FIVE FOUNDATIONAL PILLARS FOR LMICS (THE PILLARS COLORED WHITE) – CRITICAL FOR LMICS, INCLUDING NIGERIA:
demonstrates Political Will and National Prioritisation of Health e.g. Nigeria National Health Act 2014 – IMPLEMENTED TO A UNIFIED HEALTH SYSTEM.
Facility Leadership and Governance. A Health in All Policy Policy (HiAPP) ensure that all 12-Pillars are inter-related and complementary.
Model suitable for LMIC - Mandatory National Health Insurance Scheme, (optional Community Based Health Insurance Scheme); (Private Health Insurance Schemes);
Special Health Intervention Fund ( from special taxes / levy – so-called ‘sin taxes’ after products that promote ill-health including – tobacco, alcohol, mineral exploration, );
Sector Wide Approach (SWAP) – Pooled Donor Funds. ( Exemption of selected groups- disabled, unemployed, mentally ill, etc is key to UHC). NB: Ring-fenced provision e.g. Basic Health Care Provision Fund (BHCPF) for Primary Health Care to achieve Universal Health Coverage (UHC)
Pre facility -Access roads and other forms of transportation, Emergency Ambulance Service
( distinct from NEMA/SEMA). ‘Ambulances carry Living patients NOT dead bodies ( which should carried by Hearses)
Basic equipment in all health facilities Advanced equipment in selected facilities
Utilities and Ambience
mandatory ‘WASH’ Principle - 24/7 Potable Water, 24/7 Electricity ( National Grid / Generator / Solar,etc), Clean and Green environment
SEVEN PILLARS FOR LMICS (THE PILLARS COLORED BLUE) FOR ALL COUNTRIES, RICH AND POOR:
Education and Training
mandatory - Every Health practitioner must engage in: Continuing Professional Development (CPD), Employer-sponsored, management-led in the Health Facilities,
Professions support, practitioners comply to be up-to-date, Not an extra, not a chore. Part of all staff job description. ‘’If you stop learning and training, stop seeing patients’’
‘’measuring your practice against Best Global / National standards’’, Clinical Audit Cycle – individual /group reflective practice on
(both clinical and non clinical personnel), Not an extra, not a chore. Differentiates practitioners from quacks!, should be part of all staff job descriptions.
‘No Audit, No Quality’!!
A measure of ‘fit-for-purpose’ – is the intervention appropriate?, does the intervention work and to what extent?, does it represent value for money?, Continuous
Quality Refinement (CQR) following emerging evidence for: safe, effective, caring, patient centered, cost- efficient, timely interventions. Consultation and Communication
knowledge and skills for Patient Centered Care (PCC).
Staff and Staff Management
‘No matter how beautiful the buildings in hospitals and health facilities, and No matter how sophisticated the equipment, the critical
factor in delivering quality and safe care; preventing and reducing mortality and morbidity is: the ATTITUDE AND BEHAVIOR of the Health
care providers, their KNOWLEDGE,SKILLS, EXPERTISE.’ ‘’protecting patients, and supporting health workers, both aspects practised and delivered in tandem’’.
IT IS FOR ALL HEALTH CARE PROVIDERS: SPECIALIST AND GENERALIST DOCTOR, NURSE, PHARM, LAB Sc., COMMUNITY HEALTH PRACTITIONER, NON CLINICAL STAFF, ADMINISTRATOR, others
(multidisciplinary, multispecialty, multisectoral).
Patient and Public involvement (PPI):
openness & transparency to make facility consultation rooms, wards and theatres and the facility into Transparency Centres for
building public confidence, trust and support for our professions of health and the health system.
: Bad attitude and Behaviour, Poor practice and performance thrives behind ‘secrecy’, Lack of Confidentiality and Consent, Patients Charter of Rights and Responsibilities,
Practitioners Charter of Duty of Care and Rights.
Proactive and Premptive Risks to patients, Risks to practitioners, Risks to the organisation (system) / facility, Risk to Society /
Public. Risk Guarantors - Political Will, Policy / Strategy /Implementation, Funding, Adequate static Infrastructure, Data Infrastructure,
Utilities/Equipment/tests/Drugs/Waste, Standards / Capacity/capability, etc, Manpower–number, distribution, welfare, Security – patient/staff/users/facility,
compliance to Standard Operating Procedures (SOPs) Evidence-informed Guidelines, Frameworks, and Supervision/ Mentoring/ Inspection and Monitoring / Evaluation (SSMM&E).
Information / Communication Management
Promote Electronic Held Patient Record system, thereby making controlling clinical and non clinical errors, at every point in information
management continuum: collection, collation, analysis , reports and dissemination.
subsets: I Equipment, connectivity, & competent personnel, Patient records (analogue Vs digital), use of information within healthcare systems , Information for All – patients,
families, carers, Telemed, eHealth, mHealth, social media (Tweet, Facebook, Youtube, Instagram, etc), Zoom, Skype, etc. Subset II: RESEARCH FOR IMPROVEMENT (RFI)
Good professional practice emphasis on capacity to, carry out Clinical Research, write and publish in peer reviewed major journals, critically appraise research publications,
implement / use the result, formulate evidence informed guidelines and Protocols