Blood samples left on window sills. Medical waste thrown in cardboard boxes. Uncovered pit latrines. Rusty equipment laying on floors. Those were but a few of the unsafe and unsanitary conditions found in health centers in two districts in Uganda when Jhpiego, in partnership with Ugandan health authorities, began working there to help improve infection prevention practices in facilities in the Mbarara and Isingiro Districts of the East African country.
With generous support from the General Electric (GE) Foundation and leadership from the Ministry of Health and district health officials, good things have indeed come to life.
Today, more than 41 health care providers at 12 facilities have been trained in infection prevention procedures, and standards to measure progress have been established since Jhpiego and their partners first did an assessment there in 2008. The trained provicers have in turn shared their knowledge and best practices with colleagues so that health care workers initiate changes, carry out improvements and sustain them. Through the introduction of Jhpiego’s pioneering quality management approach—Standards-Based Management and Recognition (SBM-R)—improvements at the facilities are both visible and measurable. Now, there are covered waste disposal bins, clean equipment, correct storage of blood samples, pits for burning waste, improved hand washing and better access to injection safety boxes.
In addition, by introducing the SBM-R methodology, Jhpiego institutionalized a continuous performance and quality improvement process to ensure that the transfer of knowledge and skills acquired through training takes place in a facility that provides services to standard.
At Mbarara Regional Referral Hospital, for example, checklists have been developed to evaluate the cleaning staff, posters of Infection Prevention Tips have been put up and the last Saturday of every month has been designated as the day the staff thoroughly clean the maternity ward, an area that had been prone to infections.
As nurses Lubega Agiri and Mubiru Hope told Jhpiego’s representatives, “Where there is a will, there’s a way.’’
GE Foundation’s role in the infection prevention work in Uganda is but one example of Jhpiego’s efforts to build and promote public-private partnerships. Jhpiego has worked with a range of global health partners including multinationals such as ExxonMobil and companies closer to home, such as Ellicott Dredges, LLC, in Maryland.
ExxonMobil Foundation has been supporting Jhpiego’s work in Angola and Nigeria. In Nigeria, the focus has been malaria prevention among pregnant women and those efforts have reached 28,000 women. Ellicott Dredges, a Baltimore manufacturer, recently joined in that work, making a multi-year commitment to buy lifesaving anti-malaria medicines, insecticide-treated bed nets and other supplies to protect women and children in Akwa Ibom state in the Niger Delta.
“The support provided by our private sector partners allows Jhpiego to provide essential health care to thousands of women and their children who otherwise would not receive it,” said Bob Skinner, Jhpiego’s Director of Corporate Relations.
In Uganda, GE Foundation’s support of improved infection prevention in 12 public health facilities in Mbarara and Isingiro Districts led to tangible results. Sites began with an average of 43 percent of standards met and have improved an average of 30 percent over three years. Midline internal assessments of the 12 sites have shown that more than a third are meeting 80 percent of the standards they set for improvement.
At Mbarara Regional Referral Hospital, staff were engaged in improving infection prevention because of Jhpiego’s SBM-R approach, which recognizes staff for their participation. The system allows staff to participate in identifying a base set of standards by which to measure infection prevention practices and quality control, to identify infection prevention gaps and to develop a process to minimize these gaps. Additionally, Jhpiego, in consultation with Ugandan health authorities and through GE support, has provided infection prevention supplies, which have been key to the hospital’s meeting its goals.
Such participation builds ownership of the project and encourages sustained achievement in reducing the risk of clients, their families and health workers acquiring and transmitting potentially life-threatening infections through accidental exposure to blood and body fluids or contaminated objects.
Nurses Agiri and Hope said the hospital staff use SBM-R “to identify gaps and you know where you are. It’s like auditing. Then you use the standards to address the gaps.” The facility also created its own staff recognition program and gave a cell phone prize for a job well done.
The system is working—the Ugandan government last year named Mbarara Regional Referral Hospital, which serves an area of two million people, “the cleanest regional health facility.”