1. 1 |1 | Module 9 FACILITY MANAGEMENT WASH FIT Module 9 FACILITY MANAGEMENT WASH FIT

2. 2 |2 | Overview  The importance of leadership  How to manage, incentivise and value staff  The importance of patient and community engagement  Minimum staff required to provide adequate WASH services  The basics of accounting and managing a simple budget for WASH services  How to procure, manage and store supplies

3. 3 |3 | How are HCF managed in your country? Do HCF have the autonomy to make decisions? How are health care facilities financed? Are different types/sizes of facilities managed differently? Are there dedicated budgets for WASH? Group discussion

4. 4 |4 | How can you encourage people to access a health care facility?

5. 5 |5 |  Create a clean, safe environment  Keep the facility  Visibly clean  Safe and with no risk of infection  Ensure staff are friendly, trustworthy and follow appropriate IPC procedures  Staff are motivated, incentivised to work  WASH services are maintained to appropriate standards WASH FIT will help you to do all of these things! How to encourage people to access a facility

6. 6 |6 | Leadership Leadership: A good leader who is enthusiastic and driven can make changes and improvements even when resources are limited WASH focal person: There should a minimum of ONE person responsible for WASH and IPC services, who has a clear job description and is known by all staff

7. 7 |7 | Motivate and value ALL staff Leadership is the key to success Motivate and encourage staff to do a good job and recognize good performance Cleaners and support staff should be valued as much as clinical staff Reinforce the idea of team work All staff should have written job descriptions

8. 8 |8 | Incentivisation Keeping a facility clean requires ALL staff to be involved Try to empower and motivate staff Incentivise staff to change their behaviour and recognise good behaviour from staff Performance should be assessed according to job description Recognize high performers and develop improvement plans for those that do not perform and/or impose penalties Awards for best performing staff or wards –Trophy given monthly to wards/departments –Ranking system using traffic light system Trophy given to best performing ward and made visible to all

9. 9 |9 | Best practices for organisation and management of staff 1.Each staff member should have a written job description: Divide up tasks according to job descriptions and the skills of available staff 2.Organogram written and visible to all 3.On-going training and professional development 4.Regular staff meetings 5.Motivate, encourage and value ALL staff-recognizing good performance and addressing poor performers

10. 10 | Example HCF management structure (organogram)

11. 11 | Patient and community feedback Patients and the community are a critical part of a HCF and their opinions should be valued Ensure that everyone’s voice is heard: feedback mechanisms should be inclusive of people who are not able to read or write Ideas for measuring patient satisfaction –Comment box at entrance to facility –Comment books at key places in the facility –Regular surveys –Community discussions, e.g. with patients in the waiting room

12. 12 | Examples of patient engagement Community discussion group Comment box at entrance to facility Traffic light scoring system outside maternity ward

13. 13 | Basic accounting and budgeting  Having a budget for WASH is needed for managing services  Provides useful information for facility managers, administrators, donors and suppliers A facility should be able to answer the following questions  How much money is spent on WASH on a monthly or yearly basis?  What is the budget for operation and maintenance?  What is the budget for provision of supplies?  Where does the budget come from? What are the mechanisms for raising more money?

14. 14 | DRAFT To summarize all incoming and outgoing money for each month Sample monthly financial reports

15. 15 | Managing supplies Proper procurement prevents: –Shortages –Surplices –Waste Loss of supplies Mismanagement (e.g. expiration) Procurement should happen BEFORE supplies run out Order in quantities that are regularly required –Requirements are based on records of previous consumption Build a system for managing supplies into the WASH safety plan, including common spare parts for water and sanitation infrastructure

16. 16 | Receiving supplies Facilities should be responsible for ordering goods and keeping careful records of supplies going in and out Deliveries or purchases should always match the order Person collecting/receiving an order to make sure products are not expired, seal is not broken Process Nominated person(s) to verify all deliveries Manager updates stock card Products are stored immediately Copy of delivery receipt is kept on file

17. 17 | Stock record DATE, when item is received into the store or issued out of the store RECEIVED FROM, name of supplier QUANTITY RECEIVED, number of units received at the store ISSUED TO, name of dispensing area where item will be dispensed to patients QUANTITY ISSUED, number of units issued out /used BALANCE IN STOCK, number of units remaining in the store REMARKS, important information about the movement of the item, batch numbers, expiry dates, borrowed from or returned to other health facility etc. SIGNATURE, person who records the movement of the item. –Adapt as needed to facility requirements

18. 18 | DRAFT Sample stock management form

19. 19 | Stock inventories  The process of manually counting the number of each type of product present in the facility  Conduct regularly, e.g. once a month  Record in an inventory sheet  The quantity of products available should match what has been recorded as used  The inventory sheet helps the provider find where totals don’t match  Also allows you to monitor expiry dates of products in stock

20. 20 | Sample inventory sheet Product name/descri ption Theoretical amount available (beginning balance) (A) Actual quantity available (B) Difference (B – A) Product expiry date Observations Single use gloves 20 pairs10 pairs-10NAGloves missing, have not been recorded properly General observations: Actions to take: Inventory conducted by: On:

21. 21 | Storing supplies  Keep stores locked  Reduce sun exposure  Prevent water damage  Control the temperature  Keep free of pests  Clean, tidy and organised  Store supplies on shelves, in a systematic way  Supplies with upcoming expiry dates at front  Label supplies clearly

22. 22 | Managing supplies Prevents shortages if stocks are managed efficiently Necessary for good management of WASH-related supplies –E.g. detergent, mops, chlorine, protective clothing, spare parts to fix toilets and plumbing, etc Procurement, receipt, orders and stock management/storing A facility should always know: –What items are in stock –How much is available of each item in stock –How much stock is used on a regular basis –When and how much an item should be ordered –Who is responsible and arrangements when the person is absent

23. 23 | Facility management indicators (1) WASH FIT is in place, implemented and regular monitored. An annual planned budget for the facility is available and includes funding for WASH infrastructure, services and personnel which is sufficient to meet the needs of the facility. A dedicated budget for the continuous procurement of WASH items (hand hygiene products, minor supplies to repair pipes, toilets, etc.) is available and sufficient to meet the needs of the facility A protocol for operation and maintenance, including procurement of WASH supplies is visible, legible and implemented. Regular (at least weekly) ward-based audits are undertaken to assess the availability of handrub, soap, single use towels and other hand hygiene resources. An up-to-date diagram of the facility management structure is clearly visible and legible All staff have a job description written clearly and legibly, including WASH-related responsibilities. Adequate cleaners and WASH maintenance staff are available. A continuous training program for facility staff is implemented and staff are regularly assessed on their knowledge and learning (minimum requirements include Hygiene, IPC) and have opportunities to continuously refresh and increase their skills 7.1 WASH FIT is in place, implemented and regular monitored. 7.2An annual planned budget for the facility is available and includes funding for WASH infrastructure, services and personnel which is sufficient to meet the needs of the facility. 7.3 A dedicated budget for the continuous procurement of WASH items (hand hygiene products, minor supplies to repair pipes, toilets, etc.) is available and sufficient to meet the needs of the facility 7.4A protocol for operation and maintenance, including procurement of WASH supplies is visible, legible and implemented.

24. 24 | Facility management indicators (2) WASH FIT is in place, implemented and regular monitored. An annual planned budget for the facility is available and includes funding for WASH infrastructure, services and personnel which is sufficient to meet the needs of the facility. A dedicated budget for the continuous procurement of WASH items (hand hygiene products, minor supplies to repair pipes, toilets, etc.) is available and sufficient to meet the needs of the facility A protocol for operation and maintenance, including procurement of WASH supplies is visible, legible and implemented. Regular (at least weekly) ward-based audits are undertaken to assess the availability of handrub, soap, single use towels and other hand hygiene resources. An up-to-date diagram of the facility management structure is clearly visible and legible All staff have a job description written clearly and legibly, including WASH-related responsibilities. Adequate cleaners and WASH maintenance staff are available. A continuous training program for facility staff is implemented and staff are regularly assessed on their knowledge and learning (minimum requirements include Hygiene, IPC) and have opportunities to continuously refresh and increase their skills 7.5 Regular (at least weekly) ward-based audits are undertaken to assess the availability of handrub, soap, single use towels and other hand hygiene resources. 7.6 An up-to-date diagram of the facility management structure is clearly visible and legible 7.7 All staff have a job description written clearly and legibly, including WASH-related responsibilities. 7.8 Adequate cleaners and WASH maintenance staff are available. 7.9 A continuous training program for facility staff is implemented and staff are regularly assessed on their knowledge and learning (minimum requirements include Hygiene, IPC) and have opportunities to continuously refresh and increase their skills

25. 25 | Questions?