1. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org

2. Overview of presentation Background info abut SSCSiP What SSCSiP is about Activities in the Northern Pacific Regionalism lens Lessons learnt Way forward

3. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Project Scope Level of clinical support beyond that of the primary health care worker Examples: surgery, internal medicine, paediatrics, anaesthetics and trauma/critical care, obstetrics and gynaecology. The personnel providing specialised clinical services - medical specialists, nursing officers, biomedical technicians, radiographers etc

4. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Service delivery modalities Offshore referrals In-country through visiting teams In-country though local specialists Issues cost-effective and equitable - agreed medical and equity guidelines); patient outcomes Planning (Not Demand driven, no objective needs analysis, poor hosting, lack of coordination) evaluation of patient outcomes; adjunct services Lack of skill/knowledge transfer from visiting specialist to local clinicians.

5. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Example of Regionalism PICs identifying a common issue of concern PICs & Development partners coming together to discuss identify a solution – SCS Project Project design reviewed & endorsed by MoH, and Pacific Island Ministers Meeting Australian Government Funding FNU as implementing agency Australian Government Funding FNU as implementing agency SSCSiP Project

6. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org

7. Coverage

8. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org SSCSiP Team Secretariat (Based at FNU – Fiji Islands) – Dean, PM manager, Health planner, M&E coord, Project coord, Biomed engineer, clinical advisors Budget of 1.2 Million AUD p.a Next phase June 2012 – Dec 2014 – Planning, managing and evaluating SCS (VT, OR) – Information system for SCS (OR, VT, patient outcomes) – HRH planning and capacity development (SCS) – Responding to urgent needs (VT, locums)

9. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org SSCSiP Governance Secretaries/CEO of MoH and Directors of clinical services from 14 PICs Annual meeting

10. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Achievements to date Started in June 2011 (11 mo old) Collection of Baseline data – SA of SCS, Mapping of Clinicians profiles, Mapping of biomedical services capacity, Costing studies Planning workshops (Palau, FSM & RMI) – ToR for visiting teams, preparedness checklists, evaluation of visiting teams, offshore referral policies

11. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Achievements Supported capacity building initiatives for clinicians & nurses (gastroenterology – FSM) Responded to urgent needs: – Locums (Palau) – pediatrician & obstetrician – Biomed equip maintenance (Palau & FSM) – Ophthalmology scholarship (FSM)

12. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Mapping of biomedical services capacity 1.Equipment Management Policy and Procedures Procurement Inventory Minimum Equipment Standards Disposal of Old Equipment Donated Equipment guidelines New Technology Assessment 2. National Repair Capacity Service Contracts MOH/Private Sector balance MOH Engineers MOH Senior Biomeds MOH Biomeds MOH Trainees Succession Planning? Repair Facilities Urgent Spare Parts procurement? Adequate Tools/Test Equipment Work Recording Systems? Management Reports? Equipment Identification? Biomedical Budget allocation? 3. Hospital Repair Capacity Regular Preventive maintenance? Safety &Function Checks? Check Due Date marking? Job Documentation Total Equipment Inventory? Total Inventory Value? Equipment waiting diagnosis? Equipment waiting spares? Equipment waiting disposal? Service manual availability? Specialised test equipment?

13. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Northern pacific situational analysis 1.Equipment ManagementCurrent Status PalauPohnpeiKosraeYapChuukMajuro RMI Policy and Procedures Policy Being Developed Procedures No Being DevelopedYes No Procurement Contracts Yes Specs Yes Contracts OK Specs Not OK NoYes Contracts OK Specs Not OK Contracts No Specs Not sure InventoryBeing Developed NoYes HCs No Hospitals Yes Yes Minimum Equipment Standards Being Developed HCs No Hospitals Not Sure No HCs Yes Hospitals No HCs Yes Hospitals: Being Developed Disposal of Old EquipmentNot sureYesNo YesNo Donated Equipment guidelines NoNot SureNo New Technology Assessment NoNot Sure No

14. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Country scores Recruited a BME – work with PIC; coordinate BEMI BME; BMT training

15. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Total Dr (locals + expats) per 10,000 population

16. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Areas of specialization for local Drs Fiji Solomons Vanuatu Samoa FSM Kiribati Tonga RMI Palau Cooks Tuvalu Nauru Tokelau Niue General Surgery254454240121000 Medicine174233220100000 OBGYN194345140121010 Paediatrics132142220111000 Anaesthesia135241120112011 Opthlamology103100100010000 Othorpaedics21000000000000 ENT01010000000000 Psychiatry22000010000000 Plastics00000000000000 Urology10000000000000 Emergency medicine05000030000000 Radiology21000010000000 Pathology11000010100000

17. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Total no. of specialists (locals + expats) Fiji Solomons Vanuatu Samoa FSM Kiribati Tonga RMI Palau Cooks Tuvalu Nauru Tokelau Niue General Surgery264657341122100 Medicine174335322310000 OBGYN204658241122111 Paediatrics143263321111000 Anaesthesia155354220122211 Opthlamology103100101010000 Othorpaedics21000001000000 ENT21010000000000 Psychiatry32000010000000 Plastics00000000000000 Urology10000000000000 Emergency medicine05010130000000 Radiology21000010000001 Pathology21000011100000

18. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org Reflections & the way forward …

19. Strengthening Specialized Clinical Services in the Pacific www.sscsip.org