Project Plan Overview


George Foundation: PHC Project


Improving Quality in Health care Services in PHCs


 


Quality of care is the extent to which health services are likely to achieve their stated goal, or, as stated by the Institute of Medicine, “the degree to which health services for individuals and populations increase the probability of desired health outcomes and are consistent with current professional knowledge” (1990). Health services are processes of care that take place in the context of a structure, that is, inputs and system characteristics, and result in an outcome (or, more precisely, a change in likelihood of an outcome) (1980). In order for health services to achieve their intended goal, they should be necessary and appropriate, of high technical quality, and delivered with dignity and respect ( 1991).


 


Project Description


In India, one of the major problems is the health status of its people, particularly the women and the children. The George Foundation, not-for-profit organization under the Indian Trust Act, has become aware of the poor quality of the primary health care among rural communities. Consistent with their mission to work towards poverty eradication in India, promote environmental health, and strengthen democratic institutions and values in developing countries, the foundation embarked a PHC project (Improving the Quality of Health Care services in PHCs).


PHCs functioning are foreseen to be as the first level in a hierarchical system of health care facilities. At the primary level, PHCs will play two equally important roles: First, diagnosis of diseases based on symptoms and simple laboratory tests, and their treatment either at the centers or through referral. Second, health education leading to family planning, better hygiene and sanitation, and prevention of communicable diseases, especially sexually transmitted diseases.


The George Foundation, in collaboration with the Government of Tamil Nadu, is initiating a pilot project involving up to six PHCs in the Dharamapuri District. The goal is to build on the existing “infrastructure” at these PHCs, make them functional and enhance their capability. The George Foundation will coordinate and manage the project with the initial pilot project implemented at Bagalur PHC of Dharmapuri district.  


The mission of the project is to implement a diagnostic and record keeping system in support of all the activities of PHCs. The objective is to improve and enhance the services offered by Primary Health Centers (PHCs) in the rural communities of India and in other developing countries.


 


 


Problem/Result Statement


One of the major problems in India is the poor quality of health services especially in the rural areas. Rural India faces many serious problems that are not adequately addressed.


The long-term goal of the Indian government and international funding agencies has been to provide health care to rural communities through PHCs. However, even with large funding, these centers have not been successful for a variety of reasons that include lack of decent facilities, equipment for performing even simple laboratory tests, etc. Even more important is a social reality: there just are not enough trained and qualified doctors to adequately serve the entire urban and rural populations of India even if financial incentives could be provided for them to work in rural areas.


The result of non-functioning PHCs has been that, in many cases, diseases are not diagnosed in their early stages nor treated. The rural population has to often travel to urban areas when they can no longer bear the suffering caused by the disease, thus increasing the load on hospitals in urban areas and ending up with serious complications that, in many cases, could have easily been treated at their early stages. The need to rectify this problem has become critical especially given the fact that over 650 million people live in rural areas across the country with poor awareness of health issues. This ignorance, coupled with the increased mobility between rural and urban areas, has led to an explosive increase in the spread of diseases like HIV/AIDS and Hepatitis B and C.


Mission Justification


George Foundation has stated a mission to help alleviate poverty, promote health and a clean environment, and strengthen democratic institutions and values in developing countries. The foundation strives to accomplish their objectives by implementing several innovative and bold solutions that would bring about long-term sustainable results.


            Consistent with their mission, the foundation has embarked projects that help their poor communities. One of these projects is the PHC project in which aims to help improve and enhance the quality of healthcare services of PHCs in the rural areas in India and in some developing countries.


 


High Level Scope


To accomplish this project, the first step is to furbish the existing PHCs (land, building, equipment, and supplies) already set up by the government. Each PHC is to consist of an initial screening room with a computer, an examination room for the doctor, a laboratory for medical tests and supplies, and toilets. The furnishing will be simple, comfortable, and durable.


In addition, electricity, the most critical in an infrastructure should be available. The foundation is to use solar panels or diesel generators connected to batteries for uninterrupted electric power for computers and laboratory equipment.


Moreover, each PHC will have a full time staff consisting of a paramedic individual to perform initial screening with the computer, a trained nurse or physicians’ assistant, and a laboratory technician. Three to five PHCs will be shared by a qualified medical doctor. A continuous and extensive training in the novel technology and in the holistic approach will be given to the staff and their performance will be constantly monitored.


In addition to the testing capability of the on-site medical laboratory, a crucial tool for diagnosis will be the computer. A software program called EDPS2000 shall assist the technician in maintaining, in a protected and confidential manner, the medical history of all patients, in suggesting tests to perform, and to evaluate possible causes based on the symptoms displayed or the description given by the patient.


Patients visiting PHCs will also be provided health education by the staff through posters and through audiovisual demonstrations. Providing information and help with family planning, and awareness on communicable diseases, will be a key role of the staff. Community programs for which we shall form collaborations with Non-Governmental Agencies (NGOs) and social workers will supplement these activities.


Each PHC would be an isolated unit. All software updates and sharing of information would have to be uploaded/downloaded periodically by a person traveling from center to center. Over a three-year time frame, computers would be connected to different PHCs through standard phone or cell phone link. Updating and collecting data will then be in a centralized facility. In addition to simplifying the uploading/downloading of data onto the central computer, this enhancement will allow on-line access to specialists via e-mail, further reducing patient’s travel time and cost and the load on urban health care facilities.


As a final step, diagnostic capability of PHCs would be enhanced through video consultations wherein the patient will access a physician via a two-way video camera and screen. Technology and the required transmission rate using cellular connections is anticipated to become a reality in rural India in 5-10 years.


 


Measures of Success


Population-based care uses an epidemiological assessment of population needs as the trigger for priority setting and selection of interventions. This approach has recently been applied, under the term disease management, to the care of persons with specific conditions (1996;  1995; 1990; 1995;  1997). In this model, all individuals in a defined population, either a practice or, more easily, a managed care organization, who have a condition are identified. After they are identified, a comprehensive array of services is applied to maximize desired outcomes. The services included in the package of disease management tools may include not only traditional medical care, but also pharmaceuticals and devices, education (of clinician and patient), home services, case management, transportation, and the like. This model posits approaching a population with a condition, and viewing medical care as one manageable component of overall care.


 


Best Practices in Project Management


            Two of the best practices in project management that the organization could apply to ensure its success are to manage their work plan and to manage the risks.


Manage work plan


            In reality, no plans that proceeds entirely as it was estimated and planned. The challenge is having the rigor and discipline needed to apply your project management skills correctly and proactively.


Work plan should be reviewed in a regular basis to monitor the progress of the plan in terms of schedule and budget. Monitor the schedule and the budget. Identify activities that have been completed during the previous time period and update the work plan to show they are finished. Determine whether there are any other activities that should be completed but have not been. After the work plan has been updated, determine if the project will be completed within the original effort, cost, and duration. If not, determine the critical path and look for ways to accelerate these activities to get you back on track.


In addition, monitor the amount of money your project has actually consumed and determine whether your actual spending is more than originally estimated based on the work that has been completed. If so, be proactive. Either work with the team to determine how the remaining work will be completed to hit your original budget or else raise a risk that you may exceed your allocated budget.


 


Manage Risks


Risks refer to potential events or circumstances outside the project team’s control that will have an adverse impact on the project. In planning the project, it is important that all known risks should be identified by the project team. For each risk, they should also determine the probability that the risk event will occur, as well as the potential impact to the project. Risk should be evaluated in terms of the level of its occurrence and impact on the project. High level risks should be properly assessed and make sure to mitigate them to prevent them from occurring. Medium risk should also be properly addressed and proactively managed. Low risks are not likely a danger to the projects but still to be assessed.


However, once the project begins, periodically perform an updated risk assessment to determine if other risks have surfaced that need to be managed.



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