Hospitals of RBF Project show stable results
2016-03-10

13-14 July 2015, Secretariat of Project of World Bank, through “Health Results-Based Financing” project (RBF) carried out by Ministry of Health, within the frame of the fourth review of the hospital for the second quarter of this year, organized a working visit to Osh region for the participants and observers of project, including representatives of the Ministry of Finance, MHIF, World Bank and others.

In evaluation of work of health care organizations, as well as effectiveness of implemented RBF project, Nookat territorial hospital (TH) was in the centre of attention, a member of the second group of hospitals participating in the project without additional financing, and General Practioners Center Myrza-Aka in Uzgen rayon from the first group of hospitals which for their results obtained additional payments for development.

As previously reported, in the selection of hospitals of RBF project, in June 2014 totally 63 rayon and rural hospitals participated in the selection, including general practitioners centers (GPC). They were divided into 3 groups: in first of which it was decided to carry out a quarterly assessment of medical services’ quality with payment of project funds, in the second to conduct only quarterly assessment of quality of medical services and the third will be a control group. 21 hospitals and GPCs per each group.

The system of financing of randomly selected hospitals is based on the results of performance and is carried out if they have progressive indicators of qualitative medical care. To evaluate work of hospital the Scorecard was developed with specific set of criteria and indicators. Evaluation is carried out on a quarterly basis with participation of peers from other hospitals with using Scorecard. According to the results of evaluation incentive payments are made from RBF project.  

RBF project was started in Kyrgyzstan in 2014 and is carried out with support of World Bank. It aims at improving quality of health care and achieving of the Millennium Development Goals (reduce of children mortality and improving maternal health), and supports objectives of the government to improve efficiency and effectiveness of public expenditures in health sector through provision of sound and transparent base for financing of health organizations based on the results. The project intends to provide evidence to direct future strategies of the government to strengthen mechanisms of payment of health care services.

Total amount of grant funds allocated to realization of project RBF is USD 11 million. The project will last for 3 years and will last until the end of 2017.

Additional funds provided to hospitals will go for repairs of maternity houses, infant departments and intensive care, for the purchase of medicines, equipment, tools, chemicals and medical products.

Representatives of Ton, Manas hospitals evaluated the work of peers in Nookat TH and Myrza-Ake GPC. Obviously, the hospitals showed good results and stability in improving quality of services to its citizens.

"If you look categories of Scorecard, scores on patient satisfaction are increased significantly- said Memeryan Shimarova, expert on monitoring and evaluation of  RBF project. This indicator is one of ultimate objectives of the project”. Better care is provided to neonatal, hospitals are undergoing major structural changes in creation of conditions for patients, medical supplies, drugs and blood components. Hygiene and management in hospitals were improved significantly. Scorecard comprises seven categories. First is management, hygiene of medical treatments. 2. On-site training, capacity building/ library. 3.Patient satisfaction (interviewing of 10 people). 4. Quality Assurance (survey of internal system of controlling quality of hospitals). 5. Surgery (survey of quality of medical care in surgery). 6.Maternity Department (survey of quality of maternal care). 7. Pediatric/neonatal department (survey of quality of medical care to neonatal and children up to 5 years of age). The more points earned by the hospital on these categories, the more additional funds its budget receives. "

Participants of the fourth review and evaluation of Nookat TH and Myrza – Aka GPC shared their impressions about the benefits of RBF project and project implementation.

Klara Oskombaeva, Director of RBF Project: We conduct the next, fourth review of the hospitals, on the results of the second quarter of 2015. According to the results of three reviews Nookat TH is the best in the second group. It does not receive additional funding, but it has gained in the last review almost 780 points. Ministry of Health noted the work of the hospital and awarded an I-pad to Day of Health worker. In the fourth review, we wanted to show the Ministry of Finance, MHIF and  World Bank, how the project works and its approaches and results. MHIF is the main funding organization, and 85% of this grant go through MHIF. MHIF’s functions and objectives are proper allocation of money. At this time, with MHIF we are working on a mechanism of quality control with the help of RBF project, we would like to expand it, because we look not only at the treatment process, but also whole process of hospital’s activity.

Arsen Askerov, Deputy Director of RBF Project: We have completed quarterly review of quality of medical services in Nookat territorial hospital. This hospital is trying to keep a good level of quality. In the last quarter, they scored ​​77% and got 772 points, now they scored 774 points, which indicates that the hospital works stable. Of course, success is achievable through good management. Administration makes proper conditions for the hospital,  provided medicines resources, equipment, blood bank, medical devices, etc. These things allow to render a good medical aid. In particular cases of treatment of children under five years, they successfully use a pocket manual and children are provided with high-quality care. If earlier children's departments were crowded and children with heavy illness could not get timely help, at this time, precisely those children who are in need of this in-patient specialized care receive this aid. Department of surgery and intensive care improved their hygienic conditions,  created a good safe conditions to carry out safety procedures at a qualitative level.Specific team was created, Quality committees. Together with experts and specialists from other rayon hospitals Ton and Manas participated in the evaluation. Among them there are managers and leading specialists. They all are happy to note that they had exchanged with experiences, there is a cognitive process, so they are adopting good examples, such as correct record keeping, protocols, etc.We pointed out for ourselves the problem section, where more work is necessary, for example, better and safer place for conducting pathological birth. I think the team will take into account all of our recommendations in the future review and will reach at least 90% of the quality. According to General Practicioners Center Mirza-Aka, we can mention three positive moments. 1 - Quality committees have started work better, 2 - normal childbirth process and neonatal resuscitation is arranged. 3 - improved information management: preparation of analysis, charting, mapping based on the results. The problem of blood bank, correct filling of surgical histories, surgical skills still remain unsolved.  In the current review GPC Mirza-Aka scored 582 points, for 87 points less than last time.

Aida Abarbekova, Head Department on social expenditures of Ministry of Finance of KR: I really liked what I saw. Highly detailed indicators, easy to evaluate. This experience can be transferred to many areas in the whole Kyrgyzstan and MHIF system in particular. If the indicators are finalized, it will be done easily. Besides, I mentally carry this model into our budget program. Of course, we could take some indicators from those used in RBF project. I liked the atmosphere of discussions. Evidently, it depends on the head of a hospital. All staff of hospital kept together and was worrying. Team spirit develops. I am sure, that when we leave, all remarks and comments will be discussed together.

Akylbek Kalykov, Deputy Chairman of MHIF: Currently, for realization of pilot RBF project Mandatory Health Insurance Fund has signed contracts with 22 health care organizations. In accordance with the developed indicators for Scorecard, monitoring of agreements concluded within 6 months of the current year, funding in the amount of 43 029 4 thousand soms were transferred to pilot health organizations of the first group of hospitals of RBF project in 2015, whereas the whole last contributions in 2014 was - 21 821.8 thousand soms. It is encouraging, that all members of hospitals discuss openly all issues of RBF project, evidently, there is a team spirit. All involved - from director to an ordinary employee. According to the plan of RBF project, final results of the project will be seen in three years.

Asel Sargaldakova, Health Specialist of World Bank Office in the Kyrgyz Republic: Experience from RBF project can be applied to different parts of health sector, from primary health-sanitary care, to tuberculosis service, but it is important to understand that it is not a recipe for solving all problems. This project aims to piloting and see how this financing method based on the results will work in our real life. The results will show how you can use this experience further. As you know, we consider two groups of hospitals: first, that receives additional funding, and second, where only intensive monitoring, and we see changes in both groups.

Asamidin Maripov, Director of Nookat TH: Each project has its own advantages. We ran a lot of projects: Swiss, Japanese, UNDP, USAID, and others. From all projects, RBF gave us a good stimulus, but we have not received any money. We have brought the hospital to a good condition. The most important thing is to strengthen material-technical base at the expense of internal resources, enhancing the capacity of staff, cleanliness and infection control. Each hospital today must be provided with hot and cold water, sanitation, good toilets, well-dispensing in nutrition unit, a sufficient number of dishes, linens, furniture, equipment, etc. Thanks to RBF project, we have scored from 240 to 774 points. Every employee has contributed from minimum to maximum. There were, of course, the departments that received the highest scores, and those which received low scores, but we always strive to improve their results. Our budget is not big enough, so we're looking for solutions. Since 2010, every year we conduct charity marathons and have already collected about 10 million soms. With the support of people, we improved conditions for water supply, sewerage, lighting, asphalted road, bought equipment, etc. If you're a bad manager, the team just gets rid of you. And if you're a good manager, you can grow, create and create something.

Tynchtykbek Sultanov, Deputy Director of Nookat TH: Last year we celebrated 80th anniversary of our hospital. Also celebrations were organized in the 30s, and there were only 20 beds, and now we have 605 beds. We have 17 clinical departments and 5 extra, including three children's departments: resuscitation, somatic and infectious, large maternity house with 50 beds. The hospital employs about 90 doctors, 370 mid-level employees and 150 junior medical staff. Five years ago, we had a problem with a lack of staff, now all vacant positions are completed. We have enough specialists of all medical profile. And that's because we create for them favorable conditions of work. On average, physicians receive from 7 to 10 thousand soms (with additional payments for duty days), and nurses get 5-7 thousand soms, junior nurses receive about 4-5 thousand soms. We strive to be included into the first group of RBF project, to have additional incentive payments. At the beginning of RBF, we scored 240 points. In the third survey had scored 772. Our dream is to get 1 thousand points. All employees try. Here, for example, our in-hospital chemist’s shop. Every day we are doing solutions, approximately one thousand bottles. Within the project funds we have bought three refrigerators for this chemist’s shop, have installed a new ventilation, provided additional rooms and made repairs and toilet. Even without RBF funds we try to improve conditions for employees.

Batma Kudaiberdieva, Director of Myrza-Aka GPC in Uzgen district: Mirza-Aka GPC has 6 branches, 60 beds. When the conditions are good and the food is good, people are happy to come to us. At first baseline review, we scored only 27 points, and only due to maternity department. In the second review we scored 424 points, then 532, in the next quarter 669. Last time, in addition to financing, we have received more than 700 thousand soms, 30% was used for salaries. Due to RBF project, we managed to do a great deal: bought new equipment, oxygen concentrators, nebulizers, pulsoximeters, electronic scales, renewed detritus tank. We provided training, specially invited experts to raise awareness of health workers. Territory of hospital was improved. At first it was, of course, it's hard, especially to keep records, make reports, but each time we were improving, and now we do not have any specific problems.

Kamil Baitishiev, Deputy Director of Mirza-Aka GPC: We have very good results. I speak as a therapist, sharply reduced unnecessary hospitalizations, treatment is in full speed according to clinical protocols, have created good level record keeping, supply of medicines and medical equipment arranged. We made a new sterilization department, now we have three medical waste utilization rooms. Solid inventory was updated. We are saving money to buy a defibrillator.

Danakan Arykbaeva, Deputy Director of Bazar-Korgon TH: In evaluation of hospitals’ activity of  different rayons, I participate for the seventh time. Peers are working at the right level. According to their work, they get proper assessment. I like this form of work. Noticeably the quality of work improves, especially hygiene. Conditions were improved inside the hospital and wards, thus improving the provision of care to patients.

Manzoor Abdullayeva, Neonatologist of maternity department of Nookat TH: The first step begins in the delivery room, so to ensure the quality of the arrangement of delivery, we work together with the resuscitation team, which includes obstetrician-gynecologists, neonatologists, nurse. We assess the condition of a newborn. Every second is golden in rendering aid. We always take examinations within RBF project and according to knowledge, we gain points. And we have the most modern equipment.

Inobat Ismailova, Head of kitchen of Nookat TH: We employ seven people, provide food to 430 patients. Each patient is given about  60 som per day for food. Usually we prepare porridge for children, for lunch we serve first and second courses. The conditions are satisfied, we try to upgrade our equipment. RBF gives stimulus to work more and provide better care for patients.

Batma Sadirova, Nurse of treatment room of Nookat TH: According to the requirements of RBF project, a refrigerator should be in the office, a thermometer, a registration book, tools, refrigerator, cold bag, antiseptics, and more. It is necessary to do constant wet cleaning with special cleaning items.

Tannura Karpek kyzy, Pharmacist of Nookat TH: Terms and conditions of our work significantly improve. Now through RBF project we bought a new furniture. And when there is a good comfortable condition at work, environment, and work is like a holiday, patients see our good mood and quality of service.

Kalipa Dzhumabaeva, Laboratory assistant of Mirza-Aka GPC: Four people work in our laboratory. Terms and conditions of our work changed for the better. We get additional payment to salary, bought wardrobes, furniture and patients are treated better.

Puerperant, v.Salamalik, Uzgen rayon: I am 22 years old, and this is my third child I gave birth in Mirza-Aka GPC. Condition for mothers and children is very good. I'm not afraid that something will go wrong, I completely trust staff, and am grateful for conditions and kind  atmosphere they create for us.