Table of Contents
Chapters
- Understanding the Concept
- Evidence-Based Practices
- Adaptability
- Links with Other Services
- Minimizing Paperwork
- Physical Factors
- Service Hours and Scheduling
- Client Flow
- Division of Labor and Job Design
- Social Factors
- Implementing the Concept
- Bibliography
This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.
Published by the INFO Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.
Volume XXXII, Number 1,
Winter 2004
Series Q, Number 2
Maximizing Access to Quality
| Facility | |
5 |
Physical Factors |
The physical factors that need to be managed for better organization of work include both the supplies and equipment needed to provide care and the facility space in which people work. Health care staff can make the best of resources at hand when they are resourceful. Both providers’ and clients’ convenience should guide the use of available clinic space.
Principles of Physical Factors
Principles in Action Turkey: “Topping Up” Contraceptive SuppliesIn 1996 the Maternal and Child Health/Family Planning Directorate of the Turkish Ministry of Health adopted a plan to improve contraceptive availability. They developed a contraceptive distribution system known as “Top-up” to regularly replenish IUDs, oral contraceptives, and condoms throughout 22 high-priority provinces in the country. In this system specially trained distribution officers visit each clinic in the 22 provinces at four-month intervals. At each clinic the distribution officer counts the number of supplies on hand, calculates the average monthly consumption for the previous four months, uses this number to estimate needs for the next four months, and “tops up” the supplies to this amount. The officer also inspects the clinic’s storage facility and suggests ways to correct problems. A 2000 evaluation of the system found many benefits. Damaged and expired stock had been identified and removed, and storage conditions had improved. Contraceptive stockouts had been reduced substantially and in some cases eliminated entirely. Distribution of contraceptives to clients had increased greatly, too (116). |
Encourage staff to be resourceful about supplies and equipment. Worldwide, virtually every health care organization faces resource shortages, whether in funding, equipment, medical supplies, or other items needed to deliver care. Resourceful organizations do not let such constraints prevent them from doing the best they can. Resourcefulness means finding creative ways to solve problems with the resources at hand. For example, when beds were in short supply at a hospital in Tanzania, staff repaired damaged beds by welding locally available wire mesh to bed frames (30). In Mongolia during a severe winter, hospital staff sealed the windows to keep out the cold, sewed hats for newborns, and appealed to a local company to donate warm clothes and blankets (52).
Water and electricity are often in short supply. Clinics can instead collect rainwater and can use gas or firewood for heating or use solar power systems where feasible for heating and refrigeration (8, 74, 80). At a rural health center in Cambodia, the local water pump was broken. The clinic could obtain water from a nearby well and from a rainwater storage tank. But the well water was muddy, and the storage tank had no cover, allowing dust and mosquitoes to contaminate the water. To assure safe water, community members built a wooden cover for the storage tank, while the clinic made plans to dig a new well (92).
Ensuring adequate stocks of contraceptives, medicines, and other essential supplies is even more important (53, 97). To keep supplies continuously in stock, clinics need good supply management strategies (101) (see box right). Setting up emergency procedures can help (see Plan for common fluctuations in health care delivery in chapter 3). Also, staff members who are responsible for estimating and obtaining supplies need to communicate with front-line providers, who best know their clients’ needs, in order to obtain products that clients are likely to want.
Principles in Action Brazil: Organizing Space to Improve ServicesIn 1996 the director of the health unit in Camaçari, Brazil, reorganized the clinic to place related services nearer together. Previously, services were organized haphazardly across the four wings of the clinic, which was shaped like a capital “H.” The unit was redesigned to make each of the four wings into a separate service area—childcare, adult care, women’s services, and administration, where offices, meeting rooms, a kitchen, and dining area for staff were created. The reorganization reduced client and provider traffic, improved infection prevention, and made working at the clinic more pleasant and productive. For example, the sterilization room was moved to the end of the administration wing so that fewer people passed through or near it. This change reduced the risk of passers-by contaminating sterilized equipment. Access to the pharmacy was changed to an outdoor entrance only. This change eliminated the congestion caused by people waiting inside the building for medicines or contraceptives (95). |
Tailor clinic space to clients’ and providers’ convenience. Clients prefer clinics that are clean, organized, and comfortable (96). Often, simple, inexpensive solutions to problems can make the clinic setting friendlier to clients. Efforts to make visiting clinics more convenient for clients and to arrange waiting areas that reflect gender and cultural norms help clients feel comfortable. For example, a children’s corner and activities can keep children occupied while their mothers receive care. Where husbands accompany their wives but by custom cannot enter the clinic itself, a separate waiting area and educational materials can encourage couples to visit the clinic (52).
Redesigning the work space can ensure more privacy for clients through such changes as repositioning the examining table so that clients’ feet do not face the door, using screens and curtains, and minimizing traffic around examining areas. Moving door hinges so that examining room doors swing outward also can increase privacy (12).
Rearranging clinic space can help staff work more easily. For instance, the proximity of staff members’ work areas can affect the ease and time it takes to perform procedures. Moving the steps in a process closer to each other helps staff pass work directly from one step to the next, improving efficiency (94) (see box right).
