for further details), as mentioned before, could be a successful strategy. The preliminary action is to develop and implement a detailed and effective system of cost monitoring, allowing the Hospital to calculate the magnitude and the details of its total expenditures. The establishment of a Budget and Controlling division could be of help in the provision of a cost-effective care, therefore reducing hospital expenditure while maintaining a high-quality service. The estimation

56  |  SG2: INSTITUTIONAL DEVELOPMENT

of costing for giving services quotes (e.g. to partners, donors, health insurances) and the setting up of cost centres and clear references, are essential tasks in the achievement of this activity. At the same time, strengthening a culture of fundraising and enhancing the portfolio of donors for improving fundraising effectiveness, together with the registration as NGO, broadening the range of the available programs and financial instruments, could allow the hospital to seek for external financial support to meet the Strategic Goals and to face the rising healthcare cost. Although fundraising typically refers to efforts to gather money for non-profit organizations, it represents a strategic approach to the management of an organization to help ensure its continued growth and development. Fundraising is a technology, a set of rules, theories, concepts and measures for identifying, preventing and manage the potential risks in growing the business of a social enterprise. The ultimate goal of fundraising is to consistently combine the mission, the value, the culture and the action plan with the resources system. The establishment of a Fundraising Department with Research and Development Office is therefore fundamental and must be performed in a short time.


2016-2022 STRATEGIC PLAN

Strategic Objective 2.2 To sustain capacity building and human resource management through the gradual spread of the principles of participatory management style and a career development path. Health workers are the main asset of the hospital and the fundamental resource for service provision. The hospital is committed to provide a work that values and supports employees offering adequate opportunities for personal and career development. The organization is changing from being predominantly run according to a top – down hierarchy to a participatory management style. The development of a human resource policy is a strategic approach to managing people effectively in order to promote staff productivity, to maximize performance and to encourage individual selffulfilment.

We will also explore ways to improve staffing mix and deployment across ward shifts. We also intend to strengthen the performance management system to better recognize good performance and tackle under-performance. Another priority will be to strengthen the approach to human resources development to enable staff to acquire appropriate skills and competencies. A key cross-cutting issue will be to promote a productive and supportive working environment for all staff. To oversee these proposed initiatives, we recognize the need to strengthen the capacities of the Human Resources Office.

Figure 17. The Post-Natal Care Clinic (photo credit Jessica Pepper-Peterson Photography).

SG2: INSTITUTIONAL DEVELOPMENT  |  57


DR. AMBROSOLI MEMORIAL HOSPITAL

Strategic Objective 2.3 To introduce a result based financial administration. The implementation of result-based management and pay for performance payment model over the next six years, represents an approach to increase efficiency and quality of Dr. Ambrosoli Memorial Hospital, while reducing healthcare expenditure. Results-based management is a management strategy which uses feedback loops to achieve strategic goals. All people who contribute directly or indirectly to the result, map out their business processes, products and services, showing how

they contribute to the outcome. This outcome may be a physical output, a change, an impact or a contribution to a higher-level goal. In the healthcare industry, pay for performance (P4P), also known as “value-based purchasing”, is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures.

Strategic Objective 2.4 To ensure constant high patient satisfaction. Patient satisfaction is an important and commonly used indicator for measuring the quality in health care and it can be used as an important tool in the selection of priorities and monitoring of hospital policies. In fact, conducting periodic surveys among patients

or collect their comments and suggestions can foster understanding of latent needs of the population, it can combine the flow of information that comes from outside with what comes from within and it can monitor and check the effectiveness of the implemented policies.

Figure 18. Patients’ satisfaction is part of our mission (photo credit Jessica Pepper-Peterson Photography).

58  |  SG2: INSTITUTIONAL DEVELOPMENT


2016-2022 STRATEGIC PLAN

Strategic Objective 2.1: Activities, Tasks and Outputs ACTIVITIES 2.1.1. Cost-effective and high-quality of Care

TASKS Creation of an office aimed at quality, efficiency and cost of care monitoring (budget and controlling division) Monitor quality and efficiency of care using data from health indicators (performance and results indicators, see SO 1.1) Evaluate employees performance through a Pay-for-Performance Payment model using a panel of validated indicators (see SO 2.3.1)

OUTPUTS Outputs: ▪▪ Monitoring and evaluation reports on quality indicators ▪▪ Panel of Indicators and Criteria for P4P ▪▪ Costing analysis Indicators: ▪▪ Panel of indicators (quality, P4P)

Implement a cost management system: ▪▪ Create centre of costs in the departments/wards to provide a better monitoring of expenses ▪▪ Provide hospital cost for each service the Hospital dispense trough a proper costing analysis ▪▪ Identify areas for cost reduction 2.1.2. Fundraising Department and Research and Development (R&D) Office

Creation of Fundraising Department with Research and Development (R&D) Office: ▪▪ Data Management ▪▪ Donor relationship Development ▪▪ Grant Writing and proposal ▪▪ Merchandising ▪▪ Corporate partnership Sourcing for funds (both national and international) to implement projects in the Hospital: ▪▪ Clinical projects ▪▪ Health & Education ▪▪ Infrastructure & Equipment (maintenance, renovation, construction)

Outputs: ▪▪ Number of plans and proposal completed/submitted/approved ▪▪ Monitoring and evaluation reports ▪▪ Fundraising activities (both national and international) Indicators: ▪▪ Fundraising activities (both national and international) ▪▪ % projects completed on proposed ▪▪ Sustainability Ratio (see Annual Analytical Report)

Projects follow-up: monitoring and evaluation Annual reports production 2.1.3. Change Creation of a working group dedicated to NGO registration the Status of the SWOT analysis on NGO Hospital Creation of a Board of NGO

Outputs: ▪▪ Creation of a WG for NGO transition ▪▪ Creation of a Board of NGO ▪▪ NGO “Dr. Ambrosoli Memorial Hospital”

Setting up of a NGO “Dr. Ambrosoli Memorial Hospital”

Strategic Objective 2.2: Activities, Tasks and Outputs ACTIVITIES 2.2.1 Participated and transparent implementation of the policy for staff development, retention and rewarding.

TASKS Activate/revitalize training committee Orientation of staff Regular/effective/transparent communication of opportunities to staff Active and timely identification of staff deserving promotion and training (proper appraisal regular and careful) Regular and general departmental staff meeting Create regular Job Satisfaction surveys and give back regular performance reviews

OUTPUTS Outputs: ▪▪ Attract and retain valid staff ▪▪ Improvement in staff satisfaction levels ▪▪ Regular Job Satisfaction survey (at least one per year) Indicators: ▪▪ % of staff satisfaction levels ▪▪ Number of new candidatures ▪▪ % of new hired over new candidatures

CME and research opportunity (active) promotion Transparent salary scale Public and clear staff accommodation policy 2.2.2 Participatory management of personnel with clear objectives and plans (e.g. clear staff establishment guiding recruitment and career development; staff welfare)

Develop a human resource policy available to human resources officers and other key management personnel Revise and update protocols and policies (e.g. procurements protocol, financial protocol) Timely and regular internal audit for monitoring and controls Widen the resource and finance basis

Outputs: ▪▪ Number of staff trained and re-orientated each year ▪▪ Administration protocols and policies updates ▪▪ Number of internal audit each year Indicators: ▪▪ See SO 1.1

Purchase of IT equipment and software; creation of a research-dedicated area with medical library, computers and internet access Train/orientate staff: active staff training, formal and on-the-job

SG2: INSTITUTIONAL DEVELOPMENT  |  59


DR. AMBROSOLI MEMORIAL HOSPITAL ACTIVITIES

TASKS

2.2.3 Outsourcing Perform a cost-benefit analysis on services that can be outsourced some services (evidence-based decision) (such as cleaning Tender for Outsourcing Services services, regular maintenance, con- Proper quality monitoring to streamline operations struction…) 2.2.4 Networking with training & education organizations and institutions (e.g. intra-health, government, Uganda nurses and midwives councils, UMDPC)

Regular contacts with organizations, both national and international, developing new opportunities

OUTPUTS Outputs: ▪▪ Cost-benefits analysis performed ▪▪ Number of call for bids

See SO 1.2 and 4.2.1

Create a network with nearby hospitals and institutions (e.g. St. Mary’s Hospital Lacor Gulu and St. Joseph’s Hospital Kitgum), see SO 1.2 Create a network with other institutions offering the midwifery degree (e.g. Nsambya and Lira) for teacher exchanging program, see SO 4.2.1

Strategic Objective 2.3: Activities, Tasks and Outputs ACTIVITIES

TASKS

2.3.1 Strengthen Supervise and monitor the realization of SO 2.2 administration staff, Develop a human resource (HR) policy distributed to human resourcprocesses and es officers and other key management personnel policies. Introduce a Pay for Performance (P4P) payment model, offering financial incentives to health professionals for meeting certain performance measures (e.g. quality and efficiency of care)

OUTPUTS Outputs: ▪▪ HR Policy ▪▪ Panel of Indicators and Criteria for P4P Indicators: ▪▪ % of Indicators and Criteria achieved each year

Create a panel of indicators and criteria for P4P (e.g. quality of care criteria, patients’ satisfaction, Clinical Documentation improvement, application of WHO Surgical Safety Checklist…) 2.3.2 Computerize administrative Systems (including M&E/Data collection and Human resources management) and regularly updated

Creation of an electronic database of all employees of the hospital Upgrade and support Data management (collection, analysis and utilization)

Outputs: ▪▪ Database of employees

Strategic Objective 2.4: Activities, Tasks and Outputs ACTIVITIES

TASKS

2.4.1 Conduct periodic patient/client satisfaction surveys and review findings with staff members during appropriate forums (staff retreat, annual general staff meeting, departmental meeting, etc. as considered appropriate)

Perform a Patient Satisfaction survey using a validated questionnaire every 6 months (e.g. PSQ-18, a short form of the patient satisfaction questionnaire) Annual stakeholder meeting to monitor achievements of results and indicators Place a suggestion box for patients or family members in every ward Regular reviews and surveys with staff

60  |  SG2: INSTITUTIONAL DEVELOPMENT

OUTPUTS Outputs: ▪▪ Patient satisfaction surveys performed ▪▪ Stakeholder meetings each year Indicators: ▪▪ % of patient satisfaction levels


2016-2022 STRATEGIC PLAN

Strategic Goal 2: Time-line SO 2.1: To increase Dr. Ambrosoli Memorial Hospital financial sustainability, improving efficiency while providing high-quality and cost-effective care. ACTIVITIES 2.1.1. Cost-effective and high-quality of Care

TASKS

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

Budget and controlling division Monitor quality and efficiency of care Pay for Performance Payment Model Implement a cost management system

2.1.2. Fundraising Department and R&D Office

Fundraising Department with R&D Sourcing for funds Projects follow-up M&E Annual reports production

2.1.3. Change the Status of the WG for registration Hospital SWOT analysis on NGO Creation of a Board of NGO Setting up of a NGO SO 2.2: To sustain capacity building & human resource management, gradual spread of participatory management style and a career development path. ACTIVITIES 2.2.1. Participated and transparent implementation of the policy for staff development, retention and rewarding.

TASKS

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

Activate/revitalize training committee Orientation of staff Communication of opportunities to staff Proper appraisal regular and careful Departmental staff meeting Job Satisfaction surveys CME and research opportunity Transparent salary scale Staff accommodation policy

2.2.2. Participatory manage- Human resource policy ment of personnel with clear Protocols and policies objectives and plans Timely and regular internal audit Widen the resource and finance basis Research-dedicated Train/orientate staff 2.2.3. Outsourcing some services

Evidence-based decision on outsourcing Tender for Outsourcing Services Proper quality monitoring

2.2.4. Networking organizations Contacts with organizations and institutions Network with nearby hospitals Network with other degree universities SO 2.3: To introduce a result based financial administration. ACTIVITIES

TASKS

2.3.1. Strengthen adminis- Supervise and monitor SO 2.2 tration staff, processes and Develop a human resource (HR) policy policies. P4P payment model Indicators and criteria for P4P 2.3.2. Computerize administrative Systems

Electronic database of employees Upgrade and support Data management

SO 2.4: To ensure constant high patient satisfaction. ACTIVITIES 2.4.1. Conduct periodic patient/ client satisfaction surveys and review findings with staff members during appropriate forums

TASKS Perform a Patient Satisfaction survey Annual stakeholder meeting Suggestion box Regular reviews and surveys with staff

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62  |  SG3: INFRASTRUCTURE RENOVATION AND MAINTENANCE


2016-2022 STRATEGIC PLAN

SG3 Infrastructure renovation and maintenance The former Annual Analytical Report FY 2015-2016 collected data and information on Dr. Ambrosoli Memorial Hospital existing infrastructures. Some of the buildings (both medical and non-medical, e.g. staff housing, water and energy grids, equipment, stores), equipment (both medical and non-medical), furniture and hospital power and water plants, do not meet the actual standards for quality and safety. The major infrastructural issues can be summarized as it follows: ■■ Insufficient or, in some cases, lack of staff accommodation. ■■ Limited maintenance of supply lines (both water and electricity) that results in deficiency in electricity and water supplies causing power cuts and water line failures ■■ Inadequate facilities that need urgent and major renovations, like Children, Surgical and Medical wards. ■■ Solid and liquid waste disposal system needs a proper expansion to the whole hospital complex. It is fundamental to develop a strategy and a plan for infrastructure and medical equipment maintenance, including periodic reviews assessing upgrade strategies, vulnerabilities and security maintenance requirements. Rehabilitation of existing building and relocating services could be a strategy for rationalization, improving space utilization, thereby delivering financial savings and creating a more sustainable organization. Priority must be given to consolidation and upgrade of existing services. The hospital lacks an effective equipment inventory, and there is no record or itemized

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Figure 19. The HIV/AIDS Clinic (photo credit Jessica Pepper-Peterson Photography).

list of the medical and non-medical equipment. Implementing and maintaining quality inventory management procedures can quickly lead to a more efficiently run hospital, as well as significant cost savings. Moreover, performing periodical clinical equipment inventories contributes to the development of a preventive maintenance system. Such infrastructure and equipment renovation, maintenance and expansion need an important capital investment. In order to face as efficiently as possible these evident problems, the following 3 strategic objectives were developed: ■■ Strategic Objective 3.1: To develop a maintenance master plan to ensure that the hospital is able to continue delivering services. ■■ Strategic Objective 3.2: To develop a master plan and implement a clear action plan with priorities and milestones. ■■ Strategic Objective 3.3: To ensure funding for additional capital investments.

The final target is to ensure the availability of a functional, efficient and sustainable health infrastructure for effective service delivery to the people of Agago and the neighbouring districts. Next paragraphs describe how Dr. Ambrosoli Memorial Hospital aims to achieve Strategic Goal 3 and his objectives, together with a detailed definition of activities, tasks, outcome and indicators, and time-line at the end of the chapter.

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2016-2022 STRATEGIC PLAN

Strategic Objective 3.1 To develop a maintenance master plan to ensure that the hospital is able to continue delivering services. The Strategic Objective 3.1 is mainly focused on existing infrastructures and equipment. At the moment, there is no inventory listing the existing infrastructures, facilities and equipment, both medical and non-medical. The inventory of infrastructure and equipment and their needs, assessing their quality and safety, must be the first step before the development of a proper maintenance plan or master plan (see Strategic Objective 3.2). This prior assessment will provide an insight into the state and condition of infrastructures and equipment. The aims are prioritization of interventions and renovation while exploring potential funding and strategic management opportunities to address the infrastructure gap - to achieve the best possible balance between renewal and growth. The consequent step is the development a maintenance master plan for Dr. Ambrosoli Memorial Hospital’s infrastructure and equipment,

covering: water and power supply, sewage system, waste disposal, motor vehicles and IT. The realization of a comprehensive maintenance plan is a step-by-step process carried out by the implementation of: ■■ Maintenance policy, based on an assessment of the needs and analysis of infrastructure and equipment and applied to the entire site, ■■ Maintenance strategy (reviewed and updated every 2 years) ■■ Maintenance program describing all maintenance requirements to care for the Hospital and scheduling of preventive maintenance (PM) and corrective maintenance in accordance with safety and quality standards. A periodic reporting system, with annual meeting, may help to promote a more effective maintenance.

Strategic Objective 3.2 To develop a master plan and implement a clear action plan with priorities and milestones. The development of a Master Plan, a comprehensive document that sets out an overall strategy, is advised to help the organization’s management to implement a complex and widespread project (an action plan), facilitating the monitoring of progress. An action plan is a strategic organizational tool to identify the

necessary steps to ensure availability of a functional, efficient and sustainable health infrastructure for effective health services delivery. The identification of a dedicated working group (i.e. a project team) could be useful for its elaboration, starting with assessment of needs and

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DR. AMBROSOLI MEMORIAL HOSPITAL requirements analysis, and the inventory of the existing documents and plans of development (e.g. “Staff Quarter – Report and way forward” masterplan and “Dr. Ambrosoli Memorial Hospital – Wash Report”). The working group should therefore identify and evaluate key service/facilities priorities that will form the basis of the master and action plan, aligning the strategy to clinical priorities and operational requirements. An important task will be to improve space utilization reviewing the accommodation currently used and consider

options for contributing to overall rationalization and relocating hospital services. The master-plan, comprising different projects, will provide an overall view on the activities while ensuring an improved coordination between the various tasks, rationalizing expenses.

Figure 20. A view of Dr. Ambrosoli Memorial Hospital (photo credit Jessica Pepper-Peterson Photography).

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2016-2022 STRATEGIC PLAN

Strategic Objective 3.3 To ensure funding for additional capital investments. To implement the tasks and activities from Strategic Objective 3.1 and 3.2, a large amount of funding and capital investments will be needed. It will be essential to seek for external funding (both national and international) through the application to calls for proposals creating projects on health

infrastructures and equipment (maintenance, renovation, construction). Therefore, the establishment of a Fundraising Department with Research and Development Office (see Strategic Objective 2.1) will be fundamental for financial sustainability of this Strategic Goal.

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Strategic Objective 3.1: Activities, Tasks and Outputs ACTIVITIES 3.1.1 Assessment of the existing infrastructures 3.1.2 Renovation, maintenance and monitoring

TASKS To inventory the existing infrastructures, facilities and equipment, both medical and non-medical

OUTPUTS Outputs: ▪▪ Infrastructure assessment report

Assessing the quality and safety of actual infrastructures in accordance with national standards Develop a maintenance plan for Hospital’s infrastructure and equipment/machines, covering: ▪▪ Water supply ▪▪ Power supply ▪▪ Sewage system ▪▪ Waste disposal ▪▪ IT ▪▪ Motor vehicles Scheduling of preventive maintenance (PM) and corrective maintenance in accordance with safety and quality standards

Outputs: ▪▪ Infrastructure maintenance plan ▪▪ Infrastructure maintenance report Indicators: ▪▪ Fault and failure frequency (number of corrective maintenance tasks on the total amount of equipment/machine) ▪▪ % of planned activities of preventive maintenance completed (total number of completed tasks on planned tasks)

Update periodically the inventory produced Monitoring the quality and safety of actual infrastructures Maintenance training/re-orientation of staff Annual meeting 3.1.3 Programs Sourcing for funds to implement projects on equipment and diagnoson maintenance tic maintenance funding (see SO 2.1 Monitoring and evaluation of projects and SO 3.3) Annual reports production

Outputs: ▪▪ Number of projects applied ▪▪ Number of projects completed

Strategic Objective 3.2: Activities, Tasks and Outputs ACTIVITIES

TASKS

3.2.1 Project and To inventory the existing documents and plan of development action plan develWorking group creation opment Needs assessment and requirements analysis (see SO 3.1) and review of other plans e.g. “Staff Quarter – Report and way forward” master-plan (May-June 2016) and “Dr. Ambrosoli Memorial Hospital – Wash Report” (December 2016), focusing on: ▪▪ Water supply ▪▪ Power supply ▪▪ Sewage system ▪▪ Waste disposal ▪▪ IT

OUTPUTS Outputs: ▪▪ Number of plans and BOQs completed ▪▪ Number projects completed Indicators: ▪▪ % of construction, renovation and maintenance projects completed on time

Developing a comprehensive master-plan and action plan (with project plans, bill of quantities BOQs and time-line), based on the needs and requirements analysis and the existing plans Implementing the construction, renovation and maintenance projects.

Strategic Objective 3.3: Activities, Tasks and Outputs ACTIVITIES

TASKS

3.3.1 Funding resource (see SO 2.1)

Creation of Fundraising Department with Research and Development (R&D) Office Sourcing for funds to implement the infrastructural projects Monitoring and evaluation of the construction, renovation and maintenance projects Annual reports production

OUTPUTS Outputs: ▪▪ Number of plans and BOQs completed ▪▪ Number projects completed ▪▪ Monitoring and evaluation reports Indicators: ▪▪ % of construction, renovation and maintenance projects completed on time ▪▪ Fundraising activities (both national and international)

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2016-2022 STRATEGIC PLAN

Strategic Goal 3: Time-line SO 3.1: To develop a maintenance master plan to ensure that the hospital is able to continue delivering services. ACTIVITIES 3.1.1 Assessment of the existing infrastructures

TASKS

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

Infrastructure & equipment inventory Quality & safety of infrastructures

3.1.2 Renovation, maintenance Develop a maintenance plan and monitoring PM & corrective maintenance schedule Inventory periodically update Monitoring the quality & safety Maintenance staff training Annual meeting Sourcing for funds 3.1.3 Maintenance funding M&E of projects Annual reports production

SO 3.2: To develop a master plan and implement a clear action plan with priorities and mile stones. ACTIVITIES

TASKS

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

3.2.1. Project and action plan Documents & plan of development development Working group creation Review of plans & Needs assessment Developing masterplan and action plan Implementing the projects

SO 3.3: To ensure funding for additional capital investments. ACTIVITIES 3.3.1. Funding resource (see Strategic Objective 2.1)

TASKS Fundraising Department with R&D Office Sourcing for funds M&E of projects Annual reports production

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70 | SG4: TEACHING AND TRAINING SERVICES


2016-2022 STRATEGIC PLAN

SG4 Teaching and Training Services St. Mary’s Midwifery Training School has been nationally recognized for its standard of professionalism. It is one the finest midwifery training facilities in Uganda and has graduated 1,167 midwives so far. A professional midwifery education from St. Mary’s provides a firm foundation for a career in healthcare. The academic programs set the pace for the midwifery profession in Uganda, consistently producing high quality, high performing and competent midwives. The programs prepare students for professional practice positions in a variety of settings, capable of assuming leadership positions within a changing healthcare system. The school, which offers two academic programs, Diploma in Midwifery (DM) and Certificate in Midwifery (CM), operates in close cooperation with the hospital, thus creating a virtuous cycle, supporting medical training and activities To maintain its reputation and to upgrade and broaden its courses, the school needs to expand the teaching capacity, both by increasing the number of enrolled students and by a continuous and intensive further training of teachers, to ensure the quality standards so far achieved are maintained. The school is also geared to exploring new forms of organization in education, implementing a distance learning course program with the establishment of a Distance Learning Department. With the intention to provide an up-to-date education, the working group decided to complement the Diploma in Midwifery within the next six years with the establishment of a Bachelor’s Degree in Midwifery, ensuring that students gain valuable knowledge and specialist skills improving the country’s maternal health.

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DR. AMBROSOLI MEMORIAL HOSPITAL To achieve the Strategic Goal 4, the following three strategic objectives were developed: ■■ Strategic Objective 4.1: To expand the teaching capacity of St. Mary’s Midwifery Training School. ■■ Strategic Objective 4.2: To Ameliorate and upgrade the St. Mary’s Midwifery Training School to prepare the School for the Strategic Objective 4.3. ■■ Strategic Objective 4.3: Creation of the Bachelor’s Degree course in Midwifery at St. Mary’s Midwifery Training School.

These Strategic Objectives are strictly linked together and the first is propaedeutic to the second as the second is to the third. Next paragraphs describe how Dr. Ambrosoli Memorial Hospital aims to achieve Strategic Goal 4 and his objectives, together with a detailed definition of activities, tasks, outcome and indicators, and time-line at the end of the chapter.

Strategic Objective 4.1 To expand the teaching capacity of St. Mary’s Midwifery Training School. Strategic Objective 4.1 focuses on the Diploma in Midwifery (DM) and Certificate in Midwifery (CM). In order to accomplish this objective, the working group identified fundamental activities and tasks covering the following four areas: ■■ Students’ selection & admission. ■■ Teaching & learning. ■■ Staff appraisal & professional development. ■■ New forms of education organization (Distance Learning Department). Some of these will be adopted from the start of the next financial year, while others will be implemented and reviewed, if needed, over the following 5 years. The students’ selection and admission must be reviewed, guaranteeing a transparent and fair access process in the school for the students ensuring that access to higher education is open, reducing iniquities, along with an improvement in applicants’

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selection process (recruitment and selection procedures) selecting candidates with a strong academic record and ensuring quality teaching. Teachers and tutors are the main asset of the school and the fundamental resource for high-quality education provision. The school is committed to provide a workplace that values and supports employees offering adequate opportunities for personal and career development. Alongside, teaching programs and curricula will be reviewed and updated to meet the changing environment and the national standards. Exploring new forms of education through the foundation of a Distance Learning Department will be of help in expanding the teaching capacity of the School.


2016-2022 STRATEGIC PLAN

Strategic Objective 4.2 To Ameliorate and upgrade the St. Mary’s Midwifery Training School to prepare the School for the Strategic Objective 4.3. Over the next 5 years, the school also intends to ameliorate and upgrade the St. Mary’s Midwifery Training School preparing the creation of Bachelor of Science degree in Midwifery (B.Sc. midwifery degree course). This Strategic Objective will be pursued by operating both on employees, through the improvement of the teaching staff and the acquisition of new human resources, and on infrastructures, planning the foundation of a new Campus creating dynamic teaching and learning environments with state-ofthe-art facilities in line with the NCHE requirements and criteria. One of the focuses of this strategic objective is the improvement of the teaching staff through a continuous and intensive further training of teachers and the creation of a network with other

institutions offering the degree (e.g. Nsambya and Lira) for teacher exchanging program. The institution of the Bachelor of Science degree in Midwifery is a challenging objective, even at a medium-term horizon, that requires a lot of work and financial support, but is in line with the visions of the School and the Institution. The development of a Master Plan for the new Campus is advised to help the organization’s management to implement the project. Fundraising activities will be of help, especially for the creation of the new Campus, with new buildings for teaching classrooms, mixed activities facilities (computer lab, library, microbiology lab, education lab and training manikin lab), administration area and students’ facilities, to meet the strict NCHE infrastructural requirements.

Figure 21. A moment in the St. Mary’s Midwifery Training School (photo credit Jessica Pepper-Peterson Photography).

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Figure 22. Tutoring in the maternity ward (photo credit Jessica Pepper-Peterson Photography).

Strategic Objective 4.3 Creation of the Bachelor’s Degree course in Midwifery at St. Mary’s Midwifery Training School. Strategic Objective 4.3 is focused on the program conceptualization by a planning committee and the accreditation to teach of the Bachelor of Science degree in Midwifery (B.Sc. midwifery degree course) following the requirements from NCHE. Entrants to the midwifery degree course will have to be holders of diplomas in midwifery, coming both from the Diploma in Midwifery of St. Mary’s Midwifery Training School or from external institutions, and recognized by the Uganda Nurses and Midwives Council. The Bachelor of Midwifery Science program will cover two academic years, clustered in five semesters and will be helpful in improving the country’s maternal health, enhancing

74 | SG4: TEACHING AND TRAINING SERVICES

the student’s ability to use evidence-based and community-oriented approaches to provide a responsive midwifery care to the needs of the community in both rural and urban settings. The degree course, articulated in theoretical experience and clinical training, will extend the experience, the knowledge and the skills and practice of the midwives in complex maternity care. Graduate midwives will be equipped with more knowledge, attitudes and skills. In fact, this program aims to improve midwives to a higher educational level, preparing them to exercise critical thinking and decision in the provision of complex, broad and integrated reproductive health practice.


2016-2022 STRATEGIC PLAN

Strategic Objective 4.1: Activities, Tasks and Outputs ACTIVITIES 4.1.1 Students selection & admission

TASKS

OUTPUTS Outputs: ▪▪ Number of students on admission list.

Advertising, inviting applicants for training Reviewing applications Preparing for interviews

Indicators: ▪▪ % of increase in number of students admitted per course each year

Conducting interviews Communicating interview results 4.1.2 Teaching & learning

Setting minimum standards for teaching staff and students’ performances Acquisition of teaching & learning materials Development of teaching plans & preparing to teach, train, mentor Teaching, training & mentoring of students

Outputs: ▪▪ All students enrolled for each course achieved the required level of competency in the final end-of-course examinations Indicators: ▪▪ % of candidates who passed the final end-of-course examinations

Monitoring & Evaluation of teaching & learning processes 4.1.3 Staff appraisal & professional development

Outputs: ▪▪ At least 80% of teaching/non-teaching staff members satisfied with processes and outcomes of their performance appraisals. ▪▪ Upgraded qualifications of teaching staff.

Preparing for staff appraisal Performance review meetings with individual staff members Coaching & Mentoring of staff Obtaining, offering, supporting staff career development opportunities

4.1.4 Distance Learning Department

Creation of a Department for Midwifery e-learning Diploma for development, implementation and continuous monitoring of the diploma Development of the e-learning Curriculum (or adaptation of the current one), providing suitability for distance learning

Indicators: ▪▪ % of staff members satisfied with the processes and outcomes of their respective performance appraisals. ▪▪ % of teaching staff undergoing training to upgrade qualifications ▪▪ % of teaching staff who upgraded their qualifications. Outputs: ▪▪ E-learning Curriculum for midwifery training diploma ▪▪ Production of learning materials Indicators: ▪▪ % of students who undergone distance learning midwifery training diploma (compared to the current diploma) ▪▪ % of student who completed distance learning diploma (compared to the current diploma) ▪▪ % of students in first class (A) and second class upper division (B+) according to their GPA scores (compared to the current diploma)

Creation of learning materials (e.g. essential textbooks, lecture notes) for distance learning Definition of on-site internship training at Dr. Ambrosoli Memorial Hospital (Kalongo) Definition of examination regulations and procedure Periodic students’ satisfaction surveys (at least 1 per semester)

Strategic Objective 4.2: Activities, Tasks and Outputs ACTIVITIES 4.2.1 Improvement of the teaching staff and acquisition of new human resources

TASKS

OUTPUTS

Upgrade the educational levels of existing teaching staff Recruitment of external human resources (teaching and non-teaching staff) Development of a network with nearby institutions

Outputs: ▪▪ At least 80% of teaching staff upgraded their qualifications. ▪▪ Creation of a network with other institutions offering the degree (e.g. Nsambya and Lira) for teacher exchanging program ▪▪ Recruitment of new teaching staff to meet the NCHE accreditation criteria (see SO 4.3 and references). Indicators: ▪▪ % of teaching staff undergoing training to upgrade their qualifications. ▪▪ % of teaching staff who upgraded their qualifications.

4.2.2 Infrastructure and Campus

4.2.3 Teaching and learning

Creation of a new Campus outside the area of St. Mary’s Midwifery Training School (see SO 4.3): ▪▪ Acquisition of land for construction of the new campus. ▪▪ Construction of new buildings for teaching classrooms, mixed activities facilities (computer lab, library, microbiology lab, education lab and training manikin lab) and administration area. ▪▪ Construction of dormitory with kitchen facilities for the students.

Outputs: ▪▪ Building and construction plan. ▪▪ Construction of the new campus site meeting the NCHE accreditation criteria – see SO 4.3 and references.

Creation of the new degree curriculum

Outputs: ▪▪ Creation of the new 4 years’ degree curriculum meeting the NCHE accreditation criteria (see SO 4.3 and references)

Enrolment of former Midwifery Training School in the degree program.

Indicators: ▪▪ % of NCHE accreditation criteria satisfied

Indicators: ▪▪ % of NCHE accreditation criteria satisfied.

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Strategic Objective 4.3: Activities, Tasks and Outputs ACTIVITIES 4.3.1 Obtaining accreditation to teach B.Sc. midwifery degree course

TASKS

OUTPUTS

Program conceptualization.

Outputs: ▪▪ B.Sc. Degree Program Conceptualization draft, meeting the mission of St. Mary’s midwifery School and considering NCHE criteria.

Formation of a planning committee that develops a formal and detailed program including the B.Sc. Curriculum meeting the NCHE requirements and minimal standardsa: ▪▪ Infrastructure and equipment ▪▪ Minimum number and qualification of teaching staff ▪▪ Students’ Admission Policy and selection criteria. ▪▪ Development of procurement programs (duration and contact hours) ▪▪ Examination regulation and standardization of awards ▪▪ Teaching and learning (learning materials and equipment) ▪▪ Internship training

Outputs: ▪▪ Proposal of the final version of the B. Sc. Degree program meeting the NCHE requirements and minimal standards (see references) Indicators: ▪▪ % of NCHE accreditation criteria satisfied

a. see references for further details of NCHE requirements and minimal standards.

Preparation and submission of formal proposal for accreditation to NCHE (see references)

Outputs: ▪▪ Proposal approved by Hospital Management Team & by the Board of Governors. ▪▪ Accreditation of the B.Sc. Degree program obtained (accreditation certificate obtained). Indicator: ▪▪ % of NCHE accreditation criteria satisfied

Signing collaboration agreement with established educational institution(s) offering similar course

Outputs: ▪▪ MoU signed with an established education institution(s) for joint implementation of the B.Sc. Degree course. Indicators: ▪▪ Number of collaboration agreement obtained during 2021-2022

Figure 23. Waiting for the delivery (photo credit Jessica Pepper-Peterson Photography).

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2016-2022 STRATEGIC PLAN

Strategic Goal 4: Time-line SO 4.1: To expand the teaching capacity of St. Mary’s Midwifery Training School. ACTIVITIES

TASKS

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

4.1.1. Students selection & Advertising/inviting applicants admission Reviewing applications Preparing for interviews Conducting interviews Communicating interview results 4.1.2. Teaching & learning

Setting standards for staff and students Acquisition of materials Teaching plans Teaching and training of students M&E of teaching&learning processes

4.1.3. Staff appraisal & professional development

Preparing for staff appraisal Performance review meetings with staff Coaching&Mentoring of staff Obtain&offer staff career development

4.1.4. Distance Learning Department

Creation of a Department for e-learning Definition of e-learning Curriculum Creation of learning materials Definition of on-site internship training Examination regulations and procedure Periodic students’ satisfaction surveys

SO 4.2: To Ameliorate and upgrade the St. Mary’s Midwifery Training School to prepare the School for the Strategic Objective 4.3. ACTIVITIES 4.2.1. Staff’s improvement, human resources

TASKS

2016-2017

2017-2018

2018-2019

2019-2020

2020-2021

2021-2022

2018-2019

2019-2020

2020-2021

2021-2022

Upgrade teaching staff Recruitment of human resources Network with nearby institutions

4.2.2. Infrastructure and Campus

Acquisition of land Construction of new buildings Construction of dormitory Creation of a new Campus

4.2.3. Teaching and learning

Creation of the new degree curriculum Enrolment of students (from Diploma)

SO 4.3: Creation of the Bachelor’s Degree course in Midwifery at St. Mary’s Midwifery Training School. ACTIVITIES

TASKS

2016-2017

2017-2018

4.3.1. B.Sc. midwifery degree Program conceptualization accreditation Formation of a planning committee Proposal for accreditation to NCHE Collaboration agreements w/ institutions

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78  |  MONITORING & EVALUATION


2016-2022 STRATEGIC PLAN

8 Monitoring & Evaluation Monitoring and evaluating the status of implementation of the plan is as important as identifying strategic issues and goals. As we put our Strategic Plan into action and bring it to life across the organization, it will be essential to continuously monitor and measure progresses through a clearly defined monitoring and evaluation system, ensuring that the hospital is following the direction established during strategic planning with a results-based management approach (focusing on both processes and results, hence the emphasis on quality in service delivery). The strategic plan is intended to cover a six years’ period, which will be translated into annual plans of action before the end of every financial year. In order to stay on track, we have to ensure the appropriate mechanisms are in place to tell us if we are making progress and if new approaches are required to achieve our goals. Thus, the implementation of the plan will be evaluated annually, and a midterm review shall be undertaken 3 years after launching, putting in place, if needed, corrective measures or new thinking and actions to address new challenges. Monitoring and evaluation helps improve performance and achieve results, providing timely and accurate data. There are two distinguished moments: ■■ Monitoring, the set of detection devices (performance indicators) and data. ■■ Evaluation, critical interpretation of the measured data. The M&E process will serve as a framework for measuring the organizational performance and the success of our strategy and for tracking progress, supplemented by key targets and metrics (performance indicators). The Strategic Plan is a guideline,

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BOX 1: Key Questions on Status of Implementation 1. Are goals and objectives being achieved or not? If they are, then acknowledge, reward and communicate the progress. If not, then consider the following questions. 2. Will the goals be achieved according to the timelines specified in the plan? If not, then why? 3. Should the deadlines for completion be changed? 4. Do personnel have adequate resources (money, equipment, facilities, training, etc.) to achieve the goals? 5. Are the goals and objectives still realistic? 6. Should priorities be changed to put more focus on achieving the goals? 7. Should the goals be changed? 8. What can be learned from our M&E to improve future planning activities and also future M&E efforts?

not a set of strict rules which must be followed: the hospital might end up changing its course as it proceeds through the years, and M&E allows the management to recognise and understand reasons for changes and update of the plan to reflect the new directions. Deviations from the plan usually result from changes in the hospital’s external environment (e.g. introduction of new health policies, modifications in the pattern of diseases), changes in the availability of resources and funding to carry out the original plan, etc. M&E will be a multi-step process carried out by the following activities: ■■ Action Plan: the working groups will be responsible of their Strategic Goals and their implementation, translating each Strategic Objective in plans of action before the end of every FY. It will include budget analysis. ■■ Monitoring: the working groups will be responsible of collecting data during the implementation of tasks and activities on a monthly basis, quarterly reporting the status of the implementation and achievements of

80  |  MONITORING & EVALUATION

objectives to the chief, including progress toward each of the overall strategic goals. During monitoring, the working groups should answer to the key questions in Box 1. ■■ Annual Activity Report: annually, each WG will monitor and assess progresses and achievements of their plans of action using dedicated performance indicators and outcomes. This assessment will produce an Annual Activity Report, where to describe achievements and to explain failure and their reason (e.g. activities not implemented or partially revised for financial issues or external changes) including the four key points explained in Box 2. The WGs will be monitored and oversee by the Hospital Management Team. The Annual Activity Report will be part of the Annual Analytical Report and will serve as a guide for the translation in action for the subsequent FY. ■■ Mid-term review: after three years (end FY 2018-19), a mid-term review will be undertaken. Data collected from the previews Annual Activity Report, will be extensively discussed and analysed by the Working Groups and then will be presented to the Stakeholders. This will be a moment of review of the strategic plan, to identify and resolve critical issues in plan’s implementation and targets’ achievements, adjusting strategies or fine-tuning implementation,

BOX 2: Reporting Results of M&E 1. Answers to BOX 1 key questions while monitoring implementation. 2. Trends regarding the progress (or lack thereof) toward goals, including which goals and objectives 3. Recommendations about the status 4. Any actions needed by management


2016-2022 STRATEGIC PLAN and understanding reasons for deviations and update of the plan to reflect the new directions. If needed, an addendum of the Strategic Plan will be produced covering minor or major reviews, embracing: the changes to goals, objectives, responsibilities and time-lines, what is causing changes to be made and why the changes should be made. ■■ Final evaluation and Report: the final evaluation will take place after six years (first semester FY 2021-22) and will cover an analysis of data and indicators from the Strategic Goals and their critical interpretation, underlining accomplishments and failures and explaining their motivation. ■■ New Strategic Plan: the new Strategic Plan will be elaborated from the results of the Final Report in FY 2021-22 (second semester). To help in the monitoring and evaluation process, a list of relevant key targets and metrics (performance indicators) was developed, covering the four Strategic Goals. The set of performance indicators (see Box 3 aside), chosen among the list of indicators (see appendix) have been designed to meet the following criteria: ■■ Direct: an exact measure of each result. ■■ Objective: unambiguous about what is to be measured and how. ■■ Adequate: represent the minimum number required to capture the result. ■■ Practical: data can be collected in a timely and cost-effective manner. Alongside, the Annual Analytical Report and its set of data and indicators will be an important tool for monitoring the implementation of the Strategic Plan. The Analytical Report will be presented, along with the Activity Report, to the Hospital Management Team and to the Hospital Board of Governors and, together with indicators of M&E

and the Annual Activity Report, will be useful for review and making strategic decision. SG1: Health Care Service Delivery ▪▪ % of HIV+ people on ART (for 6 months) with suppressed viral load (UNAIDS target) ▪▪ % of neonatal asphyxia ▪▪ % of people living with HIV receiving ART (UNAIDS target) ▪▪ % of people with HIV knowing their status (UNAIDS target) ▪▪ % of pregnant women who attended ANC service 4 times (or more) ▪▪ % of properly filled WHO Surgical Safety Checklist over the number of surgical procedures performed ▪▪ % of staff trained and re-orientated each year ▪▪ % stock-out of 10 tracer indicator drugs/month ▪▪ Immunization coverage per disease (see UNEPI) ▪▪ Maternal mortality ratio ▪▪ Neonatal mortality ratio ▪▪ Stillbirth rate SG2: Institutional Development ▪▪ Sustainability Ratio ▪▪ % of patient satisfaction levels ▪▪ % of staff satisfaction levels ▪▪ % projects completed on proposed SG3: Infrastructure renovation and maintenance ▪▪ Fault and failure frequency ▪▪ % of construction, renovation and maintenance projects completed on time SG4: Teaching and training services ▪▪ % of candidates who passed the final end-ofcourse examinations ▪▪ % of teaching staff who upgraded their qualifications ▪▪ % of NCHE accreditation criteria satisfied Table III. Indicators for Monitoring and Evaluation.

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9 Concluding remarks The Strategic Plan sets Dr. Ambrosoli Memorial Hospital’s vision for the next six years, reflecting the need to continue providing quality health care to the people of Kalongo and Agago district. The plan is far reaching, ambitious and aims to significantly improve health services delivery, institutional and human resources development, renovation and maintenance of infrastructures and upgrade of St. Mary’s Midwifery Training School. The vision and the strategic priorities were defined through a participatory process, recognising the importance of the stakeholders, primarily the hospital’s patients. Stakeholders helped to improve our approach to deliver higher quality of care, and improve the accessibility and sustainability of services and the hospital, together with a new and unprecedented level of partnership with other providers in the community. This plan represents a pathway to the future of the hospital, a guide to prioritization and a framework for progress and development that will lead us in the next six years, giving instruments that can help us facing new challenges. It will be monitored, reviewed and revised by the staff, stakeholders and experts who wrote it in first place, continuing that participatory process designed for its creation. The plan will not achieve success unless these strategic goals are widely communicated and incorporated into the day-to-day activities of the Hospital and translated into plans of action before the end of every FY. We will monitor our performance throughout the year and adjust as needed to achieve the desired results. At the core of our strategy is the financial sustainability of Dr. Ambrosoli Memorial

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DR. AMBROSOLI MEMORIAL HOSPITAL Hospital: in fact, the conditio sine qua non to accomplish the Strategic Plan and to achieve its goals and objectives, is represented by the availability of sufficient resources. The current funding for health services is still inadequate compared to the needs; therefore, it is crucial to sustain the current levels of support and to identify new sources of funding: the establishment of a Fundraising Department with Research and Development Office will oversee maintaining financial sustainability over time and promoting a constant development of the hospital. Given that the strategic plan is more a guideline

rather then set of rules and might end up changing its course as it proceeds through the years, the budget will be estimated yearly (during the last quarter of every FY) reflecting the plans of action from the working groups. Our future success depends on every one of us working together and supporting each other in the future direction of the hospital. We will work with our partners, patients, families, providers and our community to achieve our vision.

Figure 24. The staff of Dr. Ambrosoli Memorial Hospital (photo credit Jessica Pepper-Peterson Photography).

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References Uganda Bureau of Statistics - National Population and Housing Census, 2014. Ministry of Finance, Planning and Economic Development (Republic of Uganda) - Poverty Status Report, November 2014. Dr. Ambrosoli Memorial Hospital - Annual Analytical Report, 2016. Ministry of Health (Republic of Uganda) - Annual Health Sector Performance Report 2015-16. Ministry of Health (Republic of Uganda) - Health Sector Development Plan (HSDP) 2015/16 - 2019/20. United Nations (UN) - Sustainable Developments Goals (SDG) - www.un.org. United Nations (UN) - Implementing the Millennium Development Goals: Health Inequality and the Role of Global Health Partnerships. Joint United Programme on HIV and AIDS - www.unaids.org. UNAIDS - 90-90-90 An ambitious treatment target to help end the AIDS epidemic. UCMB - ACT Program (AIDS Care & Treatment). WHO - Guidelines for safe surgery, 2009. WHO - Global Status Report on Non-Communicable Diseases, 2014. Ministry of Health (Republic of Uganda) - Uganda National Expanded Program on immunisation (UNEPI) Guidelines - www.health.go.ug/content/unepi-immunization-guidelines. WHO - Guide for the Stepwise Laboratory Improvement Process Towards accreditation in the African Region (SLIPTA). WHO - Essential Medicines and Health Supplies List for Uganda (EMHSLU), 2012. WHO Medical device technical series - Introduction to medical equipment inventory management, 2011. Dr. Ambrosoli Memorial Hospital - Staff Quarter Report and way forward Masterplan, May-June 2016. Dr. Ambrosoli Memorial Hospital - Wash Report, December 2016. Uganda National Council for High Education (NCHE) - www.unche.or.ug. Uganda NCHE - Statutory instruments no. 35. “The Universities and other Tertiary Institutions (Basic Requirements and Minimum Standards for Procurement Education and Training) regulations”, 2008. Uganda NCHE - Statutory instruments no. 80 B. “Checklist of Quality and Universities Capacity indicator for Assessment of Universities and Programmes”. Uganda NCHE - Statutory instruments no. 80 C. “Application for Provisional Licence to Establish and Operate a Private University”.

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List of indicators 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32.

SG1: Health Care Service Delivery % of births delivered by C-section % of births in the Hospital over the total birth in the district % of deaths on surgical patients % of exposed infants tested for HIV % of family satisfaction levels on palliative care % of HIV-positive newborns from HIV-positive mothers % of HIV+ clients enrolled in DSDM (target by 2022: 50%) % of HIV+ people on ART (for 6 months) with suppressed viral load (UNAIDS target: 90%) % of HIV+/TB cases starting ART within 2 months % of hospitalized patients for mental health diseases (over OPD admission for the same issues) % of mothers tested for HBV during pregnancy (ANC) or delivery % of mothers tested for HIV during pregnancy (ANC) or delivery % of neonatal asphyxia % of new investigation performed over the total number of investigations % of newborns from HBV-positive mothers vaccinated from HBV at birth [target SDGs 95% decline in new cases of chronic HBV infection between 2010 and 2030] % of newborns of received post-natal care within 48 hours % of patient satisfaction levels on palliative care % of patients’ admission for alcohol abuse % of people living with HIV receiving ART (UNAIDS target: 90%) % of people with HIV knowing their status (UNAIDS target: 90%) % of post C-section infections % of pregnant women who attended ANC service 4 times (or more) % of pregnant women who attended ANC service at least once % of pregnant women who did not attend ANC service % of pregnant women who received Intermediate Preventive Treatment for Malaria (IPT) during ANC visit % of properly filled WHO Surgical Safety Checklist over the number of surgical procedures performed % of puerperal fever/sepsis % of staff satisfaction levels on palliative care % of staff trained and re-orientated each year (at least 20-25% per year) % of surgery-related infections % of surgical wound infection % of transferred patient to other facilities

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DR. AMBROSOLI MEMORIAL HOSPITAL 33. % of women currently using modern natural Family Planning methods (i.e. LAM, TDM, SDM) 34. % SLIPTA score on on-site audit following their tiers of recognition (target: reach 5 stars rating in 2021-2022) 35. % stock-out of 10 tracer indicator drugs per month (essential drugs which run out more frequently e.g. malaria treatment or antibiotics) 36. HIV incidence (SDG target: reduce the annual number newly infected with HIV by 90%) 37. HIV/AIDS-related mortality rate (SDG target: reduce the annual number of people dying from AIDS-related causes by 80%) 38. Immunization coverage per disease (see UNEPI reference) 39. Indicators from annual analytical report (e.g. admissions, deaths, deliveries…) 40. Maternal mortality ratio: 50% reduction by 2022 (2015-2016: 116 per 100,000 live births, SDG target: less than 70 deaths per 100,000 live births) 41. Neonatal mortality ratio: 20% reduction by 2022 (2015-2016 9.9 per 1000 live births, target SDGs: less than 12 per 1000 live births) 42. Number of admission for dental, eye or ENT diseases in OPD 43. Number of attendances for mental health diseases in OPD 44. Number of women who received PAC 45. Stillbirth rate: 20% reduction by 2022 (2015-2016 13.27 per 1000 live births, target: 12 deaths per 1000 total births) SG2: Institutional Development 1. % of P4P Indicators and Criteria achieved each year 2. % of new hired over new candidatures 3. % of patient satisfaction levels 4. % of staff satisfaction levels 5. % projects completed on proposed 6. Fundraising activities (both national and international) 7. Number of new candidatures 8. Panel of indicators (quality, P4P) 9. Sustainability ratio SG3: Infrastructure renovation and maintenance 1. Fault and failure frequency (number of corrective maintenance tasks on the total amount of equipment/machine) 2. % of planned activities of preventive maintenance completed (total number of completed tasks on planned tasks) 3. % of construction, renovation and maintenance projects completed on time 4. Fundraising activities (both national and international) SG4: Teaching and training services 1. % increase in number of students admitted per course each year. 2. % of candidates who passed the final end-of-course examinations 3. % of NCHE accreditation criteria satisfied 4. % of staff members satisfied with the processes and outcomes of their respective performance appraisals. 5. % of student who completed distance learning diploma (compared to the current diploma) 6. % of students in first class (A) and second class upper division (B+) according to their GPA scores (compared to the current diploma) 7. % of students who undergone distance learning midwifery training diploma (compared to the current diploma) 8. % of teaching staff undergoing training to upgrade their qualifications. 9. % of teaching staff who upgraded their qualifications. 10. Number of collaboration agreement among institutions offering the degree obtained during 20212022

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with the contribution of

Strategic plan completo compresso  

Pubblichiamo il piano strategico 2016 -2022 del Dr. Ambrosoli Memorial Hospital che comunica la visione strategica e gli obiettivi dell'Ospe...

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